High-value supplies three-step political reform up to 50% of the price reduction finally to where?

Text . . . Zhao Weiwei
2019 AstraZeneca and the National Health Insurance Administration to carry out volume procurement negotiations video is still in the eye, less than half a year, medical supplies policy came, the reform zone pioneers have entered the deep water zone.
" there are medicine sahead, medical supplies reform go faster. An entrepreneur who has worked at the supply end of supplies for many years told Artering Net, "The ultimate goal of the supplies policy is very clear, and the purpose of each stage is some simulation of two can, like building blocks, functions of different sub-modules assembled together, but put into a brand new thing." "
policy concerns about supplies can be broadly divided into three reasons, one, this is a very large market, the market size of 2018 more than 170 billion, doctors daily use is huge, need to ensure the reliability of quality and price rationality; Data for 2015 show that the total number of drug dealers that year reached 2.8 million, compared with 3 million doctors in the same year, and that too many dealers generated higher drug prices without generating real value.
and consumables, accounting for 62.50%, the market size of about 106 billion (2018 data) high-value consumables is the focus of policy attention, such consumables content coverage is more extensive, innovation, and often related to precision surgery, more need to be strictly regulated.
, how will the entire supply chain of high-value supplies change in the midst of the wave of reform? Where should the participants go? To this end, the artery network interviewed a number of supplies dealers, dealers, try ingest in recent years, the high-value supplies reform of the provinces and cities to comb, and find out the future direction of the market.
early 2017, the State Council's Medical Reform Office, together with the National Health and Family Planning Commission and other eight departments jointly issued a paper notice, asking medical institutions to take the lead in the implementation of drug procurement "two-vote system", said to reduce the high price of drugs, reduce the burden of drug use for the masses.
this policy was questioned at the time of its introduction, and in fact, as sceptics thought: through high-open, enterprise-college synergy and other means, the two-vote system on the drug companies caused by the loss of profits can be easily circumvented by pharmaceutical companies and hospitals.
Zhuang dance sword, intended to be public.
follow-up, the policy, the most affected or dealers, especially the national level, no terminal hospital contact dealers, in this policy adjustment quickly out.
high-value supplies policy extension path and medicine similar, after seeing the rich results of medicine, high-value supplies such as the autumn wind sweeps leaves, this gang of waves, everyone is at risk. By 2020, there will be a lot of New Deal outflows.
as of October 2019, a total of 25 provinces and municipalities have implemented a "two-vote system" for supplies. Among them, Inner Mongolia, Liaoning, Shaanxi, Anhui, Hubei, Jiangxi, Guizhou, Guangdong, Fujian, Hainan, Qinghai, Tibet and 12 provinces have fully implemented the two-vote system of supplies;. For pharmaceutical circulation enterprises, their income generally comes from product price difference and production enterprise rebate, under the two-ticket system, the dealer located in the middle of the chain can not obtain the product price difference, also can not enjoy the enterprise rebate;
the market reset means more opportunities. In order to seize more resources and improve their competitiveness, dealers at the end began to try to expand their circulation added value. Sichuan dealers who handle TAVR products in southwest China told Arterial Network that they are trying to continuously optimize distribution networks, reduce logistics costs, and train a range of sales professionals with expertise to help doctors in hospitals train related products and undertake some equipment repair.
these dealers' proactive, in the past the problems in circulation are often diluted in the lengthy distribution chain, but the two-vote system for the chain control caused all these problems in the hands of drugs and hospitals, in this case, for drugs and hospitals to solve more problems dealers, there is a growing possibility of survival.
in general, the two-vote system did not solve the problem of high-value consumables price, nor can it eliminate the variety of promotion and bribery, but there is no doubt that it clears the distribution gray area, so that the entire supplies distribution chain more clear.
July 16, 2019, Anhui Provincial Health Insurance Bureau, Health and Health Commission, Finance Department and The Drug Administration jointly issued the "High-value medical supplies in Anhui Province, the high-value medical supplies centralized procurement negotiations bargaining (pilot) implementation program", this program opened the high-value supplies with the beginning of the procurement. In the initial volume procurement, only orthopaedic implants (spinal) and ophthalmology (artificial crystals) participated, requiring these two types of procurement volume in 2018 provincial public medical institutions high-value medical supplies procurement volume of 70% and 90%, respectively.
subsequently, Liaoning, Jiangsu, Shanxi, Gansu and other provinces and cities in many cities began the supply of supplies, and Sanming City and its cooperation region, Beijing-Tianjin-Yuan and Heji Liaomeng Jinlu formed a coalition model to purchase supplies at the same price, to avoid different regions to produce price differences. More regions, more consumables to join the radiation range of the volume purchase.
the role of the volume procurement is very obvious, in order to compete for near-monopoly sales rights, many enterprises have to exchange prices, resulting in the price of unit supplies is compressed to a very low range.
