GPO and Shanghai's ambition

Source: Medical observer's report 2015-05-25 Shanghai's medical reform action has always been of great concern, and this year is no exception - learning from foreign GPOs, Shanghai has even won the praise of "will lead the domestic government procurement trend" for the varieties not subject to centralized bidding within the scope of some medical insurance catalogs and the practice of exploring new models of self funded drugs However, can GPO pilot in Shanghai really become a key turning point in the reform of separation of medicine? News playback Shanghai will test water GPO although GPO, a drug circulation mode, has been widely used abroad, especially in the United States, but in China, due to the limitations of provincial bidding, the pace of promoting the mode is very slow However, the key points of deepening the reform of medical and health system in Shanghai in 2015 (hereinafter referred to as the key points) released by Shanghai development and Reform Commission revealed the ambition to break the current situation Shanghai is not a benchmark city for medical reform, but due to its large market scale and reasonable reform direction, its medical reform policies and exploration, such as "Minhang model", "Medical Association", "reform of medical insurance payment mode", have been the focus of the industry In the newly issued "key points", it is clearly proposed that we will learn from the general practice of GPO abroad, select some varieties and drugs at our own expense that are not subject to centralized bidding within the scope of medical insurance catalog, and promote the purchase mode of Pharmaceutical Group and the attitude of separate reform of medicine, which once again attracted widespread attention of the industry According to the key points, on the basis of the implementation of the pilot work of "volume procurement" in 2014, problems shall be found in time according to the pilot situation, the scope of pilot varieties shall be expanded, and the policy effect of "volume procurement" shall be further enlarged; the reform of drug group procurement mode and medicine shall be promoted separately, and the market advantage shall be brought into play through the third-party GPO Entrusted by medical institutions, establish a joint negotiation mechanism, optimize the drug supply chain, reduce the false high space of drug purchase price, and reduce the total cost of drug supply In 2015, GPO was explored in four new suburban hospitals, North Hospital of Huashan Hospital, North Hospital of Ruijin Hospital, South Hospital of Renji Hospital and East Hospital of the sixth municipal hospital In the future, it is possible to carry out further pilot projects in districts and counties with mature conditions Although the "key points" does not give specific procurement rules, only provides a GPO framework, but it is the first time to explicitly encourage pilot GPOs in provincial bidding medical reform policies From 2013 to 2014, the implementation plan of pilot "volume purchase" of medical insurance drugs in Shanghai was issued, and then to now, it is clear that in addition to further exploring the bidding mode, Shanghai is also actively exploring more personalized management methods for non bidding drugs And this GPO exploration can be said to follow its consistent "purchasing with volume" overall thinking What's more, at a time when there is a great deal of controversy about how to directly reduce the price by administrative means, the introduction of GPO in Shanghai may be expected to form a new pricing mechanism Although it still focuses on price reduction, from the feedback of the industry, the final effect should be better than the current bidding model Wu Yulan / Wen: "the core of" separation of medicine "is to cut off the drive of drug interests, rather than simply shift the price." Fu Chen, director of the medical reform office of Shanghai Health and Family Planning Commission, said at the 2015 International Summit Forum on in depth interpretation of medical industry policies Separation of medicine ≠ cancellation of drug mark up "if according to the requirements of the state, by canceling drug mark up, we can improve the price of medical services to complete the national task, but for solving the problems in the whole medical reform, I don't think it is of great significance." Fu Chen said He pointed out that when the drug markup is stripped out of the hospital's revenue, the drug becomes the hospital's cost Under such a change, the hospital's control over the drug cost will be strengthened, and the motivation to control the irrational use of drugs will be greater, which is significant from this perspective However, the problem is that canceling the drug markup can not lighten the burden of the people's drug expenses, optimize the revenue and expenditure structure of the hospital, and solve the irregular operation in the process of drug purchase and sale From this point of view, it is not of great significance The new medical reform plan issued in 2009 clearly proposes to cancel the drug markup income in the compensation of public hospitals Since the implementation of the new medical reform plan six years ago, many places in the country have successively carried out the drug markup cancellation reform In 2012, Beijing launched the separate reform of medicine At that time, the drug markup was cancelled in five hospitals to increase the doctor's service fee, which increased from the original 2 yuan to 42 yuan In the same year, Shenzhen carried out the separation of medicine in the whole city, allowing public hospital outpatients to purchase drugs In 2014, Zhejiang province implemented the drug zero difference rate in all public hospitals in the province, and bid farewell to the "medical care with drugs" completely, becoming the first province in China to realize the comprehensive reform of public hospitals Fu Chen said frankly that in terms of time, the reform of medical separation in Shanghai lags behind a little In addition to the cancellation of drug mark up in 2013 when the pilot reform of medical separation was carried out in four newly built tertiary hospitals in suburbs, most public hospitals still have drug mark up In 2015, the separation of medicine will be promoted in an all-round way, which is one of the five key tasks of Shanghai's medical reform However, the separation of medicine is not equal to the elimination of drug addition, but a systematic and comprehensive reform, which is different from the reform of separation of Medicine carried out in four suburbs of Shanghai and in Beijing, Shenzhen, Zhejiang and other provinces "When the drug markup is cancelled, the