More than half of the profits in arrears are eaten up

[China Pharmaceutical network industry trends] drug payment default is a "big problem" in the field of medicine For drug companies, in addition to drugs, drugs and imported drugs, the normal profit of drugs is about 10% Regardless of the difficulty of enterprises in raising funds, only in terms of the bank interest in arrears of drug payment, it is enough to eat up more than half of the profits of enterprises and cause great harm to pharmaceutical enterprises (more than half of the profits in arrears are eaten up The main reason is that the hospital is in arrears Picture source: Baidu picture) however, after the medical institutions have confirmed that they have received the drugs according to the contract, they are still in arrears for a long time and in large amount This is a common phenomenon in the field of medicine for many years The state has clearly broken down the mechanism of supporting medicine with drugs, and abolished the 15% mark up of the normal cost of operating drugs in hospitals Now it is obvious that in addition to the second price negotiation and price reduction to stay in the hospital, it is to use the overdue drug money to raise and advance the working capital for the hospital, and then use the drug to support the hospital in another way Debts eat up more than half of the enterprise's profits However, under the condition that medicine is not divided, the enterprise drugs are forced by the administration to press the price and dare not say it, so it can only compromise and be forced to stay in the payment for goods What else can we do? In recent years, the hospital drug debt of the national pharmaceutical industry accounts for more than 10% of the main revenue of that year, even more than the total profit of that year, and the number of days in arrears is more than 100 days For hospitals, the payment for drugs should have been only a passing effort Since the ownership of drug price difference has been eliminated, the retention of drug payment for drugs, which has the right to use, should also be eliminated It is said that the main reason for the drug payment in arrears is not that the medical insurance expenses are not paid in time, but now the medical insurance department has explained on the Internet that the normal payment is in place in time, only a small part of the payment (generally less than 10 percentage points), because there is a dispute about whether it is in line with the medical insurance regulations, it must be understood uniformly before payment; It does not lie in the acquiescence, indulgence and support of the competent department of the hospital The health administrative departments at all levels have issued administrative orders for many times, requiring gradual solution, but all of them failed to achieve the expected results The root cause of hospital default is that the hospital does so because of the mechanism The long-term large amount arrears of drug payment can supplement the working capital of medical institutions, generate huge capital appreciation benefits for hospitals through investment and financial management, and coerce enterprises to reduce prices or rebate This is also an important reason why many medical institutions are still reluctant to give up "medicine is not divided" after the cancellation of drug addition and the inevitable loss of drug sales in hospitals This is the mechanism of defaulting on drug payment! Because of the function of this mechanism, the government has no choice but to make several orders and applications The default of drug payment is the result of continuous occurrence, persistence, non-stop, and failure to change in the government departments In view of this, if we do not start from the mechanism, the long-term huge arrears of drug payments will be impossible to cure, or even difficult to ease The existing three kinds of solutions are now really concerned by the local government departments There are three typical types First, in February this year, Liaoning health and Family Planning Commission issued the notice on the implementation of the new round of price negotiation results of centralized drug purchase (direct online purchase) in Liaoning Province, which not only explicitly forbids rebate and second price negotiation, but also clarifies that "payment for goods shall be settled in strict accordance with the time and amount stipulated in the relevant national regulations or purchase contract It is strictly prohibited to delay payment in disguised form, such as acceptance bill " This comes from the document of the State Council in February 2015, "the hospital will include the revenue and expenditure of drugs into the budget management, and pay the payment strictly according to the time stipulated in the contract, from the qualified delivery and acceptance to the payment shall not exceed 30 days" This is also the practice in most parts of the country, with a clear attitude, a strong sense of reason and a strict wording It just doesn't work Second, the new centralized drug purchase platform established by Zhejiang health and Family Planning Commission in July last year, which integrates information flow, capital flow and logistics, has a regulatory account connected with the basic account of the hospital After the hospital receives the drugs and the drugs are accepted and put into storage, it shall, within 30 days, print the payment to the supervision account, which shall then call the drug production or trading enterprise If the hospital does not make the payment within 30 days, the supervision account can directly deduct the payment from the basic account and pay to the drug enterprise Zhejiang Province is a province that directly puts forward specific policies and measures for the payment of centralized purchase of drugs, which is also well conceived Unfortunately, it has been implemented for more than half a year, with little effect According to the company, the payment collection time has not changed greatly and is still very long, which still depends on the popularity of the company, the speed of drug sales and the payment collection policy Enterprise metaphor, put the meat on the tiger's mouth, but force it not to eat, can you do it? The simple way is: take the meat away, you can't! Third, Fujian Provincial Health and Family Planning Commission published in