TCM Fee Standards Urgently Need Raising
TCM fee standards as a whole are far below Western. (See appendix, Why Some TCM Hospitals Are Not "TCM" — Read by the Fee Standard.)
TCM fees urgently need raising; the whole should rise above Western fees. The reasons:
★ TCM treatment is grounded in deep theory and decades of clinical experience — high knowledge-and-technical content. Current fees do not embody the technical value.
★ The drug-heavy, doctor-light fee structure is the root cause of the inverted ratio of treatment-income to drug-income in hospitals.
★ TCM treatment covers the whole of diagnosis, prescription, and counseling — not the simple writing of test slips. A bare registration fee falls far short of TCM's labor value.
★ The registration fee is a creation of the long public-medical-care system — a distorted pricing under near-free care, replacing consultation fees; it can only reflect the value of filing, retrieval, and waiting space.
★ TCM treatment has no high-priced check, procedure, or surgery fees; the low fee level leaves TCM hospitals unable to live or grow on their own. In practice it forces TCM toward Westernization.
★ TCM fees are far below international levels — acupuncture at only 1–5% of international rates. Not only does it fail to "link with international standards"; it lowers social standing too, and makes Chinese-and-foreign-equal pricing hard to execute.
★ Low fees cannot reflect "fine quality, fine price"; doctor motivation and responsibility cannot be mobilized; quality cannot rise.
★ If TCM cannot become well-off, the talk of TCM growth is empty — not only without funds, but, more dangerous, building a poor social signal: youth no longer wish to study TCM, leaving TCM without successors.
★ After China entered the WTO, both domestic and international talent competition will sharpen. Our poor pay and rigid limits drive talent away — handing foreign companies the chance for talent localization.
★ Value diverges from price gravely; a 10-RMB registration can be resold for 100 or 200 — not a management problem alone; the deeper cause is gross violation of value-law.
★ TCM consultation fees too low fuel the bad practice of taking cuts in drug fees; basis for eradication is missing.
★ Adjusting TCM fees is no longer a problem for for-profit institutions; but non-profits still dominate, and this problem still deserves weight and resolution.
Adjusting TCM fees upward does not conflict with the present aim of high-quality care at lower medical price — on the whole, TCM's feature is simple, easy, cheap, proven; for the same illness, even after raising prices, TCM costs are still a third (or less) of Western. Raising TCM fees is a key link of TCM sustainable-development strategy and will surely further its growth, opening a new face for our health enterprise.
Appendix
Why Some TCM Hospitals Are Not "TCM" — Read by the Fee Standard
Wei Yizong
In recent press I have read on the Westernization of TCM hospitals — their not being TCM in name — and on TCM doctors Westernized, betraying the alma mater — TCM, it seems, urgently needs rescuing.
Where is TCM's real growth problem? It is in whether we act by the Constitution — while developing modern medicine, develop our traditional medicine — that is, whether Chinese and Western medicine are treated equally.
A TCM hospital not being TCM is not the director betraying TCM, but his inability to pay wages. He has more than a hundred mouths to feed; he needs RMB. To say it bluntly: because TCM scholarship cannot find money, cannot keep the hospital running, he must change name.
TCM doctors betray the alma mater. Why? Because by the knowledge the alma mater gave, he cannot eat. He needs to live, marry, start a family — the university certificate and TCM-college diploma will not sell for money. So to be a doctor, he must master a money-finding technique; the alma mater's technique is cheap-sold, won't feed family — he must learn another high craft.
Hospital income comes from the doctor's technical activity. Technical activity is no more than diagnosis, drug-use, and technical operation. Both TCM and Western. In treatment operation, beyond instrument operation, hand-operation: TCM has acupuncture, bone-setting, massage; Western has injection, surgery. Let us set aside drug income and look at fees for technical operation. Take Beijing's standard:
1. Unequal value
Western injection: IV 1.5–2 RMB; TCM: needling 4 RMB, point-injection 1 RMB. The injection is by nurses; the needling is by a 5-year-degree practitioner — technical values not comparable, prices similar.
Fracture reduction: Western open or closed reduction 350+ RMB; TCM: fracture 80, dislocation 60. The same technique — TCM at one-fifth of Western.
