New pre-judgment of centralized procurement!

During the "13th Five-Year Plan" period that just ended, China's medical and health system reform has entered the deep water area.
With centralized procurement as a breakthrough point, deepening the reform of the health system has become the current clear reform idea
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According to incomplete statistics, from 2016 to 2020, the number of industry policy documents issued at the national, provincial, and municipal levels exceeded 6,700.
The China Pharmaceutical Recruitment Alliance has calibrated the subject headings for all documents, conducted statistics based on the frequency of subject headings, and centralized procurement.
Ranked first
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It can be seen that centralized procurement is one of the most important policies affecting the pharmaceutical industry at this stage and in the future
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Breakthrough in reform: clear ideas for centralized procurement and clear results.
In
2019, the National Medical Security Administration, in accordance with the overall concept of "national organization, alliance procurement, and platform operation", actively launched the "4+7" and "expanded" national joint drug procurement belt Mass procurement pilot; the second and third batches of national joint procurement will be launched in 2020; the fourth batch of national joint procurement of medicines will be completed in February 2021, and in-depth policies have been implemented for national joint procurement with mass procurement in the medical device industry Research
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At the beginning of November last year, the first batch of high-value medical consumables coronary stents in the field of medical equipment was jointly purchased by the country.
The average price reduction reached more than 50%.
The largest price reductions for medicines and consumables reached 98.
72% and 96% respectively, a refresh of the past.
The sharpest decline in centralized procurement in 20 years
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Effectiveness is the last word
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From the five rounds of four batches of drugs and the first round of joint procurement of high-value consumables, it can be seen that the direction of the national centralized procurement policy has been basically determined, and the rules have been iteratively improved
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In the future, centralized procurement with volume will enter the normalized operation stage
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The author has noticed that the relevant documents require that, for products with large clinical usage, high purchase amount, more mature clinical use, and products produced by multiple companies , explore centralized procurement by category
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The National Medical Insurance Bureau has also implemented a system of "collecting everything that should be collected", and all medicines and consumables that occupy 80% of the medical insurance fund will be included in the scope of centralized procurement
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The industry sees that from 2019 to 2020, various provinces and cities have carried out various forms of drug and medical consumables procurement in accordance with national policy arrangements.
The shock to the industry can be described as huge, but from the perspective of national joint procurement and local procurement of varieties , The quantity procurement is still in the water test stage: first, the number of varieties involved in centralized procurement in various regions is relatively small and relatively scattered; secondly, the variety of centralized procurement catalogues in various regions has low overlap; thirdly, centralized procurement has not yet been implemented in all provinces.
Roll out
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The "1123 " system framework: the further continuation and improvement of the
"14th Five-Year Plan" period has begun.
The author believes that China's centralized procurement will be based on the "1123" centralized procurement system framework of the "13th Five-Year Plan" (that is, "a set of systems, One set of coding, two-level platform, and three-level operation") to further deepen the implementation of the mass procurement policy and consolidate the reform results achieved during the "13th Five-Year Plan" period .
"A set of systems" means that at the end of March 2019, the National Medical Security Administration organized a tender for the management subsystem of the national medical insurance drugs and medical consumables recruitment and procurement .
The system will be completed within three years, and will be connected with various provincial platforms to share data to form a complete centralized procurement information system .
At the executive meeting of the State Council in November 2019, it was even more clear to build a national centralized drug procurement platform, relying on provinces (autonomous regions, municipalities) to build a unified national open procurement market .
"A set of codes" refers to the "Notice on Printing and Distributing Guidance Opinions on Medical Security Standardization Work" issued by the National Medical Insurance Administration in June 2019 (Yibaofa [2019] No.
39), which clarifies that the medical security information system will be unified across the country by 2020 On the basis of construction, gradually realize the implementation of 15 information service coding standards including disease diagnosis and surgical operation .
During the "14th Five-Year Plan" period, a list of national medical security standards was formed, and the research, formulation, trial and improvement of some medical security standards were initiated.
　　





