Why is it difficult to regulate a prenatal screening project for several years?

Preparatory screening is related to the fate of the fetus and the entire family.In order to further reduce the birth rate of genetic defects, prenatal screening of non -invasive DNA has become the choice of many pregnant women.However, a number of people familiar with the matter reported that there were many "strange phenomena" in the Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) prenatal screening.Xinhua Daily Telecommunications reporters went to the hospital for unannounced visits many times and found that while the hospital launched a prenatal screening of non-invasive DNA (ordinary version), it "promoted" non-invasive DNA-Plus (upgraded version) to pregnant women.And the cost actually hit the personal QR code account.In an interview with reporters, the hospital stated that the hospital had never carried out the project.

Public hospital prenatal screening project charges are actually personal accounts

The Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) was established in 1947. This three hospitals are scientific research, teaching, and business training guidance centers for maternal and child health care in Shanxi Province. Many pregnant women choose to produce here.

Pre -production screening of non -invasive DNA, that is, 3 to 5 ml of peripheral venous blood was extracted during the specific gestational week of pregnant women, using a new generation of DNA sequencing technology to sequen the free DNA fragments in plasma, and judge the risk of related chromosomal diseases in the fetus.

Ms. Zhang, 30, came to the Changzhi Road Hospital of Children’s Hospital (Maternal and Child Health Hospital) in Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) in May this year for inspection and consulting non -invasive DNA prenatal screening.A attending doctor of a gynecological and gynecological comprehensive clinic introduced to her that the hospital carried out two non -invasive DNA prenatal screening items: one was to check 3 pairs of chromosomes, the price was 1,200 yuan, and the government subsidized 1,000 yuan;The upgraded version of non -invasive DNA can check 23 for chromosomes, 100 chromosome diseases, etc., which is completely at its own expense. The price is 2500 yuan.

Ms. Zhang hopes to recommend one of the projects."Do this without lack of money," said the doctor pointed at the upgraded version of the non -invasive DNA, "but the upgraded version cannot be paid through the hospital system, and there is no reimbursement and subsidy.

The reporter learned that the upgraded version of non-invasive DNA refers to non-invasive DNA-Plus, which expands the inspection items of non-invasive DNA testing for chromosomal abnormalities.

The doctor then issued a hand-tear version of "NIPT, NIPT-PLUS NPD Test Test Form" for Ms. Zhang.Behind this list is NIPT (non-invasive DNA) and NIPT-PLUS (non-invasive DNA-Plus) options. If you want to do non-invasive DNA, you can go directly to the hospital to charge the window. If you chooseThe third floor of the Gongsheng Genetics Section signed an agreement to pay at the blood collection window.

Ms. Zhang chose to make non-invasive DNA-Plus. After signing the agreement, she came to the test department to collect blood No. 5, and scanned the QR code in Window 5 and paid.But to Ms. Zhang’s surprise, the receiving WeChat QR code collection party hanging on Window 5 was actually a personal account called "Yuanyuan".The blood collection staff in the 5th Blood collection window on the 5th coat reads the "Hunan Jiahui Shanxi Maternal and Child Health Hospital Assistant Sub -Laboratory".

The reporter found that the auxiliary personnel not only collected blood for pregnant women who were non -invasive DNA, but also used blood for pregnant women who were free to screen for Chinatos.Some people familiar with the matter revealed that through blood collection, third-party institutions can directly contact all pregnant women who have been screened before giving birth, and have a lot of opportunities to introduce non-invasive DNA-Plus projects to pregnant women.During the investigation, the reporter also found that in addition to the blood collection, the blood collection personnel often walked around outside the window and introduced the project to the pregnant woman.

Another pregnant woman who chose non-invasive DNA-PLUS project said to reporters: "The main thing is to listen to the doctor’s opinion. She recommended this project, and the economy is not particularly difficult.Think so. "

For several years in the project, the hospital has denied

The reporter’s investigation also found that when the personnel of the institution recommended to pregnant women, a non-invasive DNA-PLUS screening would give away a insurance, saying that if the child was born, the disease within the scope of the screening could receive 400,000 yuan in insurance compensation.

