Outpatient co-ordination will compress the growth rate of the drug retail market and lower the expectations of the Internet medical market

After the launch of the outpatient co-ordination reform, the retail market for out-of-hospital drugs will face a significant decline, and Internet medical companies that rely on drugs for their living will face the challenge of a clear decline in market expectations in the future.
from the East Asian region, the outflow outside the hospital is limited in scale and takes a very long time, the overall effect is not good.
this is mainly due to three points: the overall control of the cost of primary outpatient clinics and hospitals is more successful, the frequency of visits to medical institutions is high, the interests of hospitals in medicine is difficult to eradicate in the short term.
First of all, in terms of outpatient costs, whether in Japan, Singapore or Hong Kong and Taiwan in China, outpatient costs are controlled at a relatively low level, not only in terms of the cost of consultation, including examinations and medicines, but also at a relatively low price.
, the average Chinese mainland of outpatients in the hospital is growing faster, especially in the third-tier hospitals.
2018, the average out-patient cost of a public three-tier hospital is 322.1 yuan, far higher than the average cost of 200 yuan or less at the grass-roots level.
the introduction of outpatient co-ordination, effective control of outpatient average cost will be one of the key elements to ensure the implementation of the system.
, the frequency of medical visits to medical institutions is higher.
because of outpatient co-ordination, patients prefer to go to a medical facility rather than buy their own medicine at a pharmacy.
such as Japan, the number of annual visits per capita reached 13, And Taiwan is more than 15.
Chinese mainland number of visits per capita in some of the most aging cities has exceeded 10.
, the trend will become more pronounced as medicare accounts shrink and outpatient co-ordination is implemented, and even some OTC drugs will be sold more in hospitals.
, this has increased the burden on medical institutions, on the other hand, it has also contributed to the overall increase in medical costs.
, the overall growth rate of health care costs remains manageable due to the maturation of total health care and control over services and drug prices.
, it is difficult for medical institutions to eradicate the benefits of medicines in the short term.
Because doctors' fees in East Asia are lying at a low level, the benefits of medical services attached to medicines are clearer, and changing the economic dynamics of medical institutions will not succeed overnight, requiring continued subsidies and strict regulation.
in Japan and Taiwan, as long as hospitals can still profit from drugs, prescription outflows are a huge challenge.
Japan's three-pronged model to promote prescription outflows, from 1974 to 45 years to 91%, Japan's prescription outflow model is premised on a large subsidy to doctors.
, for example, in 2013, prescription outflows were 67 per cent, with 763 million prescriptions issued a year and payments for prescriptions amounting to 6,650 billion yen.
china's health insurance is clearly unable to afford such high subsidies.
taiwan's hospitals are reluctant to exoded prescriptions, and even if drug service charges are over-halved, hospitals are still clinging to prescriptions.
The prescription outflow rate in Taiwan hospitals is less than 1%, and if the grass roots are included, the prescription outflow rate in Taiwan is 34%, but even so, most of the prescriptions go to pharmacies in hospitalside shops or clinics.
because hospital side shops often have a clear interest relationship with the hospital, such a prescription outflow is of little practical significance.
, even in the United States, where fees are high, medical institutions are still drug-based, and this is not simply an increase in fees to achieve the goal.
as the trend for U.S. hospitals to acquire clinics grows, hospitals are more likely to sell their drugs through outpatient clinics than through pharmacies.
because U.S. hospitals can make big profits by selling drugs in outpatient clinics.
hospital's outpatient business and commercial insurance are settled at 67% of the hospital's fees, which have become a new way for hospitals to make money by selling drugs through outpatient clinics because of the high hospital fees.
a report released in early 2019 by Allianz Bernstein, a study of outpatient drug prices at 34 medical groups found that outpatient drug prices in hospitals were 3-7 times the average price.
, whether generic or brand-name, research hospitals have the highest prices.
For example, Neulasta, an oncology drug at New York's E.G., sells for $55,000, 12.5 times Medicare's average, while Other research hospitals sell for $20,000, 4.5 times Medicare's average.
therefore, as large hospitals and the grass-roots level continue to integrate, the future prescriptions will be more and more retained within the hospital group, rather than outside the hospital, which is a global trend.
However, China's generic drug market is facing a drastic reshuffle, especially as drug collection continues in hospitals, and the prices of drugs that have been included in the collection have fallen sharply, forcing some drug companies that have failed to integrate into the collection or are unwilling to cut prices to focus on opening up the retail market outside the hospital.
, especially before medicare payments are fully pushed out, there is still a certain sales window for such drugs in the retail market.
but with the development of outpatient co-ordination and the gradual landing of medical insurance payments, patients' access to medicines will be concentrated in medical institutions.
of course, there will still be some out-of-pocket users in the drug retail market, but the size is extremely limited to support the loss of any one variety in withdrawing from health insurance.
From Japan's OTC drug tax cuts have not been effective, health care and tax policy on the user's positive and negative incentives are not at all on an equal scale, let than entirely at the user's own expense.
The Japanese government wants to reduce the number of visits to hospitals for minor illnesses because of the high frequency of visits per capita in Japan, so in 2017 it introduced a self-medication tax credit, which allows users to deduct a tax by buying OTC drugs and peripheral health products for more than 12,000 yen a year.
but the tax cuts are indirect than Medicare payments, the overall effect is not good, users continue to go to medical institutions, rather than drugstores to buy OTC drugs.
And, from the point of view of prescription drugs themselves, because they can not be directly targeted at individuals to promote publicity, and by the impact of early gold sales, doctors and users of brand loyalty does not exist, once into the drug retail sector, unless converted to OTC drugs, it is difficult to make it like OTC drugs with a strong brand effect of products, which is another factor in the prescription drug outflow has a greater challenge.
, as outpatient co-ordination unfolds, users will flow more into hospitals and primary health care facilities, where prescriptions do not have a basis for large-scale outflows, and even OTC will flow back into hospitals.
and the Internet medical coverage is based entirely on offline medical institutions, third-party platforms have difficulty obtaining scalable coverage.
In two ways, this constrains the future scale of third-party Internet healthcare platforms, where patients will be accelerated into medical facilities and prescription drugs and OTC products will be more digested in the hospital as a result of outpatient co-ordination and shrinking health insurance accounts, contrary to the trend that platform companies want from patient outflows."
From the simple analysis above, as health insurance coverage expands, while out-of-the-way costs still account for a percentage of spending, this is mainly the out-of-the-way and out-of-the-money portion of health insurance coverage, and it is difficult to create a fully out-of-the-way market outside of health insurance.
third-party Internet medical platforms, which sell OTC and surrounding health products, need to be more realistic in terms of market size expectations, and it is clearly unrealistic to expect large-scale outflows of prescriptions and user-owned digestion.