, for example, the orthopaedic spine material sourcing Anhui Province, saw an average price reduction of 55.9 percent for its national products, 40.5 percent in imports and 95 percent for individual components. The average decrease in hemostatic materials in Nantong City, Jiangsu Province was 47.21 percent, the largest decrease in individual products was 70.35 percent, the average decrease in hemostatic materials was 45.26 percent, and the largest decrease in individual products was 79.37 percent.
. In addition to high-value consumables are forced to bid at low prices, the survival space of circulation enterprises has been further compressed. Large medical device circulation enterprises in a more competitive environment more survival advantage.
issued in October 2019, "Jinan Fourth People's Hospital medical supplies centralized distribution supplier selection and medical supplies supply chain extension services ( SPD) project bid announcement" is a good example. In this centralized distribution and SPD project tender, the winning enterprises are China's medical equipment, national pharmaceutical equipment, Viag, the first flight, medicine, Ruikang and other large-scale medical circulation enterprise subsidiaries.
to catch up with it, Jinan City, the fourth people's hospital on the circulation of enterprises warehouse hardware facilities put forward a very high demand. Specifically, the hospital requires the total area of the warehouse of 3 points of 10000m2, the cold storage area of 750m2 to get 3 points, in addition, the number of supplies bidding enterprises of the supply-consuming varieties of s.4000 in order to get the "supplies variety" item full score.
in addition, the announcement also revealed the winning bid of the winning enterprises over the years, they have won a number of second-tier hospitals, triple-A hospital supplies centralized distribution rights, its service cycle of 5 years, distribution scale of hundreds of millions of dollars.
to large circulation enterprises as service providers has become a trend, in the volume of procurement, "distribution" word has ceased to exist, hospitals will only fancy the supply chain capacity of circulation enterprises. In this case, small and medium-sized dealers are more difficult to survive. The ultimate goal of
-band procurement is still drug dealers. Under the policy, the market value of high-value consumables rapidly shrinks, most of the enterprises that have not successfully bid will lose almost the entire region of the business, the industry concentration increased. In addition, when the two-vote system, enterprises can also through the high open to circumvent the policy, and now these means have also failed - supplies prices are finally down.
in addition to the above mentioned changes, supplies belt procurement policy in the process of implementation has also derived a number of new models. The "one-vote system" is one of them.
because the price fell too much after the negotiations, some products have no room for rebates, so most circulation enterprises refused to do loss-making business, gave up the distribution rights. At the same time, many arms and pharmaceutical companies have already chosen to self-distribute. This means that the product actually has only one vote in circulation.
countries support the promotion of the one-vote system and have promulgated corresponding policies to support the one-vote system. Today, 11 provinces and cities, including Fujian, Zhejiang, Hubei, Shanxi, Shaanxi, Tianjin and Shandong, have explicitly encouraged the implementation of a one-vote system.
but the one-vote system can also cause a lot of problems. As the amount of money that both medical companies need to pay is increasing after the purchase, hospitals often delay payments by months or even a year, which is a significant loss for device manufacturers.
2019, the supporting policy of volume procurement followed, in its most far-reaching promotion in Jiangsu Province, the Communist Party of Jiangsu Provincial Commission for Discipline Inspection, Jiangsu Provincial Supervision Commission Office, Jiangsu Provincial Medical Security Bureau and Jiangsu Provincial Health and Health Commission issued "on the promotion of the province's high-value medical supplies sunshine procurement work notice", the medical and health institutions to limit the loan payment time, requiring hospitals to complete the delivery of 30 days after the payment of loans must be paid to the settlement account. In the same year, Liaoning Province also established a health insurance fund advance working capital system. Medical insurance advance working capital in principle is not less than 30% of the purchase amount, in the medical supplies and testing reagent tape quantity purchase results before the implementation of pre-dial in place.
at the same time, this document in Jiangsu Province also requires the province's public medical institutions procurement costs through the provincial platform settlement, in order to unified settlement guidance and promote online procurement, to achieve the provincial platform business flow, information flow, capital flow, referred to as "three-stream one."
