The hidden rule of ＂adding items to earn money＂ in medical institutions： finding illness in the morning and recovering in the afternoon.

　　A physical examination package with a group purchase price of 1056 yuan has the embarrassment of "finding the disease in the morning and recovering in the afternoon".

　　In November this year, Ms. Chen from Shanghai bought a health check-up package for middle-aged and elderly people with a price of 1056 yuan online, and made an appointment for a physical examination at the store by telephone according to the group purchase instructions. The contents of this physical examination include internal medicine, surgery, tumor markers, 11 items of liver function and 3 items of renal function.

　　"On the website, the cheapest medical examination package is only three or four hundred yuan, the expensive one is 1,500 yuan, and the middle-aged and elderly package of 1,056 yuan is above average." Ms. Chen is 32 years old. She told reporters that she has compared the packages of many well-known medical institutions such as ikang, Mei Nianda Health and Ruici Physical Examination. The price of 1,056 yuan does not belong to the ranks of "low-cost medical examination" in any medical examination center. "I specially chose expensive ones to make the institutions earn enough money, so I should never be cheated again."

　　However, later facts proved that she was wrong.

　　The physical examination report is inconsistent with the examination results of the top three hospitals.

　　During the physical examination, the "doctor" who did the neck B-ultrasound told Ms. Chen that her thyroid was "bad" and had serious inflammation. The B-ultrasound report showed that there was a serious "diffuse echo" in the thyroid gland. The "doctor" reminded Ms. Chen, "Go to Shou Feitai on the first floor and have a blood test of thyroid function. You don’t need to draw blood again, just pay."

　　During the surgical examination, the surgical "doctor" touched the thyroid gland of Ms. Chen’s neck and reminded her again, "You can already feel the nodule here, at least you have thyroiditis. Go to the first floor to pay for it and check the thyroid function."

　　This is not the first time that Ms. Chen has paid for the blood test of "thyroid function" in the United States. Last November, in the same health store, B-ultrasound showed that she had "thyroid nodules". To this end, she paid about 200 yuan’s thyroid function examination fee after the discount.

　　"Every time I say that there is a problem with the thyroid gland, check the function. If the blood is fine, it doesn’t matter." Two blood test reports of Ms. Chen showed that her thyroid function was normal.

　　This year, because of the "diffuse echo" accompanied by thyroid nodules, Ms. Chen went to the endocrinology department of a well-known 3A hospital in Shanghai for re-examination after the physical examination that morning. After introducing her physical examination to the doctor, the doctor gave a diagnosis of "thyroiditis" and asked her to do another B-ultrasound and thyroid function examination in the hospital.

　　This time, the doctor who did the B-ultrasound told her, "Are you thyroiditis? Congratulations, you have recovered. " Ms. Chen once again asked if her thyroid nodules were still there. The doctor of B-ultrasound told her with great certainty: "From the imaging point of view, your thyroid gland is all normal, without nodules and inflammation."

　　The blood test report is also the same result, and everything is normal. "I can’t believe that the surgical experts in the physical examination center in the morning can even find out that I have a big nodule; In the afternoon, the B-ultrasound of the regular hospital showed no nodules. " It is worth noting that when Ms. Chen told her family about her experience, her father, mother, father-in-law and mother-in-law all replied that they had also encountered the above situation. Four elderly people have never had thyroid diseases, and all the medical examination packages use the 1056-yuan beauty health package purchased online by Ms. Chen, and all of them pay for the thyroid function on the spot during the medical examination.

　　A few days ago, the reporter visited the Mei Nianda Health Check-up Center in Shanghai Pudong Changhang Hospital mentioned by Ms. Chen, and saw a long queue for paying fees on the first floor. All the people in the queue buy temporary physical examination items after purchasing the physical examination package, and six of the nine people pay for thyroid function examination.

　　A similar situation occurred in many medical institutions.

　　Coincidentally, the same problem happened to Ms. Lin and her colleagues in Luoyang, Henan Province, and the thyroid function test was the one that broke the problem.

　　"You have a big problem, diffuse thyroid disease." Ms. Lin still remembers the diagnosis given by the B-ultrasound "doctor" on the spot when she was examined at the Mei Nianda Health Physical Examination Center in Luoyang. The situation she encountered was almost exactly the same as that of Ms. Chen in Shanghai. The "doctor" reminded her, "You just took blood, so go and pay the money. You don’t need to take any more blood. Have a test."