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In the early stage, focus on testing and using 4 information business coding standards for medical insurance disease diagnosis and surgical operations, medical service items, medicines, and medical consumables, and timely sum up experience and practices, and provide feasible experience and demonstration guidance for the full implementation of the remaining 11 information business coding standards
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The "two-level platform" refers to the establishment of a national and provincial two-level platform.
All regions rely on the provincial procurement platform to carry out centralized procurement and build a unified open procurement market across the country; prefecture-level procurement platforms in some provinces are gradually closed
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"Three-level operation" The country, province, and city each perform their duties and implement bidding operations for medicines and consumables at three levels
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Judging from the current situation, the national level mainly deals with medicines and patented medicines that pass consistency evaluation; medical consumables with large amounts occupying more funds; medicines and consumables with unstable demand; medicines and consumables with fewer manufacturers and insufficient provincial bargaining power Collectively
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At the provincial level, through provincial or provincial alliances, centralized procurement or negotiation is adopted, mainly to collect drugs and medical consumables that have not passed the consistency evaluation of quality and efficacy, and have large clinical usage, so as to realize the linkage of volume and price.
an amount of change in the price and the like
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At the prefecture and city level, the provincial platform is used to collect drugs and medical consumables other than the centralized procurement at the national and provincial levels, through prefecture and city alliances, prefectures, medical associations, medical communities, medical institutions, etc.
, For the main body to negotiate price and purchase with quantity
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During the "14th Five-Year Plan" period: the development trend and characteristics of
centralized procurement First, mass procurement has become the main feature of centralized procurement at this stage and a breakthrough in the medical reform; price reduction and cost control are still the main goals of centralized procurement at this stage .
Medicines and consumables will enter a new stage of "low price and high quality" .
Second, the scope of bulk purchases will be further expanded, and proprietary Chinese medicines, biological products and medical consumables will all be included in the scope of procurement; the scope of medical insurance agreement units will also be further expanded, and more and more regions will be carried out; the form of bulk purchases will also be expanded.
Will be more diversified, with the addition of commercial insurance, third-party GPO procurement models are booming　　


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Third, national joint procurement, inter-provincial volume procurement, regional alliance procurement, and provincial-level direct online procurement will become the main forms of centralized procurement; alliance procurement has become the direction required by the policy, and more types of alliance organizations will emerge
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Fourth, classified procurement is still the direction of centralized procurement.
In centralized procurement, differentiated treatment will be based on the characteristics of varieties and clinical requirements, and more detailed evaluation rules will be established
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Fifth, the information system has been continuously improved, and the price and credit evaluation system for recruitment and procurement has become the requirements for centralized procurement, the standards followed by bidding companies, and the reference for medical institutions to select products
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Sixth, use big data and semi-quantitative evaluation by experts to solve the related problems of product quality evaluation in centralized procurement , effectively solve the difficult problem that the consistency evaluation system cannot cover all products; accelerate the process of drug consistency evaluation, and explore Application in the field of medical consumables
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Seventh, low-price selection and price linkage have become the policy direction; recruitment and procurement are unified, and medical insurance uses the leverage of payment to solve the problem of long-term payment arrears by medical institutions in centralized procurement
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Eighth, centralized procurement has become a "price discovery mechanism", which provides a reference for the formulation of medical insurance payment prices; the coordination, perspective, and control mechanism of medical insurance and medical care will be closely integrated with centralized procurement; ninth, centralized procurement of traditional Chinese medical insurance "surplus retention" system It will change the attitude of medical institutions to participate in centralized procurement and bring about changes in the purchasing behavior of medical institutions
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Tenth, the concentration of clinical varieties, production companies, and circulation companies will be greatly increased, the business ecology will change, the industry structure will be rebuilt, and the sales rules will be rewritten
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