300% increase in the price of imported medical devices

2014-01-03 source: the false high price of medical devices (medical high value consumables) in the 21st century economic report is not the secret of the medical industry As with drugs, it is normal for the price of medical devices to double from manufacturer to patient But the closed chain to achieve such a result is very logical: the motivation of the bidding group to purchase high prices, the motivation of the hospital's drug addition, and the motivation of the patients to spend money to buy safety But when this "Convention" became common knowledge, eventually the trust between doctors and patients fell to the lowest point To solve the false high price of medical equipment, the competent department offered the way of centralized bidding procurement At the beginning of 2013, the health and Family Planning Commission issued the document of "centralized procurement of high value medical consumables (Trial)", which stipulates that the people's governments at and above the county level, state-owned enterprises (including state-owned holding enterprises) All the qualified non-profit medical institutions must participate in the centralized purchase when purchasing high-value medical consumables, and it is stipulated that in principle, medical institutions shall not purchase high-value medical consumables outside the shortlisted varieties For more than ten years, the centralized bidding and purchase of drugs has not curbed the false high price of drugs, making it more difficult to solve the problem of rising medical costs for patients, which still cannot be solved by the old methods It was said that centralized bidding procurement could not be expected to solve all problems in the medical and health system, and system and mechanism reform of supporting system was needed But we can see that in many new policies of medical reform, this is the fastest field for local competent departments to implement document policies It is hard to hide the intention of "seeking power" In the four years of the new health care reform, trillion yuan of financial investment has been accepted by both suppliers (hospitals) and demanders (medical insurance), and it is still insufficient to appeal for investment through their own channels But when we need the corresponding mechanism, such as medical insurance payment system, the separation of management and management of public hospitals from the separation of politics and affairs, we are faltering and struggling The reform is not only to increase government investment, but also to adjust the system and mechanism and touch the vested interests Although it is difficult to nibble, it is the final solution to the problem of higher medical treatment with the price of drugs and medical devices being inflated "The deposit is 60000 yuan, of which the price of titanium plate is 30000 yuan, which is imported Our hospital only has this brand." At the beginning of September, when Zhang Wei (pseudonym) accompanied his father to register in a top three hospital in Beijing, a middle-aged male doctor in the ninth consulting room of general neurosurgery clinic made a diagnosis and treatment plan: his father needed to do skull trauma repair surgery, in which a medical material (special market area) titanium plate must be used Titanium plate, also known as titanium mesh, is the most commonly used medical consumables to repair skull trauma In surgery, the missing skull will be replaced by titanium mesh Titanium mesh is commonly used in neurosurgery in three-level comprehensive hospitals, which focus on neurosurgery "30000 yuan should be the total cost of titanium mesh, fixed screws and computer molding Except for 1000 yuan of screws and 3000 yuan of computer molding cost, the unit price of titanium mesh should be about 25000 yuan." Liu Chang (pseudonym), a senior person who has been engaged in the medical device agency industry for more than ten years, told the 21st century economic reporter and "disclosed" the real price of titanium mesh "According to the 15 × 15 cm specification, our average purchase price from foreign manufacturers is 6000 yuan, and the 9 × 9 cm specification is only 3300 yuan." Liu Chang said According to the 21st century economic news reporter who interviewed people related to medical consumables, after the "five steps of price increase", when using imported medical devices, Chinese patients pay the most expensive price in the world More than four times of the price difference between purchase and sale is finally realized after five links of "obtaining medical device registration certificate, publicity and promotion, entrusting sales agency company, bidding and pricing, and hospital increasing price to sell to patients" The sum of the price increases of the latter two links is as high as 70% - 80% of the final sales price The reporter learned that the doubling of titanium mesh price is only a microcosm of the doubling of medical consumables price For example, the price of ventriculoperitoneal shunt, which is only 3500 yuan from the manufacturer, has soared to nearly 17000 yuan by the time it reaches the patient's hands In fact, the price difference of four to five times has become the current "practice" of China's medical consumables industry According to the survey conducted by the pharmaceutical industry center of Zongheng management consulting group of Peking University, the revenue of the top 65 drugs sold by the hospital accounts for half of the total revenue of the hospital, and the average price difference between the purchase and sale of these drugs is about four times The bidding system originated from the western countries has shown the current situation that the purchasers want to raise the price in China However, behind this seemingly jaw dropping result, it follows a set of "reasonable" Chinese closed-loop logic, and even "win-win" is often "great joy" The higher the price increase, the higher the profits of manufacturers and distributors, and the higher the income of doctors and hospitals Therefore, the higher the sales volume of high priced products, the higher the markup of the products In all links of the five part of the price increase of a skull repair plate, the price of imported medical devices has been improved by bidding At the beginning of September, Zhang Wei accompanied his father to a third-class registered consultation in Beijing In the afternoon of that day, a middle-aged male doctor in the ninth consulting room of general neurosurgery clinic said, "pay 60000 yuan as a deposit, of which the price of titanium plate is 30000 yuan, which is imported This is the only brand in our hospital." In the sixth emergency room of the hospital, the reporter received the same reply from another doctor