Key play in 2020: high value consumables purchasing with volume | observation of medical line

A few days ago, a notice on submitting procurement data related to expanding the scope of centralized procurement and drug use by national organizations came out of the industry, showing that provinces will report the procurement volume of 35 varieties before October 31, 2018 and 2019 Two months ago, the cruelty of the offer is still fresh in my memory, but the purchase of a new tire volume once again stirred the nerves of the industry Some people marvel at "this rhythm is a little strong", some are pessimistic "no one thought it was so fast", and some feel that "an era is coming to an end" However, not only is a new round of drug volume procurement ready, another new storm is brewing Just three days before the "35 kinds of procurement with quantity" began to spread, the medical insurance bureau of Beijing, Tianjin and Hebei jointly issued the work opinions on the joint procurement with quantity of medical consumables of Beijing, Tianjin and Hebei, which is the first landing of the cross provincial and Regional Union of China's procurement with quantity of consumables The three places share a platform to fully integrate the bidding and procurement, which means that the linkage of procurement with volume will be stronger and the landing speed will be faster Many media exclaimed that the purchase of consumables with volume had begun However, will the fate of drug volume procurement be repeated in the field of consumables? Will the era of huge profits from consumables really end or will a new era begin? In the coming storm, in order to have a more comprehensive understanding of the volume purchase of consumables, we combed the relevant core content as comprehensively as possible Welcome to further discussion 1 In the past, the high-value consumables bidding was only based on the bidding price, but there is no clear procurement quantity The winning enterprise also needs to organize the sales team to go to the medical institution for marketing On the other hand, in the bidding stage, we promise to sell high-value consumables and ensure that they will be used up within one year, that is, the so-called "on volume procurement, quantity for price" The implementation background of high-value consumables with quantity purchase, in addition to learning from the drug with quantity purchase, the deeper reason lies in the determination of the state to the management of high-value consumables It is reported that since its establishment in 2018, many leaders of the state health insurance bureau have investigated the governance of high-value consumables in many places By January 2019, the key work of 2019 proposed by the national medical security working conference will include: strengthening the circulation and use management of high-value consumables From the perspective of time axis, on May 29, the eighth meeting of the comprehensive deepening reform committee of the Central Committee adopted the reform plan on the management of high-value medical consumables The meeting proposed that the management of high-value medical consumables is related to reducing the medical burden of the people We should straighten out the price system of high-value medical consumables, improve the supervision and management of the whole process, purify the market environment and medical service practice environment, promote the formation of a management pattern with reliable quality, quick circulation, reasonable price and standardized use of high-value medical consumables, and promote the healthy and orderly development of the industry This move is generally considered by the industry as a strong signal of price reduction of high value consumables Almost at the same time, the research group of the State Medical Insurance Bureau went to Shandong for investigation and mentioned that since the national launch of the 4 + 7 drug centralized procurement pilot policy in January 2019, it has achieved obvious results How to learn from the drug centralized procurement practice and control the relatively high price of high-value medical consumables? The State Medical Insurance Bureau conducted in-depth research in relevant provinces Then on June 4, the media reported that the National Medical Insurance Bureau convened a meeting of clinical experts to discuss the high-value consumables with volume procurement, pointing out that "centralized procurement may start from cardiovascular interventional devices (stents), and at the same time, the stent products will be classified and coded to prepare for centralized procurement." The voice of "high value consumables 4 + 7 will only be late, and will not be absent" soared On July 31, the reform plan for the treatment of high value medical consumables was officially announced by the State Council It is clear that by the end of this year, the high-value medical consumables bonus will be cancelled, and medical institutions will be encouraged to jointly carry out volume negotiation and procurement from the second half of this year For high value medical consumables with large clinical dosage, high purchase