先日、中国の医療事情についてお話を聞きました。何せ国民皆保険制度に乗り出したアメリカもそうですが、中国はさらに遅れているので大変です。
昔、日経メディカルにて連載されていました日経メディカルブログ：内山 伸の「ハーバード留学日記」 2008.
より
「中国では医者をやっているより、臨床疫学などの専門家になった方が給料がいいからとのことである。彼女の場合はさらに、給料の問題だけではなく、中国での医者としての生活が耐えられなかったからともいう。」
まぁ、いろいろあります。中国人の医師が日本に留学して日本で医師としてではなく、色々な形で働いているのを知っていますし、日本に留学してさらにNIHに渡った先生も知っています。
もちろん、日本よりも中国の医師の状況がどうも違うなぁ・・・ってのはほんの20年前までは卒業時の国家試験の成績でそれこそトップの北京、上海から、僻地までの赴任が自動的に決まっていて、一生そのまま・・・って恐ろしいシステムがあったとかは聞いていましたが、３年ほど前にNHKスペシャル「激流中国」で病人大行列 ～13億人の医療～っての放映されて、かなり問題がある国だなぁ・・・ってのを知りました。
世界で５人に１人は中国の国民。新たに８億人の国民を公的医療保険でカバーしようという壮大なプロジェクト。医療保険は2011年までに国民の90%、2020年に皆保険を目指すことになっていますが、何せ戸籍が農民と都市部で分かれているし、まだ医療機関もこれからのようです。
医学生は毎年３０万人入学してくるそうですが、国家試験に合格するのはなにせ２３％。現在医師数は90万人(あと残り90万人ほど医学部も出ていない農村部の医士が存在するようです)とのことですが、人口３億人のアメリカで６０万人の医師、その４倍の医師が必要なのに、圧倒的に足りません。
さて、そんな中国ですが、Broombergにこんな記事が・・・
[China Doctors Earning $300 a Month Flock to Drug Companies]
ちなみに中国では治験なんかの業務をするCRC(Clinical Research Coordinator )の大半が医師だってのは聞いていましたが、記事によると今後も5年間で14000人の医師がMRになって増える見込みとされておりました。
でもって医師が転職していく原因は国家公務員ゆえの安月給：月収が310-464ドルで、そのうちほとんどがアパートに消えるんじゃ・・・ねぇ汗。
「A newly qualified doctor makes about 2,000-3,000 yuan ($309-464) a month, while a one-bedroom apartment in Dalian, a city of 6 million people, goes for 2,000-2,500 yuan, Mao said. Typically three or four newly qualified doctors will rent a flat together to defray their costs, he said.」
中国の医師がMRをやる理由もうひとつ・・・中国には純然たる薬科大学が２つしかないう話・・・そりゃ医師がそっちに行くでしょう。
他に賄賂し放題で、ほんの少し前までは接待漬けだったんですが、最近FCPAと同じ公務員(含む医師)への贈収賄を処分する法律が出来たから厳しくなったのだけどまだやっている・・・というところ。
ちなみに日本の製薬企業で中国で成功したのは目薬の参天製薬だけ(シェア98%だとか)。４大卸(メディパル、スズケン、アルフレッサ、東邦)は皆中国に出資しているとかも聞きました。 卸の利幅はまだ高いし再編もこれからということでがんばって頂きたいところです。
ちなみに中国の医療状況で文章を読んでってつきあたったは「92.4 million adults with Type-2 diabetes and more than half are undiagnosed」で、9240万人の糖尿病でしかも半分が未治療どころか診断されていないって推計も・・・汗。
「Pharmaceutical sales grew an average of 24 percent a year in China from 2006 to 2010 and will expand at a 19 to 22 percent annual clip over the next five years 」毎年24%成長して、しかもまだあと5年も続くって・・・驚愕でした。
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[China Doctors Earning $300 a Month Flock to Drug Companies]
By Bloomberg News - Jul 11, 2011
Mao, 26, tripled his income after quitting his job at a hospital in northeastern China to work as a medical sales representative in 2009. As many as 14,000 physicians like Mao will join foreign pharmaceutical companies over the next five years, according to Aon Corp. (AON)’s Shanghai-based human resources advisory firm.
The new recruits will sell medicines made by companies from New York-based Pfizer Inc. (PFE) to Paris-based Sanofi in the world’s fastest-growing major drugs market. Their career-switch is curbing the supply of doctors that China’s government wants in rural and regional areas, where inadequate medical care is hampering efforts to cut infant mortality and prevent diabetes.