February this year the sunshine purchase rules for joint price limit of drugs based on medical insurance payment and settlement price in Fujian Province, which clearly states: "the payment for drugs purchased by designated medical institutions on Provincial platforms shall be settled by all levels of medical insurance departments and local distribution enterprises in accordance with the territorial principle and hierarchical management, and shall be paid before the 15th day of the next month when the drugs are put into storage Paragraph This method can completely solve the problem of drug payment default without human factors It is a policy of "taking meat away", which is more reasonable and advanced than that of Zhejiang Province In 2015, Zhejiang Pharmaceutical Industry Association put forward the method of virtual settlement and real payment Virtual settlement means that the medical insurance agency still uses the current way to settle the drug payment for the hospital, but the settlement result only exists in the book and does not make the actual payment Actual payment means that after receiving the drugs and passing the acceptance, the hospital will issue relevant certificates to the drug enterprises and the medical insurance agencies on the Internet, and the medical insurance agencies will directly remit the payment to the drug enterprises with this certificate Pharmaceutical enterprises only hand over and settle accounts with hospitals, and pay and settle accounts with medical insurance agencies As drug users, hospitals still play a key role in determining payment However, no matter how much money is owed or how long it is owed, the hospital will not benefit from the economic benefits, so there is no power and opportunity to pay in arrears Never and never need to default! That's the mechanism Direct payment, simple procedures, fewer links, and can improve the efficiency of the use of funds, reduce the possibility of corruption in rent-seeking by the competent departments and institutions This is what the state has always stressed, "reducing circulation links, reducing circulation costs and improving circulation efficiency" It is a detour for medical insurance agencies to turn to drug companies to pay for drugs through hospitals, which is to add to the cake by drawing on the snake and bring about various contradictions instead The hospital has zero margin It only cares about the medicine and does not make money As long as it is confirmed that the medicine has been received as promised, there is no need to intervene in the capital flow Since the government is going to do its best to get rid of the "medicine for medical care" and cancel the drug mark up, why should it use the drug loan as the hospital's working capital to carry out the "medicine for medical care"? Borrowing the anti-corruption words of the Party Central Committee, we need to change the mechanism and make an article from the "can't" point of view Only in this way, combined with the "don't want" publicity and education, and the "dare not" administrative instructions, Fujian is opening up an effective way to cure the persistent problem of drug arrears Medical insurance fund has a special position among medical treatment, medical insurance and medical reform It should play a role of coordinating relations, easing contradictions and promoting cooperation as much as possible Fujian Province has taken a good lead! It also plays a greater role in medical insurance reform and makes a useful exploration In the centralized purchase of drugs, the medical insurance agency can act as the payer (the other payer is the patient, because the individual is scattered, and cannot play a role) to cooperate with the hospital, directly negotiate the price with the drug enterprise, directly sign the contract, directly supervise the performance of the contract obligations of other contract signing subjects, and directly pay the cost to the drug enterprise, which is its own function Jianzhijun is optimistic about the result of medical insurance payment for drug purchase in Fujian But for hospitals, a way to make money has been cut off Under the condition of zero drug difference rate, how to ensure the income level of medical staff and mobilize the enthusiasm of medical staff, especially under the expectation of increasing the salary of medical service staff, how to ensure the development of hospital and the stability of medical staff is a problem that all hospital presidents need to solve For pharmaceutical enterprises, a big advantage is that when the settlement department becomes the medical insurance department, in addition to the relatively abundant funds and the relatively reduced interest burden, the power of the hospital's second price negotiation will be much smaller, and the pressure of the corresponding enterprises on price reduction will also be reduced But there are two same concerns: one is whether the medical insurance can pay back on time? The other is whether the medical insurance department is carrying out a comprehensive control of fees, and whether the settlement fees will become another bargaining tool like the medical insurance payment standard? In addition, the current standard for the medical insurance Department to assess the hospital is the rational use of drugs in the hospital If the unreasonable use of drugs, not only not The hospital will also face a fine when paying for the expenses If the varieties of drug companies have an unconventional amount in the hospital, will the medical insurance refuse to pay for the drugs openly? The pressure of drug marketing may be greater, and even if the drugs have been used in the hospital, the corresponding drug expenses cannot be obtained The medical insurance has increased the binding force on the drug companies Therefore, in the case of medical insurance payment, jianzhijun believes that the pressure of rational drug use may be greater After all, the payment for goods is not paid by the hospital, but by the medical insurance department and the patients In fact, the focus on rational drug use is mainly passive behavior When the payment settlement party becomes the medical insurance department, the direct payment party will be more sensitive to the payment, and the pressure to reduce the waste of medical insurance will be more sufficient The era of rational drug use in the hospital is really coming!