amount, mature clinical use and produced by many enterprises, the plan proposes to explore centralized procurement by category, encourage medical institutions to jointly carry out negotiation and procurement with quantity, actively explore inter provincial alliance procurement, and the State Medical Insurance Bureau shall be solely responsible for it By November 15, the leading group of deepening medical reform of the State Council further clarified the requirements in the notice on further promoting the experience of deepening medical and health system reform in Fujian Province and Sanming City Before the end of September 2020, the pilot provinces of comprehensive medical reform should take the lead in centralized procurement of high-value consumables That is to say, Anhui, Zhejiang, Fujian, Jiangsu, Shanghai and other 11 medical reform pilot provinces and cities must complete the new situation of high-value consumables procurement with volume procurement as a major focus by next September 2 attitude of the medical insurance bureau: unswervingly, however, due to the complex categories of consumables and the lack of unified quality evaluation standards, it is obviously more difficult to purchase consumables with quantity than the centralized purchase of drugs, so the industry also has different voices For example, at this year's two sessions, some members of the CPPCC put forward that "4 + 7" pilot procurement with volume is one of the exploratory measures taken by the medical insurance bureau to solve the problem of "medical insurance gap" in China, which may play a positive role in reducing drug prices, eliminating some unreasonable intermediate links, and saving the limited medical insurance funds of the country However, before the actual effect of "4 + 7" has been accurately and comprehensively evaluated, it is not suitable to expand to the field of high-end medical devices, especially high-value consumables that directly affect the life, health and safety of patients According to the committee, China's high-value consumables industry is still weak, and there is no unified coding system and scoring standards Most importantly, there is no scientific method to distinguish the different quality levels or grades of high-value consumables at present If the common practice of winning the bid at a low price is adopted, it will inevitably lead to the phenomenon of "bad currency expelling good currency" In response to the proposal of "prudent implementation of high value consumables with quantity procurement", the state health insurance bureau gave a reply The letter of the State Medical Security Bureau on the reply to the proposal No 3243 (medical and sports No 359) of the second session of the 13th National Committee of the CPPCC, issued on September 24, made it clear that the policy of volume purchase had a positive impact on the development of China's pharmaceutical industry, and pointed out the necessity of the pilot reform of high-value medical consumables purchase "On the whole, the problem of false high price of high-value medical consumables is also serious It has become a trend to promote the experience of 4 + 7 drugs to high-value medical consumables." 3 wind vane: the volume procurement of Beijing Tianjin Hebei alliance the volume procurement of Beijing Tianjin Hebei alliance takes all medical institutions designated by medical insurance in three regions of Beijing, Tianjin and Hebei as the procurement subject, and exchanges the price with the volume at not less than 60% of the total annual consumption The procurement cycle is one year in principle Specifically, each hospital shall declare the historical procurement data and price according to the clinical needs and historical procurement situation, and at the same time declare the planned procurement demand of the next year Finally, the Beijing Tianjin Hebei procurement center shall summarize the procurement demand reported by the medical institutions, issue the procurement documents, and determine the negotiation procurement method It is reported that the joint procurement working group has taken intraocular lens ophthalmic consumables as a joint procurement product, and the enterprise digital certificate collection and information filling work has been started It is also clear in the opinions on the joint volume purchase of medical consumables in Beijing, Tianjin and Hebei that the joint volume purchase shall be given priority to the procurement and use of the selected varieties, and the secondary price negotiation shall not be organized for the selected price determined by the joint volume purchase In order to ensure the payment collection and reduce the transaction cost, the opinion shows that medical insurance prepayment will be promoted and medical insurance prepayment system will be established Medical institutions are the first person responsible for the payment, and the payment should be settled according to the agreement If there is a condition for the overall planning area, medical insurance direct settlement can be piloted In fact, as early as 2016, Beijing, Tianjin and Hebei launched the joint procurement of medical