“The pay for new doctors is low, which makes it hard to survive,” said Mao, who was one of 30 to graduate in 2005 from the medical college he attended in Dalian, 460 kilometers (286 miles) east of Beijing. Nine of his classmates have jobs in pharmaceutical sales, he said.
A newly qualified doctor makes about 2,000-3,000 yuan ($309-464) a month, while a one-bedroom apartment in Dalian, a city of 6 million people, goes for 2,000-2,500 yuan, Mao said. Typically three or four newly qualified doctors will rent a flat together to defray their costs, he said.
Fewer Doctors
The U.S. has one public health professional for every 635 people. The rate in China is one per 7,000, according to Kun Chen, a doctor at Zhejiang University’s school of public health. Moreover, medical demands are surging. The country has 92.4 million adults with Type-2 diabetes and more than half are undiagnosed, a 2010 study showed.
“There is a great lack of doctors at the most primary levels like county and small-city hospitals, and that’s also where it’s hardest to find them,” said Shi Yingkang, dean of the West China Medical School at Sichuan University in Chengdu, and vice president of the Chinese Medical Doctor Association.
After graduation, half of his students spurn local hospitals for better-paying jobs overseas or in drug sales, Shi said. Pay for local rookie doctors starts at 2,000 yuan a month, while medical representatives may get two to three times more, he said.
“To them, the pay does not match the effort put in,” said Shi, who also works as a heart surgeon at the West China Hospital in Sichuan province. His father and grandfather were both doctors, as is his daughter.
China’s health officials are trying to encourage more doctors like the Shis, offering incentives such as free training to entice as many as 300,000 general practitioners in clinics and hospitals in villages and small towns over the next decade.
Incentive Money
Hebei province, which skirts Beijing, is offering 1,000 graduates a 2,000 yuan relocation fee and priority placement at major hospitals for those willing to work for two years in a village. Of the province’s 50,000 villages, 6,000 lack a qualified doctor, the official People’s Daily newspaper reported on May 29.
China’s policy-setting State Council, in a session chaired by Premier Wen Jiabao, announced on June 22 a plan to improve medical care by raising education standards for general practitioners. It also proposes to have two or three better- qualified doctors for every 10,000 residents by 2012.
That comes on top of a three-year plan to invest 850 billion yuan ($131 billion) narrowing discrepancies in access to medical care and providing more than 90 percent of China’s people with basic health insurance. The plan is also spurring demand for medicines and people trained to sell them. Sanofi runs classes for its medical representatives from a center in the 20-story BenBen tower in downtown Shanghai which it calls the Sanofi-Aventis University.
‘Love to Be Trained’
“We brand it as a university, and it does work when we go to campuses and do mass recruitments,” said Freddie Chow, Sanofi’s vice president of human resources in China. “Chinese people love to be trained. The hunger for knowledge acquisition is very high.”
Foreign drugmakers like Sanofi and their local affiliates will hire at least 35,000 sales staff by the end of 2014, Aon Hewitt China estimates, based on a survey of 24 companies. The same employers had 33,000 on staff at the end of 2010. About 30 to 40 percent of people recruited for sales jobs will have a medical degree, said Jarroad Zhang, a consulting director with Aon Hewitt in Shanghai.
‘Extremely Rare’
“In most other countries, it’s extremely rare to get fully trained doctors as medical representatives,” said Chris Lee, managing director of Bayer Healthcare China, a Beijing-based arm of Bayer AG (BAYN), Germany’s largest drugmaker. Doctors -- followed by pharmacists and nurses -- are sought after by drugmakers in China for their medical knowledge, he said.
Lee has already met his 2011 target for hiring 1,000 sales representatives and says he may recruit a similar number next year. China will overtake the U.S. as Bayer’s largest pharmaceuticals market in the next seven to eight years, he says.
“There’s an understanding within the company that we will need to hire to meet that goal,” said Lee, who began his career in drug sales with Merck & Co. in New Jersey.
Pharmaceutical sales grew an average of 24 percent a year in China from 2006 to 2010 and will expand at a 19 to 22 percent annual clip over the next five years, according to the IMS Institute for Healthcare Informatics. The market will probably be worth $115 billion by 2015, the Norwalk, Connecticut-based researcher said in a report in May.
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