Reducing the false high drug price becomes the first work of medical reform this year

Yesterday, the prime minister again proposed to reduce the false high drug price at the national health reform teleconference In the past decade of the new health care reform, the problem of high drug prices has not been solved Experts believe that only by establishing a unified medical insurance payment standard for public hospitals and social pharmacies can prescription drugs be separated from hospital pharmacies, allowing the outflow of prescriptions, forming competition between different drug purchase channels in public hospitals and social pharmacies, and a reasonable formation mechanism for drug prices According to Xinhua news agency, the 2018 national medical reform work teleconference was held in Beijing on August 27 Premier Li Keqiang pointed out in his instructions that he should dare to touch interests and dare to "bite the bullet", and continue to intensify the reform of medical, medical insurance and pharmaceutical linkage He made great efforts to reduce the high price of drugs, deepen the reform of public hospitals, improve the basic medical insurance and grading treatment system, and develop Internet plus medical health Since the new health care reform, the policy of reducing drug prices has been mentioned every year, but it has little effect, and even many drug prices have risen instead of falling Under the influence of the policy of "two vote system", the marketing expenses of pharmaceutical enterprises have increased greatly, and the profit margin has declined greatly Recently, yaomaitong combed 174 listed pharmaceutical companies' semi annual reports and found that the sales expenses of 33 of them increased by at least 100% But in terms of profit growth rate, some listed pharmaceutical companies do not have such good-looking figures For example, the profit growth rate of Harbin Sanlian Pharmaceutical Co., Ltd is less than one tenth of its sales expense growth rate Under the condition that the sales expense increases by 431%, the profit of Dali Pharmaceutical Co., Ltd has decreased from 31.17 million yuan in the same period last year to 880000 yuan Drug price reduction continues to be the focus of medical reform since the new medical reform in 2009, the reform of drugs has not stopped On January 21, 2009, the executive meeting of the State Council deliberated and approved in principle the opinions on deepening the reform of the medical and health system and the implementation plan for deepening the reform of the medical and health system in 2009-2011, and the new medical reform kicked off Before the implementation of the new medical reform plan, people were consulted Finally, 24.7% of the opinions are on strengthening the construction of drug supply security system, ranking the third among all opinions On December 22, 2009, the leading group of medical reform proposed to speed up the construction of basic drug system, reduce the false high drug price, and let the people really benefit Since then, almost every year in the work conference of medical reform, the price of drugs and its corresponding policies and measures will be raised, and new measures will be taken continuously to solve the problems of maintaining medicine with drugs and the high price of drugs In terms of drug procurement, the new medical reform in 2009 proposed "open bidding procurement and unified distribution of essential drugs" and "the guiding price for retail sale of essential drugs formulated by the state Within the guiding price, the provincial people's government will determine the unified purchasing price of the region according to the bidding situation", which will leave room for local operation On the other hand, the new health care reform has always taken the cancellation of the bonus as a breakthrough to break through the medicine based medicine Drug markup has been implemented in New China for decades It was initially positive, but later abused by hospitals to pursue profits In 2011, all government run grass-roots public medical institutions cancelled drug mark up Since then, county-level public hospitals and pilot cities of comprehensive reform of public hospitals have cancelled drug mark up one after another until last year However, this medical reform has not cut off all kinds of interest transmission relations in the chain of drug bidding, hospital drug selection and doctor drug prescribing In order to squeeze out the water in the drug price, after the implementation and adoption of the provincial bidding procurement, drug zero margin, two envelope system and two vote system, "all failed to reduce the virtual high drug price." Wang Zhen, deputy director of the public policy research center of the Chinese Academy of Social Sciences, told the health point that the new health care reform since 2009 is actually mainly "drug reform" Ten years later, the "I'm not the God of medicine" and the upsurge of public opinion about drug prices caused by the rise of drug prices show that the problem of inflated drug prices has not been solved Wang Zhen believes that the reform of medicine