以下文章来源于张琨随笔 ，作者张琨 张琨随笔 . 勤于思考，勇于实践，乐于分享 本文来自微信公众号： 张琨随笔 ，作者：张琨，题图来自：AI生成 昨日读完《以日为鉴：衰退时代生存指南》这本书。合上书的那一刻，我感到一种从脊背升起的寒 意。我们常说"摸着石头过河"，但如果河对岸的人已经把路走塌了，甚至付出了两代人的惨痛代价才 爬出泥潭，我们是否还要闭着眼睛重蹈覆辙？ 书中我重点精读的是日本医疗体系的部分，特别是医生培养制度在"失去的三十年"里的演变史。它折 射出的正是我们正在经历的现在，和极有可能面临的未来。 人老了，是要生病的。书里给出了一个数据：65岁以上老人的医疗资源消耗量是年轻人的4倍。这就 是老龄化社会对医疗资源需求的"乘数效应"。当日本在20世纪90年代一头扎进深度老龄化社会时， 他们惊恐地发现，虽然总人口没怎么变，医疗需求却呈指数级爆炸。而在供给端，是80年代的"医生 过剩论"导致的缩招，医生储备严重不足。 这一进一出，直接导致90年代日本医疗体系的硬着陆。整整两代年轻医生为此付出了沉重的代价。 二、被"围猎"的白大褂 如果说80年代是决策的傲慢，那么90年代就是现实的报复。书里把这段时期称为"医 ...

晨 会 纪 要 [2025]第 227 号 整理记录：贺钰偲 研究所今日晨会要点如下: 一、行业公司 1、医疗服务行业（蒋栋） 医药卫生事业稳定发展，老龄化下需考虑支付意愿 12 月 2 日，据国家卫生健康委网站消息，国家卫健委发布了《2024 年我国卫生健康事业 发展统计公报》。《公报》公布，我国人均预期寿命达到 79 岁，孕产妇死亡率下降到 14.3/10 万，婴儿死亡率下降至 4.0‰。一批创新性、普惠性、兜底性服务举措推出，卫生健康事 业得到了新发展，人民健康水平持续提升。总体来看我国医药卫生事业稳定发展，但有些 数据出现了明显的增速下降，甚至负增长值得关注：（1）医疗卫生费用占 GDP 比重同比 下降 0.3 个百分点。医疗卫生费用结构中政府支出下降较大，同比下降 6.4%，占总支出的 比例为 24.9%，下降 1.8 个百分点。（2）医院数量 38710 家，同比增长 0.9%，床位数 811.99 万张，同比增长 1.4%，创历史新低。（3）从诊疗需求来看，居民总诊疗人次 101.5 亿人 次，同比增长 6.2%，诊疗需求提升，符合老龄化下需求提升逻辑，但门诊人均费用 361.0 元，按当年价格 ...

2025 年 12 月 4 日 星期四 ➢ 每日大市点评 中国香港 11 月标普全球 PMI 为 52.9，高于 10 月的 51.2。 美国 11 月私企职位减少 3.2 万个，差于市场预期的增加 1 万个，及 10 月的增加 4.2 万个。 美国 11 月 ISM 服务业 PMI 为 52.6，皆高于市场预期的 52.1，及 10 月的 52.4。 行业动态： 汽车行业方面，周三港股大盘下行，汽车板块持续受压。临近年底，新能源汽车行业没有出现市场先前预期的"翘尾" 行情，加上投资担忧明年销量压力。比亚迪(1211 HK)、吉利汽车(175 HK)和长城汽车(2333 HK)周三下跌 1.5%-2%。新能 源板块下跌幅度更大，小鹏汽车(9868 HK)跌 4.2%，蔚来(9866 HK)跌 3.3%。Robotaxi 企业文远知行(800 HK)近期连续跑 赢同业，周三上升 4.8%。 周三港股下跌，恒生指数失守 26,000 点。恒生指数及国企指数分别收报 25,761 点及 9,029 点，下跌 1.3%及 1.7%。港股 成交合共 1,644 亿港元，较周二的 1,782 亿港元，下跌 7.7%。成交 ...

近期，有跨国药企开始出售其部分在华业务，与以往多将资产出售给同行业药企的模式不同，此次的接盘方变成了投资机构。 此前，有报道称，百时美施贵宝公司（BMS）将其持有的中美上海施贵宝制药有限公司（是中国改革开放后首家中美合资制药企业）的60%股权，连同为 中国大陆市场制造的关联产品，一并出售给高瓴资本集团，交易预计于2026年初完成。 另据《科创板日报》记者从知情人士处获悉，日前，拜耳将其旗下抗生素药物Avelox（莫西沙星）的知识产权、品牌所有权及全球商业权益出售给了红杉 中国，该交易预计将于2026年第一季度完成。 而在更早之前，优时比将其华成熟的产品业务打包出售给了康桥资本等两家投资机构。 这一系列"资本接盘药企资产"的背后，是跨国药企在华投资逻辑悄然转向，还是投资机构的产业布局边界正在持续拓宽，而这一趋势，又是否会引发医药 行业更深层次的连锁变局？ 利润被压缩谋求"轻装上阵" "随着国家集采、医保控费等政策的常态化推进，跨国药企在华布局的部分成熟业务面临显著的盈利压力，利润空间被持续挤压。这也成为其推动该类资 产剥离的关键动因之一。与此同时，本土药企凭借仿制药领域的成本控制优势与深度渠道下沉能力，正在快速 ...

