Why is it difficult to standardize a prenatal screening program that has been running for several years?
Our reporters Li Ziwei, Zhao Yang, Faye Wong
Prenatal screening affects the fate of the fetus and the entire family.
In order to further reduce the birth rate of genetically defective babies, non-invasive DNA prenatal screening has become the choice of many pregnant women.
However, many people familiar with the matter reported that there are many "weird phenomena" in the non-invasive DNA prenatal screening of Shanxi Children's Hospital (Maternal and Child Health Hospital).
Xinhua Daily Telegraph reporters have visited the hospital many times and found that while the hospital is carrying out non-invasive DNA (normal version) prenatal screening, it is "selling" non-invasive DNA-PLUS (upgraded version) to pregnant women. This project is not only expensive, but also And the fee was actually charged to the personal QR code account.
In an interview with reporters, the hospital said that the hospital has never carried out this project.
Public hospital prenatal screening program charges are actually personal accounts
Shanxi Children's Hospital (Maternal and Child Health Hospital) was established in 1947. This tertiary hospital is the scientific research, teaching, and business training guidance center for maternal and child health care in Shanxi Province. Many pregnant women choose to give birth here.
Non-invasive DNA prenatal screening, that is, taking 3 to 5 ml of peripheral venous blood from pregnant women during a specific pregnancy week, and using next-generation DNA sequencing technology to sequence cell-free DNA fragments in plasma to determine the risk of fetal chromosomal diseases.
The 30-year-old Ms. Zhang came to the Changzhi Road District of Shanxi Children's Hospital (Maternal and Child Health Hospital) in May this year for an obstetric examination and consulted on non-invasive DNA prenatal screening.
An attending doctor in a comprehensive maternity health care clinic introduced to her that the hospital carries out two types of non-invasive DNA prenatal screening programs: one is to check 3 pairs of chromosomes, the price is 1,200 yuan, and the government subsidy is 1,000 yuan; the other is The upgraded version of non-invasive DNA can check 23 pairs of chromosomes, 100 kinds of chromosomal diseases, etc. It is completely at your own expense and the price is 2,500 yuan.
Ms. Zhang wants the doctor to recommend one of these programs.
"Do this if you don't lack money," the doctor said, pointing to the upgraded version of non-invasive DNA, "but the upgraded version cannot be paid through the hospital system, and there is no reimbursement or subsidy, you choose."
The reporter learned that the upgraded version of non-invasive DNA refers to non-invasive DNA-PLUS, which expands the non-invasive DNA test for chromosomal abnormalities.
The doctor then issued a torn version of the "NIPT, NIPT-plus Prenatal Testing Application Form" to Ms. Zhang.
There are two options behind this list: NIPT (non-invasive DNA) and NIPT-plus (non-invasive DNA-PLUS). If you want to do non-invasive DNA, you can go directly to the hospital to pay the bill. If you choose to do non-invasive DNA-PLUS, you have to go to the hospital. After signing the agreement, the Eugenics and Genetics Department on the third floor pays the fee at the blood collection window.
Ms. Zhang chose to do non-invasive DNA-PLUS. After signing the agreement, she came to the No. 5 window of the laboratory to collect blood, and scanned the QR code at the No. 5 window and paid the fee.
But to Ms. Zhang's surprise, the recipient of the WeChat QR code hanging on the 5th window was actually a personal account named "Yuanyuan".
On the 5th blood collection window, the blood collection staff wearing white coats said "Hunan Jiahui Shanxi Provincial Maternal and Child Health Hospital Joint Laboratory Auxiliary Staff".
The reporter found that this assistant not only collected blood for pregnant women who did non-invasive DNA, but also collected blood for pregnant women who did free Down's screening.
According to people familiar with the matter, through blood collection, third-party agency personnel can directly contact all pregnant women undergoing prenatal screening, and there are many more opportunities to introduce the non-invasive DNA-PLUS project to pregnant women.
During the investigation, the reporter also found that in addition to collecting blood, the blood collection personnel often walked back and forth outside the window to introduce this project to pregnant women.
Another pregnant woman who chose the non-invasive DNA-PLUS project told reporters: "The main reason for the prenatal check-up is to listen to the doctor's opinion. She recommended this project, and the economy is not particularly difficult, so she did the non-invasive DNA-PLUS project. Everyone must be happy. That's what I thought."
The project has been carried out for several years, but the hospital has denied it
The reporter's investigation also found that when the staff of the agency recommended non-invasive DNA-PLUS screening to pregnant women, they would give out an insurance, saying that if the child was born with a disease within the scope of the screening, he could get 400,000 yuan in insurance compensation.
"This is an obvious sales method, and it is suspected of inducement." An industry insider who disagreed with this approach said.
In practice, this insurance has become the reason why doctors recommend this program to patients.
