Pharmacy trusteeship still has hidden dangers

Source: Sina Finance and economics announced on the evening of February 11, 2014 that Kangmei Pharmaceutical (19.27, - 0.14, - 0.72%) had signed the strategic cooperation framework agreement with Liaoning University of traditional Chinese medicine and Benxi Municipal People's government respectively, trusteeing the traditional Chinese Medicine pharmacies of four hospitals directly under Liaoning University of traditional Chinese medicine and 22 hospitals under Liaoning Medical Group of traditional Chinese medicine Previously, on January 31, February 8 and February 10, Kangmei pharmaceutical also disclosed the pharmacy custody work of three batches of 55 hospitals, covering Tonghua City, Jilin Province, Huilai County, Jieyang City and Puning City, Guangdong Province In less than half a month, Kangmei pharmaceutical won the custody right of nearly 80 hospital pharmacies, which shocked many people in the industry "It's not surprising to have a hospital pharmacy, but it's extremely rare to have more than 80 in such a short period of time." A senior official of a domestic pharmaceutical company told the reporter at the weekend of the rule of law, "the reform of the national medical system puts forward the idea of" medical separation ", the hospital pharmacy is separated from the hospital, and the pharmacy trusteeship is a new attempt But at present, there is no clear mechanism for pharmacy trusteeship There is a lot of water in it " Zhang Wensheng, a lawyer for medicine, admitted: "when choosing a company to trust a pharmacy, the hospital itself can not do it." has always been the executive organ of the higher authorities has the final say Liao Xinbo, deputy director of the Department of health of Guangdong Province, once said publicly that the trusteeship of pharmacies is just a change of the managers of pharmacies, and there is no real "separation of medicine" Moreover, there is only one pharmaceutical company in the trusteeship side, and the one-to-one and one to many mode results in the monopoly of the trusteeship side In Liao Xinbo's view, pharmacy trusteeship is a formalism of self deception under the banner of "separation of medicine", a typical manifestation of bureaucracy in violation of market rules, and a practice from "fair" corruption to monopoly corruption The term "change soup without changing medicine" refers to that the medical institutions entrust their pharmacies to the pharmaceutical enterprises with strong management ability and the ability to bear the corresponding risks for paid operation and management in the form of contracts It is reported that at present, there are three modes for hospitals to entrust pharmacies to pharmaceutical enterprises: the first is that medical institutions retain the ownership and partial management right of pharmacies and drug stores, and hand over the supply right and purchase right to pharmaceutical commercial enterprises, and the trustee only earns the circulation fee; the second is that medical institutions entrust pharmacies to pharmaceutical enterprises, and pharmaceutical enterprises pay the custody fee to hospitals every year; The third is that pharmaceutical companies and hospitals sign agreements to share profits The reporter called the Securities Affairs Department of Kangmei Pharmaceutical Co., Ltd to inquire about its custody mode As of the date of publication, the other party did not reply However, Kangmei pharmaceutical has previously disclosed that all drugs used in 10 hospitals in Jieyang City, Guangdong Province are supplied and centrally distributed by Kangmei pharmaceutical The warehouse of the hospital will serve as the drug supply platform of Kangmei, which is responsible for the management and use of Kangmei, and the drugs will be owned by the hospital only after entering the pharmacy After the custody of the pharmacy, the drugs will be deemed as confirmed purchase by the hospital when they are received from the warehouse The hospital will settle the amount and price of the drugs received to the company according to the actual amount and price The settlement price of the drugs shall be subject to the price of Guangdong Province unified bidding and Internet hanging It is understood that the initial idea of pharmacy trusteeship is to reduce the circulation of drugs from pharmaceutical companies to hospitals, cut off the numerous price increasing interest chains in the circulation of drugs, so as to reduce the price of drugs and solve the problem of "supporting doctors with drugs" "But at present, the way of hospital pharmacy trusteeship is only a form of" medical separation " In fact, the wool is still from sheep Only changing the circulation of drugs is actually" changing soup without changing medicine " Zhang Wensheng said in an interview, "the trusteeship pharmacy is just a reshuffle of the interest distribution link For consumers, the retail price is unchanged, and for doctors, the" grey income "will not be affected." Guo Fanli, director of research at CIC, also raised concerns: "pharmacy trusteeship may breed corruption, enterprises pursue profit maximization, may take the opportunity to deepen 'contacts' with hospitals, and doctors' prescription drugs are more likely to use the brand medicine of the enterprise." Chang Lei (pseudonym), a staff member of a hospital in Jiangsu Province, told the law Weekend reporter: "the impact of the trusteeship pharmacy on the hospital's revenue is not significant In the actual operation process, the pharmacy operator will give a certain rebate to the hospital to make up for the loss of hospital drug revenue In addition, pharmaceutical enterprises will also bear the expenses incurred by the operation of pharmacies, such as water and electricity, drug transportation, personnel expenses, etc., reducing the cost of hospitals " Chang Lei said that after the drugstore is entrusted, the prescription right is still in the hands of doctors If doctors do not prescribe, the drugs will still not be sold, which makes