Investment Rating - The report does not explicitly state an investment rating for the pharmaceutical industry Core Insights - The pharmaceutical industry is gradually stabilizing, with a total revenue of 16,766.9 billion yuan in the first three quarters of 2025, reflecting a slight decline of 0.7% year-on-year. The net profit attributable to shareholders decreased by 1.1% to 1,427.5 billion yuan, while the net profit excluding non-recurring items fell by 8.5% to 1,219.9 billion yuan [3][13][37] - Among the 388 selected pharmaceutical companies, 197 companies achieved revenue growth, accounting for 51%, while 189 companies reported positive net profit growth, representing 49% [3][13] - The third quarter of 2025 saw a positive revenue growth rate of 1.9% year-on-year, with net profit showing stable growth [14] Summary by Sections Overall Industry Performance - The pharmaceutical industry experienced a revenue decline of 0.7% in the first three quarters of 2025, with a total revenue of 16,766.9 billion yuan. The net profit attributable to shareholders decreased by 1.1% to 1,427.5 billion yuan [3][37] - The first three quarters showed a quarterly revenue of 5,586 billion yuan in Q1, 5,593 billion yuan in Q2, and 5,588 billion yuan in Q3, with Q3 marking a return to positive growth [14][16] Sector Performance - **Innovative Drugs and Formulations**: Revenue of 3,437.8 billion yuan (+0.6%) and net profit of 342.8 billion yuan (+5.0%) [4] - **Medical Devices**: Revenue of 1,457 billion yuan (-2.4%) and net profit of 265 billion yuan (-14.4%) [5] - **CXO**: Revenue of 695.7 billion yuan (+13.0%) and net profit of 165.4 billion yuan (+60.0%) [5][30] - **Active Pharmaceutical Ingredients**: Revenue of 782.1 billion yuan (-1.5%) and net profit of 114.2 billion yuan (+6.6%) [5] - **Life Sciences Upstream**: Revenue of 60.2 billion yuan (+0.1%) and net profit of 4.4 billion yuan (+15.6%) [5] - **Medical Services**: Revenue of 436 billion yuan (+0.4%) and net profit of 57.3 billion yuan (-13.8%) [5] - **Blood Products**: Revenue of approximately 176 billion yuan (+0.5%) and net profit of approximately 37.7 billion yuan (-20.0%) [5] - **Retail Pharmacies**: Revenue of 859 billion yuan (+0.7%) and net profit of 35.2 billion yuan (+8.9%) [6] - **Pharmaceutical Distribution**: Revenue of 6,087.3 billion yuan (+1.4%) and net profit of 116.8 billion yuan (+5.5%) [6] - **Traditional Chinese Medicine**: Revenue of 2,506 billion yuan (-3.6%) and net profit of 292.7 billion yuan (-0.5%) [6] - **Vaccine Sector**: Revenue of 174 billion yuan (-49.2%) and net profit of -9 billion yuan (-121.6%) [6] Profitability Analysis - The overall industry saw a decline in gross profit margin and net profit margin, with the gross profit margin at 33.7% and net profit margin at 8.5% [37][40] - The CXO sector exhibited the highest growth in net profit, increasing by 60% [31][35] - The medical device sector faced significant profit pressure, with a net profit decline of 14.4% [5][30]

Core Viewpoint - The article highlights a significant trend of salary reductions among doctors across various hospitals in China, driven by economic conditions, healthcare cost control measures, and the financial strain of hospital construction and renovation projects [4][6][16]. Salary Reduction Trends - Many doctors report salary cuts, with some experiencing reductions of 30% in performance bonuses and overall income [5][9]. - A survey indicated that 57.9% of healthcare workers experienced salary decreases in 2024, a notable increase from 37% in the previous year [11]. - Performance bonuses, which constitute a major part of doctors' income, have been significantly reduced, leading to financial distress among medical professionals [8][12]. Factors Contributing to Salary Cuts - The decline in patient volume due to lower birth rates and economic conditions has led to reduced hospital revenues, impacting doctors' salaries [15][16]. - The implementation of DRG (Diagnosis-Related Group) payment reforms has further constrained hospital budgets, affecting doctors' performance-related pay [16][17]. - Hospitals are facing increased operational costs due to extensive renovations and expansions, which have not been matched by revenue growth [17][18]. Impact on Healthcare Professionals - Many doctors are struggling to make ends meet, with some reporting monthly incomes insufficient to support their families [7][9]. - The article notes a trend of doctors taking on additional jobs outside of their medical practice to supplement their income [5][6]. - The overall morale among healthcare workers is declining as they face ongoing financial challenges and uncertainty about the future [18].