The doctor consulted by Ms. Zhang also said, "PLUS comes with insurance, which is also a kind of guarantee."
Some people in the industry pointed out that the insurance plus the exemption agreement signed by the hospital for pregnant women in advance means that even if there is a missed inspection, the hospital will not bear any consequences.
A person familiar with the Shanxi Children's Hospital (Maternal and Child Health Hospital) told reporters that since the beginning of 2019, the genetic room on the sixth floor of the East 6th floor of the North Campus of the hospital and the No. 5 window of the Laboratory Department of the Obstetrics District (Changzhi Road Campus) have always been this way. situation.
The so-called "doctors" recommend the non-invasive DNA-PLUS project to pregnant women, and then use the charging QR code that does not belong to the hospital to charge, bypassing the hospital and evading management.
According to the person familiar with the matter, according to a simple estimate, about 200 pregnant women are tested every month in the non-invasive DNA-PLUS project, and the monthly amount involved is about 500,000 yuan, or about 6 million yuan a year.
The head of the prenatal diagnosis center of Shanxi Provincial Children's Hospital (Maternal and Child Health Hospital) said that the hospital signed an agreement with the genetic testing party, but because the price of non-invasive DNA-PLUS has not been standardized, the hospital did not carry out this testing.
A person in charge of the comprehensive maternity care clinic of Shanxi Children's Hospital (Maternal and Child Health Hospital) also said that he had never heard of this project in the hospital.
However, Ms. Wang, a staff member of a public institution in Taiyuan, told reporters that as early as 2018, she had done a non-invasive DNA-PLUS test in the Wuyi Road District of Shanxi Children's Hospital (Maternal and Child Health Hospital) at a fee of 3,000 yuan. The reporter was shown the contract and the fee invoice.
The contract cover shows Berry Gene, and the invoice stamp shows Jiahui Genetics Specialized Hospital of Hunan Jiahui Biotechnology Co., Ltd.
Another woman who had a maternity checkup at the hospital in 2018 also showed reporters the same contract, invoice and test results.
An insider of the hospital revealed to reporters that the hospital is tearing up the application form for the non-invasive DNA-PLUS prenatal screening program, and told the medical staff that in any unit's investigation, they must categorically deny that this project has been carried out for at least 4 years, Complete prenatal screening program for many pregnant women.
It is urgent to form a standardized market game mechanism
Many experts believe that genetic testing technology is a good way to reduce defective births brought by medical development to patients, but the current cooperation model between some public hospitals and testing institutions needs to be standardized.
The reporter learned from Shanxi Children's Hospital (Maternal and Child Health Hospital) that the hospital has signed agreements with Berry Gene and BGI to carry out non-invasive DNA and non-invasive DNA-PLUS.
The reporter learned that the cost of non-invasive DNA testing is 1,200 yuan, and Shanxi Province's subsidy standard for pregnant women who carry out this project is 1,000 yuan per case, which is borne by the provincial finance.
Therefore, Wang Yue, a professor at the Department of Medical Ethics and Law at the School of Medical Humanities at Peking University, pointed out that the service procurement of public hospitals is actually the scope of government procurement, and should be tendered.
In addition, people familiar with the matter revealed to reporters that the relevant leaders of Shanxi Provincial Children's Hospital (Maternal and Child Health Hospital) have asked doctors to issue test orders from only one of the companies on multiple occasions.
Experts pointed out that this kind of behavior is actually unfair competition, suspected of designated consumption, and disrupted the market order.
Experts also said that the current cooperation between some public hospitals and third-party institutions is chaotic and needs to be standardized.
At this time, government intervention is required, or management measures for public hospitals and third-party cooperative institutions may be introduced.
For example, non-invasive DNA projects should be centrally purchased by medical insurance institutions on behalf of public hospitals to reduce costs and improve screening rates.
At the same time, multiple subjects are encouraged to participate in centralized procurement. Public hospitals can also carry out genetic screening. Through fair competition, the quality and cost of this project can be improved.
In addition, Wang Yue pointed out that hospitals and doctors have a monopoly position in knowledge and have arbitrary power. If doctors in public hospitals give medical orders mixed with business considerations, it will increase the medical burden of patients, which violates the word "public".
He suggested that through the establishment of a strict mechanism for experts to withdraw from work and a mechanism for embargoes, doctors who conduct business diagnosis should be strictly punished, so as to form doctors' self-discipline.
my country's Physician Law, which came into effect on March 1, added a new system for the first time for a lifetime ban, but the punishment for a lifetime ban is too loose after "causing a greater impact on society", and the system should be further refined and improved.
Before the press release, Shanxi Children's Hospital (Maternal and Child Health Hospital) stated that it will conduct a self-examination on the chaos of the non-invasive DNA-PLUS project, and start the bidding process for the non-invasive DNA project as soon as possible.