　　"At the payment office, I met five or six colleagues who came to add money to do thyroid function (examination). It didn’t feel right." After consulting her brother who works in the county people’s hospital, Ms. Lin gave up the payment and went to the county hospital for re-examination the next day. The hospital B-ultrasound and blood test report showed that Ms. Lin’s thyroid gland was all normal.

　　According to "China Consumer News", in June this year, Ms. Shi, a citizen of Nanjing, found that "the right thyroid nodule is accompanied by calcification, and there is a hypoechoic nodule in the right thyroid lobe, the size is about 10mm×8mm". But later, when Ms. Shi was reexamined in jiangsu province hospital, the B-ultrasound showed that "bilateral thyroid glands were normal in shape, with clear boundaries, smooth surface and normal internal blood flow, and no obvious abnormal lymph images were found in bilateral necks".

　　In response to this problem, the medical examination institution in Nanjing replied that "the doctor was sick and paralyzed and returned to his hometown". In response to the error in the medical report, the person in charge said that "it may be caused by many factors such as doctor technology and medical equipment problems".

　　The reporter noted that the chaos in the medical examination market has already become the focus of public opinion. Previously, the "Analysis Report on the Development Prospects and Investment Forecast of Health Examination Industry" released by Forward-looking Industry Research Institute showed that the health examination industry in China grew to 94 billion yuan with a growth rate of more than 25% in 2015, which was more than twice the growth rate of 29.5 billion yuan in 2010. The compound growth rate of the industry in the five years from 2011 to 2015 reached 21%, which was higher than that of the entire medical service industry. It is estimated that the scale of the health examination market in China will reach in 2018.

　　Do medical institutions earn money by adding items?

　　"Some institutions rely on capital to promote physical examination business. It sells physical examination as a product, collects money by project, and gives commissions according to the total amount of fees." The relevant person in charge of the physical examination center of a public hospital in Shanghai told the reporter that taking the physical examination project of middle-aged and elderly people as an example, the products purchased by private institutions at a price around 1000 yuan may cost 1,200 yuan to 1,300 yuan in public hospitals. "It can’t lose money, so he wants you to add projects, and it is most appropriate to make efforts on the A-level and liver-level."

　　According to the person in charge, thyroid diseases mostly occur in women aged 30-50, and the incidence of liver diseases is higher in men, and both diseases have the characteristics of "B-ultrasound+blood test". "The package of medical institutions generally only contains B-ultrasound examination, and blood test items are purchased on site."

　　The reporter interviewed the relevant person in charge of the Health Marketing Department of Mei Nianda. The person in charge responded that the agency has a strict review system for the customer’s physical examination report, and customers can consult and answer questions by telephone or online according to the process. In response to the question of "adding thyroid function", the person in charge said, "From the perspective of disease screening, thyroid ultrasound and thyroid function are indeed more suitable for combined detection and cannot replace each other."

　　"Thyroid function should be a must-check item, and it is not necessary to have surgery or B-ultrasound abnormalities to do thyroid function (examination)." The person in charge said that the incidence of thyroid-related diseases is relatively high at present, so it is suggested that medical examination consumers list this as a "must-check item".

　　The reporter noted that in recent years, complaints and disputes against private medical institutions have continued. Some people took the medical examination institution to court because the medical examination failed to detect cancer, and some people claimed compensation from the medical examination institution through the Consumers Association because of the malicious addition of the medical examination. "Can’t find the problem, to complain; After finding out the problem, there is no problem after being examined by a regular hospital, and you have to complain. " The person in charge of the medical examination department of the above-mentioned public hospital told the reporter. With the improvement of people’s living standards, physical examination has become an important means of health management for many people to "check out their own pockets" every year. However, physical examination is not a formal treatment after all, and it can only play a role of prompting and reminding. "There will definitely be inaccurate situations, and eventually we will go to a regular hospital for review and follow-up."

　　The 2017 annual report released by Mei Nianda Health in the middle of this year shows that physical examination service is the main business of Mei Nianda Health. In 2017, this business achieved an operating income of 6.142 billion yuan, accounting for 98.54% of the total revenue and a gross profit margin of 46.61%.

　　China Youth Daily Zhongqing Online Reporter Wang Yejie