Of course there are many possibilities. It may be that the doctor is getting kickbacks, or the hospital really does not have this drug because of relevant policies, or the need to control medical insurance costs. ?

First of all, I don’t know if you have heard of a new name: zero markup. That is to say, the current medical reform requires hospitals to implement zero markup on drugs. In other words, the purchase price of drugs is The sales price, the hospital's drug purchase volume is the amount sold to patients, and drugs have no profit for the hospital. However, from the perspective of hospital management, the more drugs the hospital sells, the higher the cost and the more money is lost during the transportation, storage, custody, repackaging and use of drugs. Therefore, restricting doctors from prescribing drugs has become a helpless choice for hospital management. In this way, some medicines are transferred to pharmacies in society. After doctors prescribe medicines, patients can buy them from pharmacies in society. Correspondingly, the proportion of medicines sold by hospitals has also been reduced. At the same time, after the zero price increase on medicines, hospitals were forced to reduce the variety of medicines. Many medicines are not available in hospitals at all, which also results in that some medicines can only be purchased outside the hospital.

Secondly, the centralized drug procurement system in public hospitals has been implemented for more than ten years. This article does not evaluate the advantages and disadvantages of this system, but only objective facts. Because of the implementation of low-price bidding, some pharmaceutical manufacturers control costs at the expense of reducing drug quality in order to win the bid. The question is, is low price necessarily good medicine? Must it be an effective drug? In fact, as a result, the winning bid may not be absolutely guaranteed to be a drug that is urgently needed in clinical practice and has proven efficacy, and a drug that has been proven to be effective and reasonable in clinical practice may not win the bid. Therefore, some doctors ask patients to buy needed medications outside the hospital.

Third, it is the need to control medical insurance costs.

I don’t know if you have heard of another new term: the proportion of drugs. That is to say, in the process of seeing a doctor, the purchase cost of drugs accounts for the proportion of the patient’s total cost.

Currently, the hospital’s quota is that the proportion of medicines does not exceed 30%. For example, if a doctor wants to prescribe 30 yuan of medicine to a patient, he must also prescribe an additional 70 yuan for examination and treatment to avoid exceeding the standard. Otherwise, some medicines must be purchased outside the hospital. In this way, his medicine expenses will not be included in the medical insurance, and he will not be punished for exceeding the standard (if the drug ratio exceeds the standard, the doctor should deduct it from his salary). In order to control the proportion of medicines, many hospitals have to cut off medicines and remove some auxiliary medicines from the hospital. Although they are auxiliary drugs, some drugs need to be used due to the patient's condition, which also makes doctors ask patients to buy drugs outside the hospital. On the surface, the control of "drug ratio" has great restrictions on the excessive use of doctors' prescriptions, especially the use of high-priced drugs. However, the proportion of the drug is limited to inpatients. Once there is no medicine available, patients can only go to outpatient clinics, other hospitals or pharmacies to buy medicines.

Fourth, some drugs are not included in the scope of medical insurance reimbursement.