consumables in public hospitals, completed the construction of the joint procurement platform for medical consumables in Beijing, Tianjin and Hebei, jointly purchased six categories of varieties, including intracardiac vascular stent, cardiac rhythm management, anti adhesion, hemostasis, artificial customs and stapler, and established a unified price linkage mechanism in Beijing, Tianjin and Hebei Since the implementation on June 30, 2018, the price of six types of consumables has dropped by an average of 15%, with a significant drop According to the 2017 statistical analysis report on the operation of drug circulation industry issued by the Ministry of Commerce, the total sales volume of medical devices in Beijing, Tianjin and Hebei in 2017 was about 1051702 (ten thousand yuan), accounting for 11.19% of the total sales volume in China It can be seen that after the implementation of the joint volume procurement in Beijing, Tianjin and Hebei, the impact of the huge volume of procurement involved is not hard to imagine, and this will undoubtedly be a wind vane for the next high-value consumables volume procurement 4 model: Anhui + Jiangsu, with the highest price cut of 95% At present, Anhui Province and Jiangsu Province should take the lead in the provinces and regions that actively test the high-value consumables with volume purchase, and their successful experience is worth learning to a large extent Anhui took the lead in firing the first shot On July 30, as the first provincial high-value consumables purchasing Province in China, the negotiation and price reduction results of two major high-value consumables in Anhui province came out: the average price reduction of domestic orthopedic spine materials is 55.9%, the average price reduction of imported products is 40.5%, the average price reduction of overall products is 53.4%, and the maximum price reduction of single component is 95%; the average price reduction of domestic intraocular lens products is 18.1%, the average price reduction of imported products is 20.9%, and the overall price is flat The average price is reduced by 20.5%; the annual savings are 370 million yuan and 29 million yuan respectively In the procurement of the tire quantity, Anhui province takes 70% of the amount of orthopedic implant spine and 90% of the amount of ophthalmic intraocular lens used in the provincial public medical institutions in 2018 as chips, and exchanges the amount for the price, and stipulates that the purchase amount of medical institutions shall not be less than 80% of the amount in 2018, and the payment settlement period shall be 90 days, etc "This time, we took out consumables of Orthopaedics and ophthalmology products with large consumption and high price to integrate bidding and procurement, which increased our bargaining power of price reduction." Yuan Zhiying, deputy director of Anhui Medical Insurance Bureau, said It is also worth noting that among the three reference base prices in this negotiation, one of them is "the first price in the two vote system", which was later evaluated as "not that there is no middleman to earn the difference, but that there is no middleman to earn the difference" Jiangsu Province is a joint procurement alliance composed of 55 three-level public medical institutions, which provides 70% of the annual consumption for procurement The negotiated varieties are rapamycin and its derivative stents and dual chamber pacemakers Finally, the stent was negotiated according to individual varieties, with an average decrease of 51.01% and a maximum decrease of 66.07%; the pacemaker was negotiated according to production enterprises, with an average decrease of 15.86% and a maximum decrease of 38.13% for the varieties involved in the selected enterprises Zhou Ying, director of Jiangsu Medical Security Bureau, said, "from the procurement volume and the amount of varieties of public hospitals in the province, we sorted out the top ones about stents and pacemakers, and combined with the market competitiveness, the ones with strong substitutability are suitable for alliance procurement." In September, Jiangsu started the second round of high-value consumables procurement, including ophthalmic intraocular lens, vascular intervention balloon, orthopedic artificial hip joint high-value medical consumables Finally, the average decrease of vascular interventional balloon was 74.37%, the maximum decrease was 81.05%; the average decrease of orthopedic hip prosthesis was 47.20%, the maximum decrease was 76.70%; the average decrease of ophthalmic intraocular lens was 26.89%, the maximum decrease was 38% After the price reduction, it is expected to save more than 400 million yuan in the whole year It can be seen that compared with the first round, the procurement of the second round of belts in Jiangsu Province is not only rapid, but also the procurement varieties are further expanded, and the degree of bargaining is more intense "The scale of the pilot volume procurement in the two provinces is not large, but the effect is obvious." Director of the medical price and bidding procurement department of the State Health Insurance Bureau