The patient could only spend 60000 yuan to use the only imported product in the hospital for skull trauma treatment, and had no choice Liu Chang's neurosurgery consumables include the titanium mesh for skull repair and the ventriculoperitoneal shunt produced by Johnson & Johnson, Sofia, and Medtronic, which are used to draw water from the brain Compared with the purchase price of the agent, the price Liu Chang sold to the hospital often increased fourfold According to Liu Chang's statement, before a certain medical device arrives at the patient, it generally goes through five price increase steps: obtaining the medical device registration certificate, publicity and promotion, entrusting the sales agency, bidding and pricing, and selling the medical device to the patient at a higher price Among them, the sum of the last two price increases is as high as 70% - 80% of the final sales price The first step is to obtain the registration certificate If any medical device wants to be sold in mainland China, it must obtain the medical device registration certificate of the people's Republic of China (hereinafter referred to as the "registration certificate") issued by the drug administration The registration certificate is valid for four years For foreign businessmen, it is a tedious and long process to obtain and renew the registration certificate "It usually takes more than two years." A staff member of a foreign medical consumables manufacturer told 21st century economic news In order to enter the Chinese market as soon as possible, medical consumables manufacturers often entrust Chinese companies to handle the registration certificate on their behalf Liu Chang told 21st century economic news: "according to the different categories of product declaration, there are more than 100000 yuan less than 340000 yuan." An agency company with internal relationship with the drug administration shall be entrusted for handling " The second step is publicity and promotion After obtaining the registration certificate of medical consumables products, manufacturers need to promote them in various professional academic conferences and magazines Taking neurosurgery as an example, the most famous professional journals in mainland China include Chinese Journal of surgery and Chinese Journal of neurosurgery Publishing professional papers is not the ultimate goal of manufacturers Another important form of publicity and promotion is to hold professional academic conferences In such conferences, the manufacturers who sponsor the conferences can not only publicize their own products, but also take this opportunity to meet well-known doctors The role of well-known doctors is limitless They often have a large number of advanced students from hospitals all over the country to carry out medical and surgical training Generally speaking, the promotion expenses of manufacturers account for 5% - 10% of their total sales revenue The third step is to appoint a sales agent After obtaining the registration certificate and promotion, foreign manufacturers often appoint several sales agencies, which saves a lot of costs and avoids many legal risks Through agents, manufacturers do not have to establish a strong terminal sales network, thus saving a lot of money In addition, through the agent sales mode, the manufacturer directly wholesales the products to the sales agent company, the latter carries on the fund settlement with the hospital, once the fund cannot be recovered, it has nothing to do with the manufacturer What's more, the huge kickbacks happen between the sales agent and the doctor, so the manufacturer can avoid the legal risks Hundreds of thousands of yuan of registration certificate and 5% - 10% of promotion expenditure spent by foreign manufacturers in the first two links are reflected in the wholesale price of purchase from foreign manufacturers by sales agencies Taking the anti siphon ventriculoperitoneal shunt produced by Sofia company in France as an example, the wholesale price of the agent company operated by Liu Chang from Sofia company is 3500 yuan; the wholesale price of 9 × 9 cm titanium mesh produced by Johnson & Johnson company in the United States is 3300 yuan In fact, even if the price seems so low, it is still much higher than the price Sofia and Johnson & Johnson sold to foreign hospitals Liu Chang told 21st century economic news: "if compared with the customs price, the price of entering China is 40% higher than that of entering Indonesia, Singapore and other Southeast Asian countries." The fourth step is to increase the bidding price In all links, the price of imported medical devices has been increased by bidding, and the bidding price is generally about four times of the agent's purchase price, which is also the hospital's purchase guide price "The Chinese market doesn't care about price." The head of sales of a pharmaceutical company told reporters that his conclusions were mainly from the bidding and pricing process For example, the wholesale price of 9 × 9 cm titanium mesh of Johnson & Johnson is 3300 yuan to the agent, but the final bidding price organized by a city recently is 12000 yuan; the wholesale price of 15 × 15 cm titanium mesh is 6000 yuan to the agent, while the municipal bidding price is about 22000 yuan According to the relevant laws and regulations, at present, the medical devices in most regions of China are subject to provincial and municipal bidding organized by the provincial and municipal health bureaus (departments) The bid price is an important reference for the hospital's purchase price Generally speaking, the hospital's purchase price should not be higher than the bid price Similar to the soaring bid price of Johnson & Johnson titanium, the anti siphon ventriculoperitoneal shunt pipe manufactured by Sofia, France, was sold to agents at a wholesale price of 3500 yuan, but its bid price rose to 14600 yuan in the same bidding In all links, the price of imported medical devices has been increased by bidding, and the bid price of imported medical consumables is generally about four times of the purchase price of agents If the final price sold to patients after the hospital's price increase is calculated, the proportion of price increase in the bidding process is generally more than 70% Step 5: the journey of the hospital to increase the price by selling it to patients is not over The hospital's purchase price based on the bid price is not the price sold to patients According to the existing national policy, in all links of the hospital, the price increase of bidding makes the price of imported medical devices leap On the basis of the winning price, the price will be increased again by 15% and sold to the patients This price is the "material fee" paid by the patient during the operation.