Core Viewpoint - The article discusses the significant salary reductions faced by doctors across various hospitals in China, attributing these changes to economic conditions, medical insurance cost control, and the financial burdens of hospital construction and renovation [3][4][15]. Group 1: Salary Reductions - Many doctors report salary cuts, with some experiencing a decrease of around 30% in their performance bonuses [3][4]. - A doctor in Chongqing noted that their monthly salary dropped from approximately 6,000 yuan to 4,000 yuan, reflecting a 30% reduction [3]. - In a provincial children's hospital, another doctor reported a similar decline, with salaries reduced by one-third compared to the previous year [4]. Group 2: Performance Bonuses - Performance bonuses, which constitute a significant portion of doctors' income, have been halved in some cases, leading to financial distress among medical staff [5][11]. - The performance calculation method has changed multiple times, with recent adjustments resulting in a performance base drop from around 10,000 yuan to 7,000 yuan [8][10]. - A survey indicated that 57.9% of medical personnel experienced salary reductions in 2024, primarily due to decreased performance bonuses [13]. Group 3: Contributing Factors - The decline in patient numbers is a major factor, with many hospitals reporting fewer admissions and outpatient visits, particularly in pediatric departments [16]. - Medical insurance cost control measures, such as the DRG payment reform, have also impacted hospital revenues and, consequently, doctors' salaries [17][18]. - The financial strain from hospital renovations and expansions has led to increased operational costs, further exacerbating the salary issues for medical staff [18].

智通财经记者 | 黄华 智通财经编辑 | 谢欣 智通财经记者截自新乡医保公众号 11月11日，河南新乡市医疗保障局公告称，从11月12日零时起，取消新乡市基本医疗保险门诊统筹日支付限额的规定。 所谓"限额"，来自新乡市医保局在今年6月发布的一项新规——以日为单位，对该区域内城乡居民、在职职工、退休职工的医保门诊统筹支付划定限额，每 日最高限额为50元、150元、200元。 11月12日下午，智通财经记者致电新乡市医保局医药服务管理科，询问关于新乡市三级医疗机构报销的最新情况；接线人员表示，相关信息可以查看该市公 众号，未发布内容无法作答。 智通财经记者截自新乡医保公众号 另在今年8月，新乡市决定暂停该市三级医疗机构城乡居民门诊统筹医保服务。 智通财经记者截自新乡医保公众号 即使在目前，仍有大量网友在小红书上感慨将50元划为医保上限的荒诞。有网友表示："50元只够挂号，拍个片子都不够，这也叫医保。"另有网友称："医 保一天只能报50元，那看病，还靠谁？" 甚至有网友开始算起账，比如，"我门诊做个手术花4000多元，医保报销150元，感觉都没有交的意义。跟自费没区别了"，"防止骗保，为大家好"，或者 是"从自己身 ...

多位受访医生认为，降薪是经济大环境、医保控费、医院大修大建这三大因素综合影响后的 结果。 "是的，降薪了。"面对是否降薪的提问，多地多名医生这样回答经济观察报。 郭奇在重庆一家县医院做普外科主治医师，他是从今年8月感受到明显降薪的。这半年，工资每月会晚 发两三天，扣完五险一金后，到手基本工资约2000元，绩效工资则从年初的6000元左右，降到现在的 4000元左右，降幅为30%左右。 和郭奇情况类似，在西部某省级儿童医院工作的许星工资也比去年降了三分之一。她觉得这可能只是开 始，因为最近一个月，她又三次听到书记在院务会上提到降薪话题。 在华中地区一家大型三甲医院担任科主任的杜月，最近正为科室几十位医生的收入发愁。医院每月根据 门诊量、使用药品和耗材情况、住院天数、抗菌素使用比例等指标核算出各科室的绩效基数，住院医 师、主治医师、副主任医师、主任医师分别按绩效基数的1倍、1.2倍、1.3倍、2倍拿绩效。9月，杜月科 室的绩效基数从上月的1万元左右，降至7000余元。 上海一位资深医院管理者李鸣了解的情况显示，医生降薪是个大趋势，有的基层医院医生月收入降到两 三千元，还有些欠发达地区的医院连基本工资都发不出来，部 ...

Core Viewpoint - The article discusses the significant salary reductions experienced by doctors across various regions, attributing these changes to the broader economic environment, healthcare cost control measures, and the financial burdens of hospital renovations and constructions [1][4]. Group 1: Salary Reductions - Many doctors report salary cuts, with some experiencing a decrease of around 30% in performance bonuses, leading to total monthly incomes dropping to approximately 2,000 to 4,000 yuan [2][6]. - In some areas, doctors' salaries have fallen by one-third, with reports of basic salaries being delayed and reduced [3][7]. - A survey indicated that 57.9% of healthcare workers experienced salary reductions in 2024, a significant increase from 37% in the previous year [10]. Group 2: Factors Contributing to Salary Cuts - The decline in patient numbers is a primary reason for reduced salaries, with many hospitals reporting fewer patients due to lower birth rates and economic conditions [13]. - Healthcare cost control measures, particularly the implementation of the DRG payment system, have led to decreased hospital revenues, impacting doctors' performance bonuses [14][15]. - The financial strain from hospital renovations and expansions has also been identified as a contributing factor to salary reductions, as many hospitals struggle with increased operational costs [16].