drug manufacturers or agents still need to return to doctors In addition, the trusteeship side is the only one, so other drug manufacturers or agents also need to "manage" the trusteeship side According to the information that has been disclosed, the alleged monopoly of Kangmei Pharmaceutical Co., Ltd and the hospital have cooperated in trusteeship of pharmacies for 15 to 20 years This time, Kangmei Pharmaceutical Co., Ltd will bring considerable profits to the enterprise through large-scale "collection" of hospital pharmacies According to the announcement information of Kangmei pharmaceutical industry, the people's Hospital of Huilai County in Guangdong Province had a revenue of 110 million yuan in 2013; four hospitals in Puning City in Guangdong Province had a revenue of about 1.2 billion yuan in 2013, and the other five town hospitals had a small revenue; 45 hospitals in Tonghua City in Jilin province had a revenue of about 2 billion yuan in 2013 The annual drug purchase volume of the hospital accounts for about 45% of the business income Shen Wanyan pointed out that Kangmei pharmaceutical industry has entrusted pharmacy business of 50 public hospitals, and the drug purchase amount of unified distribution is about 1.4-1.5 billion yuan, equivalent to 10% of the company's revenue in 2013 "For Kangmei pharmaceutical industry, the trusteeship pharmacy can master the hospital medication data, reasonably control the output and ensure the effective supply At the same time, Kangmei pharmaceutical industry can earn transportation fees through large-scale logistics distribution At present, the demand for logistics of special products such as medicine is high, but there is also a high threshold, and the profit space in distribution is large " Guo Fanli said "Generally speaking, a hospital has dozens of distribution companies Pharmacy hosting means that there is only one distribution company left, which will be a fatal blow to other distribution companies." Zhu Feng (a pseudonym), a pharmaceutical agent in Beijing, believes that drugstore trusteeship seems to be legal, but in essence it is monopoly "With so many distribution companies competing, Kangmei pharmaceutical industry can stand out as a trusteeship pharmacy, which may be related to the local government's local protection," Zhu Feng told reporters Zhu Feng's point of view is not a single one According to the analysis report of Guoxin Securities on February 10, Kangmei Pharmaceutical Co., Ltd "has accumulated certain social and government resources in the process of integrating the industry chain of traditional Chinese medicine, creating many opportunities for the company to participate in the reform of public hospitals" Taking Tonghua City of Jilin Province as an example, Kangmei pharmaceutical announced that it had signed a 15-year trusteeship cooperation agreement with Tonghua Municipal People's Government on 45 hospitals, and the two sides decided to establish a trusteeship cooperation relationship with Tonghua municipal public hospitals Tonghua city is the location of Kangmei pharmaceutical's new Kaihe company In Puning City, Guangdong Province, where its headquarters is located, Kangmei pharmaceutical also signed the hospital pharmacy custody agreement with nine hospitals According to Zhang Wensheng, "the drug market in China is under strict control Under control, the division of the market is to some extent determined by the executive On the surface, the trusteeship of the pharmacy of Kangmei pharmaceutical industry is the monopoly behavior of the enterprise, but in a strict sense, it belongs to the monopoly of administrative nature " The controversial term of pharmacy trusteeship, hidden danger of pharmacy trusteeship, first appeared on the spot meeting held by the former Ministry of health in Liuzhou Hospital of traditional Chinese medicine in 2002 After that meeting, there was a wave of trusteeship across the country In May 2013, according to the data in the 2012 statistical analysis report on the operation of drug circulation industry released by the Ministry of Commerce, there were 29 enterprises undertaking the custody business of pharmacy in 2012 On February 10, 2014, Yao Hongwen, spokesman of the national health and Family Planning Commission, said in response to the phenomenon of pharmacy trusteeship: "the phenomenon that some regions separate pharmacies from outpatient clinics will play a certain role in cutting off the direct interest relationship between medical and health personnel and drugs." However, Zhu Feng is cautious and optimistic about the future of hospital pharmacy trusteeship: "many areas have hospital pharmacy trusteeship, but there is no mature domestic trusteeship model." "In the trusteeship relationship of the pharmacy, the hospital is in a strong position Generally, the hospital will not take the initiative to talk to the enterprise about trusteeship The enterprise is the driving force of the hospital pharmacy trusteeship." Zhu Feng said that the rent-seeking phenomenon of power in this process is inevitable "As far as I know, there is no standard for the determination of the hospital pharmacy trusteeship, which is all based on the public relations ability of the enterprise." Zhang Wensheng is worried about the profit-seeking nature of pharmaceutical companies: "after the custodian pharmaceutical companies have formed a certain scale in a certain region, their bargaining power will be very strong, and they have an absolute voice in the circulation field Enterprises will take their own interests into consideration, and within the scope of bidding, they will certainly tend to produce their own products, or products with higher gross profit margin " Guo Fanli suggested: "when determining the trusteeship party, the list of interested trusteeship parties should be reported to the drug regulatory department, and the drug regulatory department should conduct unified bidding to ensure the transparency and openness of the bidding process and avoid the phenomenon of power rent-seeking."