price adjustment items and range will be involved." Fu Chen pointed out that in terms of project selection, Beijing chose the doctor service fee, and put the task of canceling the drug plus compensation on the doctor service fee, so the fee of this project will increase 21 times, which will break the balance of the price comparison relationship of medical service projects In this way, Shanghai will not focus the price adjustment on 1-2 items, but will first do a price comparison study, taking a medical service charge item as a benchmark, to study the price comparison relationship between other items and it Through this price comparison study, we can find the items with the lowest price performance ratio in the current hospital and give priority to price adjustment The coexistence of medical insurance with quantity purchase and GPO purchase "can not completely reform the whole drug circulation and the purchase and sale of hospitals only by canceling the drug markup." Fu Chen's attitude is not only to cancel the drug markup and adjust the price of medical services, but also to explore the optimization of price comparison and the reform of procurement mode He said that the government's medical insurance department is not strong in driving force and low in efficiency If it is now a company to do procurement intermediary, because of its own interests, it can be promoted efficiently and quickly Therefore, in the reform of drug procurement mode in Shanghai this year, on the one hand, medical insurance will continue to promote government led procurement with volume, on the other hand, GPO procurement of market mechanism will be explored, and a third-party hospital procurement service company will be established through market entities "All hospitals can entrust this intermediary service company to negotiate prices, that is, everyone can participate in a group purchase Through GPO organization, a larger procurement scale can be formed Through the combination of orders and the reduction of product specifications, the concentration of procurement can be improved, so as to obtain a lower procurement price." Fu Chen believes that if the national development and Reform Commission cancels the drug pricing, the drug price will eventually be formed through the market mechanism, and the price formed by the market will be related to the quantity The price will be formed through the quantity price linkage mechanism, and the GPO model can establish the market formation mechanism of the drug price "GPO mode not only forms group purchase scale through merging orders, but also has the function of coordinating drug supply enterprises and hospitals to transform the supply chain." Fu Chen said He pointed out that the drug supply chain through the integrated management of the external logistics of drug enterprises and the internal logistics of hospitals, and with the support of information system, the supply cost of drug supply enterprises will be reduced, and enterprises will share the distribution cost of hospitals more "GPO is a kind of market mechanism group purchase method and supply chain reengineering different from medical insurance with volume purchase Through the reform of supply purchase mechanism, it will bring changes in hospital revenue and expenditure structure After the drug concentration is increased, the purchase cost and internal logistics cost will decrease, which can account for 8% - 10% of the purchase cost." It is understood that in addition to the gradual elimination of drug markup and optimization of procurement mode, the reform of Shanghai's pharmaceutical separation also includes the adjustment of hospital revenue and expenditure structure, the supervision of the rationality of clinical medication, and the establishment of a multi-party credit management system for pharmaceutical production and distribution enterprises, doctors and patients "What we need to do in Shanghai's pharmaceutical separation reform is a systematic and comprehensive pharmaceutical separation reform The cancellation of the bonus is only a small part of the whole reform Hospitals and enterprises need to think about how to adapt and adjust in such a pharmaceutical separation mode." Fu Chen suggested Does industry watch follow the example of Shanghai? ◆ reporter of our newspaper: Liao Shaomin, Kuang Haiyan and Shanghai's GPO exploration deserve to be expected Although it is the first time that the provincial bidding policy encourages the pilot, some insiders pointed out that Shanghai Minhang has always adopted GPO Shanghai should learn from Minhang's experience in this way As the designer of Minhang's drug bidding model, Li Xianxian once pointed out in an interview with the media that Minhang's medicine should be explored separately, mainly reflected in three links of purchase, distribution and payment: purchase through joint selection, public hospitals should be combined by administrative or market means to form a purchase consortium, integrate drug purchase demand and cut off the interest chain of purchase; distribution Through logistics outsourcing, the internal pharmaceutical logistics resources of public hospitals are integrated and stripped, so that enterprises with modern pharmaceutical logistics service capabilities can provide extended supply chain services for public medical institutions and cut off the interest chain of logistics and distribution; the third-party payment changes the price payment and financing mode of pharmaceutical procurement, cuts off the interest chain of payment and settlement, and can ensure the winning drugs The goods supply enterprises get the payment on time, greatly reducing the cost of drug circulation "Minhang experience has indeed lowered the price of drugs, lightened the burden of the masses, and reduced the financial pressure of the government and the medical insurance department." Chen Hao, a special observer of this newspaper and researcher of the center for drug policy and management of Huazhong University of science and technology, agreed However, he also pointed out that Minhang's experience is also controversial, which is mainly due to the fair competition in the market, and the excessive administrative power interferes with the market behavior From the perspective of the legendary Shanghai plan, it has made a lot of improvements in the fair market competition, which is also an expected aspect However, although Shanghai has some innovation in GPO exploration, from the perspective of its main target set as "non bidding and self financing varieties in medical insurance", Shanghai is also worried about the model, so it holds a more cautious attitude, which is bound to not in the short term