[exclusive] can 4 + 7 volume purchase get out of the strange circle of Chinese medicine price reduction

On December 6, the 4 + 7 volume purchase led by the state health insurance bureau was opened in Shanghai 11 cities were selected as the pilot cities for this volume procurement, including Beijing, Shanghai, Tianjin and Chongqing, and 7 cities including Guangzhou, Shenzhen, Shenyang, Dalian, Xi'an, Chengdu and Xiamen As a new bidding method, the volume purchase involves 31 varieties (42 specifications) of drugs The generic drugs that were originally researched or passed the consistency evaluation and approved according to the new registration classification can participate in the bidding application Compared with the previous centralized purchase, the biggest difference of volume purchase is that "volume for price", that is, the sales volume of drugs is promised at the time of bidding, For the first pilot project, the procurement cycle is 12 months (if the agreed procurement volume is completed in advance within the procurement cycle, the excess part will still be purchased at the selected price until the expiration of the procurement cycle) However, on the 6th, the network reported the result of pre winning the bid, and the drug price dropped significantly There were not a few drugs with a drop of 60% to 90%, which caused great turbulence in the pharmaceutical stocks and heated discussions in the industry The official list was released on July 7, and compared with the outgoing version to be awarded, 6 varieties dropped out of the competition Why? The original intention of volume purchase is to control the medical insurance expenses reasonably The starting point is to reduce the drug price, reduce the operating cost of the enterprise market, and guide the hospital to standardize the drug use As a new way to reduce the drug price, the industry is looking forward to it Now, the price reduction seems to exceed the expectation, and then the market effect is unknown In view of the historical situation, it is not difficult to see that in recent years, in order to regulate drug prices and solve the problem of high drug prices, the relevant departments can be said to have made great efforts, but in terms of its typical models, it seems that they always fall into a strange circle The strange circle of price reduction of the national development and Reform Commission: "price reduction is dead" in the 1990s, when the government's pricing was liberalized, the drug price soared People: can't afford medicine, worry! Expert: Recently, people have been complaining The price of drugs is too disordered It still needs to be controlled by "visible hand" Leader: Yes, let's give the pricing power to us In 1996, the State Planning Commission (renamed the State Development Planning Commission in 1998, and then merged some functions of the former State Council reform office and the State Economic and Trade Commission into the national development and Reform Commission in 2003, which is called the national development and Reform Commission for short) The Interim Measures for the administration of drug prices were promulgated, the power of drug pricing was formally regained, and a series of price reduction actions were initiated According to incomplete statistics, from 1997 to 2015, the national development and Reform Commission implemented a total of 30 + price cuts, but after each price cut, the market feedback seems to be embarrassed Once there is a price cut, the drugs will be stopped production and disappear, and then there will be other high-priced drugs with the same indication Then the development and Reform Commission will carry out a new round of price cuts, which will be repeated and tangled one after another Then there was the following scene: xiaoq heard that the national development and Reform Commission had recently reduced the price of a medicine from 100 yuan to 10 yuan He was very happy and rushed to the hospital Xiao Q: Hello, doctor, I also want to buy the a medicine you prescribed last time The effect is good, and I heard that the price is reduced? Hospital: sorry, the hospital has not purchased medicine a recently Medicine B is almost the same as medicine a, with better curative effect and fewer side effects Use medicine B Little Q: how much is it? Hospital: a box of 150 yuan, so xiaoq ran to many hospitals and replied the same thing Xiaoq could only buy 150 yuan of medicine B with despondency, sighing: worry! Expert: Recently, people have said that they can't buy low-cost drugs Government regulation will destroy the natural competition in the market It's better not to interfere Leader: Yes, then we still have the right to rely on the market rules Therefore, on May 5, 2015, seven departments including the national development and Reform Commission, the national health and Family Planning Commission and the Ministry of human resources and Social Security jointly issued the opinions on promoting drug price reform It is stipulated that from June 1, 2015, in addition to narcotic drugs and class I psychotropic drugs, the price of original drugs set by the government shall be cancelled, and the actual transaction price of drugs shall return to the market rule The era of price cuts by the national development and Reform Commission has come to an end The strange circle of drug proportion mode price reduction: "mathematical formula method" drug price returns to the market, although the situation of low-cost drug shortage decreases with the end of the price reduction mode of the national development and Reform Commission, but driven by the interest mechanism, the situation of drug maintenance and medical expenses increasing year by year highlights People: can't afford hospital, can't afford medicine, worry! Expert: Recently, the people are still crying for help It makes the drug price too high and the burden on the people is too heavy It is not good to directly control the drug price We have to change from the hospital side, control the hospital expenses, let the hospital balance with the drug companies and the people from the middle, indirectly choose low-cost drugs and control the medical expenses Leader: Yes, we will reform from the hospital In May 2015, the State Council issued the guiding opinions on the pilot comprehensive reform of urban public hospitals, which clearly proposed that the proportion of drugs in urban public hospitals should be reduced to 30% by the end of 2017 According to the official definition, the proportion of drugs = the hospital's drug revenue (drug revenue - Chinese Herbal Pieces revenue) / medical revenue × 100% Among the requirements for the proportion of drugs, a clear formula and a clear proportion make the reform of reducing the price of drugs go to another circle that cannot be bypassed In order to control the proportion of drugs and maintain the income of drugs, changing other medical income (denominator) has become a solution Not only can the drug price not be very low, but also increases other medical expenses This wave of operation of mathematical formula method 666, the teacher really didn't deceive people, and learning mathematics well can go around the world So there are the following scenes: xiaoq heard that recently the public hospitals are controlling the proportion of drugs, and he can buy low-cost medicine A he was very happy and rushed to the hospital When he saw the medical settlement bill, he looked at xiaoq at the cost and was at a loss Xiaoq thought to himself: Why did you buy low-cost drug a this time? Compared with the total cost of medical treatment in the past, the cost paid this time is still high? So xiaoq compared the cost with that of the past, and found that there were more examinations this time, and the cost of some equipment used in the examination increased, so xiaoq went to the hospital for consultation Xiao Q: Hello, doctor Why do so many tests need to be done this time, and the price of the same test seems to be higher? Hospital: Well, in order to make a more accurate diagnosis, we need more precise equipment inspection to ensure that there is no mistake and ensure your treatment And now we are using imported equipment from XX Besides, we have changed the cotton swabs, syringes, gauze and other equipment with better quality, and the price is.. Small Q: embarrassment.. Expert: Er.. Leader:?? is the next strange circle of purchasing with quantity? The proportion of drugs failed to solve the problem of drug price, and the people fell into another kind of depression The drug price increased layer by layer, and other medical expenses also increased People: dare not be sick, dare not take medicine, dare not enter the hospital, worry! Expert: Recently, the people are still crying, and the drug price has to be reduced It requires the relevant departments, pharmaceutical enterprises and hospitals to play games together to reduce the link of raising the drug price level by level in purchasing, give enterprises a quantitative market share and a quantitative purchase quantity Leader: Yes, we will take the lead in the new centralized procurement mode, reducing the procurement links and costs between pharmaceutical enterprises and hospitals In order to further promote drug price reduction, on the morning of November 15, 2018, Shanghai Sunshine pharmaceutical purchase network officially posted the "4 + 7 urban drug centralized purchase document", and the new centralized purchase price reduction mode was officially launched On December 7, the proposed bid winning enterprises will be publicized, and what will be the follow-up process? It is assumed that the purchase volume of drug a (generic name) given to the bid winning enterprises is 70% of the total annual drug consumption of all public medical institutions in the pilot area Drug a (generic name) of an enterprise won the bid, with 70% market share of the drug in the first year Then the unsuccessful enterprises compete for the remaining 30% of the market, with low price and small market volume, which may lead to many enterprises having to give up the drug to explore other drugs with the same indications Will the winning company enjoy the cake alone? If you want to eat cake, I want to eat cake, so: assume that the remaining 30% of the market share of drug a in the first year, other unsuccessful enterprises give up drug a and fill 30% of the market share with drug B So although winning enterprise a holds 70% of the market in 2019, it may only hold 49% (70% * 70%) of the market in 2020, and only 34% (70% * 70% * 70%) of the market share in 2021... winning enterprise marvels: my big cake! Then, reduce the purchase of another batch of high priced drugs B to start a new round, which seems to be familiar?? .. so it's possible to have the following scenario: small Q: it seems that purchasing low-cost drug a with volume has appeared for a year or two, how can't I buy it? Hospital: medicine a is not as effective as medicine B buy medicine B! Xiao Q: but medicine B is expensive Hospital: it's OK I'm going to buy medicine B with quantity and reduce the price immediately! Xiaoq: I have a high frequency of dressing change, worry! .. can volume purchase break the magic circle of Chinese medicine price reduction? Get people's exclamation: Hi! Welcome to leave a message and exchange views! Statement: this opinion only represents the author, not the position of yaozhi.com, welcome to exchange and supplement in the message area; if you need to reprint, please be sure to indicate the author and source of the article.