"This is a very obvious means of sales, suspicion of induction," said an industry insider who had objections to this approach.In actual operation, this insurance has become a reason for doctors to recommend this project to patients.The doctor Zhang consulted by Ms. Zhang also said, "Plus is also a guarantee with insurance."

Some people in the industry pointed out that insurance and the hospital’s exemption agreement signed by the hospital in advance, even if there is a missed inspection, the hospital will not have any consequences.

A person at the Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) told reporters that since the beginning of 2019, the window No. 5, which has been in the East Sixth Floor Heritage Section of the North Hospital of the hospital, has always been thissituation.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 for charging, bypass the hospital to escape management.According to this person familiar with the matter, after a simple estimate, there are about 200 pregnant women who have been tested per month for non-invasive DNA-PLUS projects, which involve about 500,000 yuan per month and about 6 million yuan a year.

The person in charge of the prenatal diagnosis Center of Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) said that the hospital and genetic testist signed an agreement, but because the price of non-invasive DNA-Plus was not standardized, the hospital did not conduct this test.A person in charge of the Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) Obstetrics Health Health Clinic also said that he has 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 performed non-invasive DNA-PLUS test at the Wuyi Road Hospital of Shanxi Province (Maternal and Child Health Hospital)Show the reporter’s contract and charge invoice.The cover of the contract is Bearing gene, the invoice is displayed as the Jiahui genetic specialist hospital of Hunan Jiahui Biotechnology Co., Ltd.Another lady who had a production inspection in the hospital in 2018 also showed the same contract, invoice and test results to reporters.

An insider of the hospital revealed to reporters that the hospital is tearing the application form of non-invasive DNA-PLUS prenatal screening project testing project, and told the medical staff that in any unit’s investigation, it must deny that this item has been carried out for at least 4 years, and at least 4 years, and at least 4 years, at least 4 years, and at least 4 years, at least 4 years, and at least 4 years, at least 4 years, and at least 4 years.Complete prenatal screening 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 fertility caused by medical development to patients, but the cooperation model between some public hospitals and testing institutions needs to be regulated.

The reporter learned from the Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) that the hospital and Berry Gene and Huada gene have signed an agreement to conduct non-invasive DNA and non-invasive DNA-Plus.

The reporter learned that the non -invasive DNA testing cost was 1,200 yuan. Shanxi Province’s subsidy standard for pregnant women to carry out this project was 1,000 yuan/example, which was borne by the provincial financial.Therefore, Wang Yue, a professor of medical ethics and legal at the School of Medicine of Peking University, pointed out that the service procurement of public hospitals is actually the scope of government procurement, and bidding should be conducted.

In addition, people familiar with the matter revealed to reporters that the relevant leaders of the Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) have asked doctors to issue only one of the companies’ test forms on multiple occasions.

Experts point out that this behavior is actually inappropriate competition, and it is suspected of designated consumption, which disrupts the market order.Experts also said that the cooperation between some public hospitals and third -party institutions is relatively chaotic and urgently need to be regulated.At this time, the government’s intervention is required, or the management methods of public hospitals and third -party cooperation agencies can be issued.For example, non -invasive DNA projects shall be concentrated on behalf of public hospitals on behalf of public hospitals to reduce costs and increase screening rates.At the same time, multi -subjects are encouraged to participate in collecting collection, and public hospitals themselves can also carry out genetic screening, and through fair competition to achieve quality and fees for this project.

In addition, Wang Yue pointed out that the hospital and doctors have a knowledgeable position and have specialized power. If a public hospital doctor gives the doctor’s advice mixed with business considerations, it will increase the medical burden of patients and violate the word "public".He suggested that through the establishment of a strict expert withdrawal mechanism and a business ban, doctors who conduct business diagnosis strictly punish the doctors and form doctors’ self -discipline.For the first time, the Physician Law, which was implemented in my country on March 1st, added a lifelong forbidden system for the first time.

Before the reporter released, Shanxi Provincial Children’s Hospital (Maternal and Child Health Hospital) stated that it would conduct a self-examination of the chaos of non-invasive DNA-PLUS projects and start the bidding procedures for non-invasive DNA projects as soon as possible.(Reporter Li Ziwei, Zhao Yang, Faye Wongfei)

Source: Xinhua Daily Telecom

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