depends on the reform of medical services, especially the comprehensive reform of public hospitals After the cancellation of drug markup, only the "clear income" of medical institutions has been cancelled, but medical institutions and clinicians still have a lot of "dark income" and still rely on the inflated drug price In March of this year, Caixin Weekly reported that about 50% of the price of drugs sold in hospitals is the real price, and the rest is the gray income of some doctors and hospitals After the two vote system, part of the payers of gray income transferred from circulation to pharmaceutical enterprises Recently, various listed companies have published semi annual reports Among the 10 listed pharmaceutical companies with the highest growth rate of sales expenses sorted out by yaomaitong, 5 have sales expenses exceeding half of the operating revenue, and 3 have sales expenses exceeding one third of the operating revenue "In essence, it's still nourishing medicine with medicine," a researcher from a secondary market investment institution in Shanghai told the health point Behind the rise of the enterprise's selling expenses, the essence is the rise of the proportion of payment at this end of the interest chain of traditional Chinese medicine enterprises Through the following set of data, we can more intuitively observe the depth of this interest chain According to the analysis of the insiders, in a prefecture level city in South China, in 2016, five years after the reform, the total income was 2.593 billion yuan, an increase of 903 million yuan compared with that before the reform, but the medical income was 1.733 billion yuan, a net increase of 1.058 billion yuan This means that not only the 903 million yuan increased in five years has been turned into the actual income of the hospital, but also the medical consumables in the total income before the reform have been squeezed out by nearly 200 million yuan to become the actual income of the hospital The prescription right of doctors determines the main position of "selling drugs" in hospitals, and doctors will inevitably become the key target of medical representatives to tackle key problems and fight "kickback" war If the hospital wants to get 1 yuan profit from the bonus, the patient and fund will spend 7.67 yuan, and the doctor will spend about 4 yuan to get 1 yuan from the rebate From the above data, we can see how much water is in the drug price But people familiar with the industry also said that when discussing the "virtual high" drug price, we should not blindly set the price benchmark, we must break it down to see which is the reasonable circulation cost and which is the gray and black interest chain to be cut Experts suggest: what's in the "toolbox" of drug price reduction? "Now (drug companies) profits have been squeezed very low by the two vote system", the researcher told the health point In his view, if the price is kept down blindly, there may be no channels for circulation to be compressed, "on the surface, it is the interests of doctors who are actually motivated by the drug companies." Also may cause the enterprise to walk the low quality old road An expert close to the leading group of medical reform of the State Council told the health point that at present, it seems that there is no better way to reduce the false high drug price except through drug bidding by the National Health Insurance Bureau Health point has reported that the National Health Insurance Bureau may carry out pilot drug centralized procurement at the national level As long as the lowest price in China can be quoted, 70% market share of each pilot city will be obtained The market researcher of the above-mentioned investment institutions also believes that centralized procurement is a good way, but it is still necessary to observe its effect Wang Zhen believes that to reduce the false high price of drugs, we should first define what is the "reasonable price" of drugs However, up to now, China has not formed a normal drug price formation mechanism What medical insurance pays doctors is the cost of diagnosis and treatment Only when the hospital negotiates with the drug supplier to determine the price, can the real sense of "medical separation" be realized Wang Zhen said that only by establishing a unified medical insurance payment standard for public hospitals and social pharmacies, can prescription drugs be separated from hospital pharmacies, allowing the outflow of prescriptions, forming competition between different purchase channels of public hospitals and social pharmacies, and a reasonable formation mechanism for drug prices be established In addition, through the "Internet plus medical health" supply side mode innovation, bypassing institutional and policy barriers, and realizing the outflow of electronic prescriptions and the distribution of drugs outside the hospital, we can really squeeze out the price of medicine Wang Zhen believes that only by promoting the free flow of high-quality medical resources among different regions through the Internet can we push forward the reform of public hospitals in depth.