Tuina, massage: TCM 20-minutes-or-less 10 RMB; market masseuse 45 minutes 480 RMB. TCM masseur is a 5-year-degree therapist, at one-eighteenth to one-forty-eighth of the masseuse. How not change career? Many TCM-university massage graduates work at sauna parlors — what do TCM-university presidents make of this?
Traction therapy: Western 16 RMB, TCM 3. Why does the same operation cost one-fifth in TCM?
2. Most is priceless
Among TCM technical fees the items are amazingly few. The whole fee schedule lists 4,045 items; of these, 3,970 are Western; only 75 are TCM — 0.019%. Equality, or discrimination? Black ink on white paper, open and read.
Acupuncture: only 14 fee items, including modern electro-acupuncture and instrument-needling. But on needling-method alone, the Huangdi Neijing two thousand years ago listed 9 needles and 26 methods. Why does Western for the same operation have different fees by location and pathology? Acupuncture practitioners know acupuncture too has different methods by site, point, and disease — why one price?
Bone-injury: Western orthopedics has 217 items, fees detailed to a tendon operation on a single small finger. TCM bone-injury has only one fracture, one dislocation — as if every fracture, every dislocation, used the same operation. Is that possible? Why is one TCM bone-setting flat for all sites, while Western bone-setting differs by site? Western lists over 100 fracture-reduction methods. Does the patient TCM treats differ from the patient Western treats? Shang Tianyu's Chinese Bone-Setting Theory alone records over 30 methods for reduction by site. Saddest of all: as early as the 70s, the small-splint technique — used over 3,000 years by TCM, affirmed by Premier Zhou Enlai, awarded at the National Science Conference — has no fee standard at all. Treatment for free?
3. TCM techniques are priced abroad
In her homeland TCM is sold cheap; once across the border, prices multiply a hundred-fold. Look at acupuncture fees (insurance-recognized):
Malaysia: 20–50 MYR (1 MYR ≈ 2.2 RMB);
Singapore: 20–50 SGD (1 SGD ≈ 5.5 RMB);
Australia: 30–60 AUD (1 AUD ≈ 5.5 RMB);
USA: 40–60 USD (1 USD ≈ 8.2 RMB).
Some say living standards are higher abroad — but anyone who has been abroad knows fees match standards. In the US a boxed lunch is 4 USD; one acupuncture is about 10 lunches. In the homeland, one acupuncture buys only one lunch. As for chiropractic and bone-setting — one Singapore manipulation is 60–100 SGD; one US chiropractic manipulation is 60–150 USD; one of our cervical-or-lumbar bone-setting is 25 RMB. That is the secret by which a TCM doctor strikes it rich abroad.
Some say Western medicine is "imported" — that is, has an overseas price reference; while TCM is farm produce, self-grown-and-sold for thousands of years — hence simple, easy, cheap. A comparison: TCM and Western on the market — like a mountain peasant selling his native chicken. The peasant, in a remote mountain, isolated, ignorant of market: brings a basket of his own-fed native chickens to market; sees others selling factory-chicken (feedlot) at 5 RMB/jin; he wants 5 RMB too. He is told: factory chicken needs factory, special tending, factory-made feed, high technology content, hence high price; your chicken needs no such equipment, only 1 RMB/jin. He sighs at his bad luck. Our TCM at market is like that peasant. Everyone knows native chicken tastes better than factory-chicken (higher use-value), yet cannot sell at a higher price.
Now TCM has exported: why should TCM's market price not undergo export-turning-back-inland pricing?
Such fee standards mean China's TCM is serving free (or discount) lunch.
Such fees force TCM doctors to change careers, TCM bone-injury doctors to go to the surgical table, TCM hospitals to Westernize. So the foresighted TCM director must lean heavy on TCM preparations; with three to five preparation numbers he can keep the TCM hospital running.
So many TCM-development and TCM-preservation policies fall short of one pricing policy. In a market economy, price guides the market. To develop TCM scholarship we must give a reasonable, fair, academic price. Where is a free lunch? If TCM cannot enter the market, it will be eliminated. How to advance and protect TCM — worth deep thought. Let competent government bodies put forward concrete steps to support and protect TCM. Otherwise we wrong our ancestors and we wrong our descendants.
Originally in China TCM News, 6 February 2002.