through the "three-stream-in-one" procurement of new platform, supplies production enterprises can directly receive payment from the medical institutions, and then pay the logistics costs of commercial companies. In order to achieve from the "tender procurement services" to "service tender procurement" function change, and also facilitate the delivery of supplies purchase orders and payment methods, but commercial companies in this function will be greatly reduced, profit margins will be further compressed.
platform procurement means price linkage. According to the national unified medical insurance medical supplies classification and coding, the establishment of inter-departmental and inter-provincial high-value medical supplies price information sharing mechanism, promote the purchase of price information linkage, to achieve medical institutions at a relatively reasonable low-cost procurement of high-value medical supplies, is one of the important functions of the platform.
to this point, the policy role of volume procurement is almost complete. Medical insurance in the procurement link directly access to high-value supplies price limit, in the settlement link kicked out of the hospital, by the medical insurance department to the supplier directly settlement of the purchase price. All the transaction information is in the hands of the health insurance agency, and the entire drug sales are more open and transparent.
, in addition to the drug price reduction, the newly established health care bureau also through the "three-stream-in-one", set "recruitment, payment, supervision" of the power. Solved the information asymmetry in the circulation of drugs, the medical insurance bureau can go a good next trick.
looking back, the two-ticket system eliminated dealers in the circulation of drugs, and the volume of purchases allowed drug dealers to cut meat, but neither policy fully affected hospitals and doctors. In fact, these two policies do not eliminate the incentive for doctors to abuse supplies.
, however, these two policies undoubtedly remove the redundant part of the flow of medicineand and make the entire chain of medicine spent in control from production to use, at which point DRG becomes a control doctor and hospital recruit.
this technique was used in efficiency surveys between hospitals before DRG was used to control fees. By comparing the cost consumption index and the time consumption index for the same disease in different hospitals, we can easily identify the hospitals with abnormal values and identify the problems in a timely manner. This means that every operation makes precise requirements for the use of high-value consumables.
in the past most hospital medical supplies management, distribution mode is extensive type, there is a lot of waste. If there is consuming supplies, DRG will find out what is unusual about the doctor's operation from the consumption of consumables.
at the same time, DRG means an innovation in the doctor's incentive mechanism, which internalizes medicines and consumables into hospital operating costs in the form of packaging fees. Under this incentive mechanism, there is no reason for doctors to use consumables at will, and it is wise to do so carefully.
by the end of the DRG, the ultimate beneficiaries are clear. After two-vote system, volume procurement, DRG three big steps, drug manufacturers, distributors, doctors hospitals have been restricted, at this time, with the interests of patients consistent with the health care bureau, "health insurance control fee" for the ultimate purpose of the health care bureau became the final winner.
. In general, in an ideal state, through a series of policies as a means, China's high-value consumables market price confusion, procurement mechanism is not perfect, price can not be compared at the same time, bill management problem, public hospital loan arrears, procurement information asymmetry problem will be resolved one by one, and finally gradually realize the national health insurance control fee.
the whole reform process seems to have gone through from the two-vote system to the volume of procurement, to the DRG three big steps, but in practice, supplies policy is often in the province and city as a unit, the pace of reform varies from region to region, the degree of participation is not the same, it is difficult for a single region to implement a policy in place at the same time, Jiangsu Province, Nanjing Province, Fujian Sanming City and other places to go to the forefront, roughly out of the above-mentioned path, but more cities are in the same way to achieve the pilot
, assuming that the sequential path of "one-vote-band procurement-DRG" is feasible, the focus of the next policy exercise will tend to fill the gaps in the existing structure.
without coding, it is difficult to define quality standards and ensure the effect of later diagnosis and treatment. Therefore, the first thing to be addressed in this area is the problem of inconsistent coding of consumables in high value consumables. In March 2019, the National Health Insurance Administration held a symposium to discuss the issue, and by 2020 many supplies have been coded, but the whole work is not over.
Secondly, how to establish high-value consumables consistency evaluation is a more far-reaching issue. The 2020 high-value consumables market is a great opportunity for import substitution, because before the evaluation mechanism is established, the regional procurement platform sits at "low price" as a priority, which means that high-priced, high-quality imported consumables will face a higher-than-expected price reduction and the loss of the market.
a lot of interventional high-value consumables will exist in the patient body for many years, if the procurement of a "low price" without evaluating quality, this pair.