Second price negotiation will overturn the achievements of drug price reform

Source: sabilan 2015-5-22 in May this year, seven ministries and commissions including the national development and Reform Commission formulated and issued the opinions on promoting drug price reform (document 904) The general saying of the society is that the state liberalizes the drug price, and then infers that the government withdraws from the drug price management, the market determines the drug price, and then worries about whether the drug price will skyrocket? The conclusion is that the drug price will not skyrocket In fact, the basic content of the document is not "drug price liberalization", but "drug price reform", which clarifies the new price formation mechanism of different types of drugs, so as to match the classified purchase of drugs The key point is that at present, the centralized procurement of drugs mainly adopts the form of bidding, which is not implemented in accordance with the national bidding law and the government procurement law, but carries out various administrative regulations of the provincial or even pilot municipal bidding departments Under the strong interference of the administrative power ignoring the law, it is necessary to observe the implementation effect of document 904 The crux of expensive medical treatment is that medicine is the mechanism that leads to more and more expensive drugs, because more drugs are sold and you have all kinds of legal and illegal economic benefits (not only 15% bonus!) for the hospital The so-called high price is easy to sell, and even the price overwhelms the quality and curative effect If there is no bidding, the mechanism of medicine plays a major role; if there is bidding, the mechanism of bidding plays a major role where the effectiveness of bidding reaches Bidding is the mechanism that leads to the lower drug price, because the main role of bidding is bidding Unless it is an exclusive product without competition, or a veto with quality and efficacy, the low price bid is an inevitable result This point, the leadership of the State Council's medical reform office has fully emphasized in a speech Now, the price of drugs almost depends on the number of competitors and the number of times of bidding As long as these two "more" drugs are involved, the price can never be inflated And the prices of two "less" drugs are almost inflated In the past ten years, the national development and Reform Commission has made nearly 30 times of drug administrative price reduction with a total amount of nearly 100 billion yuan The society basically has no feeling about it, because the price is high and easy to sell Now, drug prices are going to be liberalized In drug bidding, there are more and more compulsory administrative regulations In such a case, will the new price formation mechanism become the four price formation mechanisms set by Jili No 904 document which is not applicable in "tasteless food and a pity to discard"? Analysis on the four price formation mechanisms set by No 904 document, namely, medical insurance payment, price negotiation, independent pricing of enterprises, and ceiling price Let's see separately 1 Determination of medical insurance payment standard Originally, the medical insurance payment standard is to adjust the ratio between the medical insurance payment part and the individual payment part under the condition that the default medical treatment and the drug price are reasonable It is a balance between the individual burden and the social burden and a part of social security At the same time, as the main payer of total medical expenses, medical insurance institutions negotiate medical prices and drug prices with hospitals and pharmaceutical enterprises, with the goal of "being optimistic about diseases and not wasting" Among them, the only way to raise and lower the price of medicine is to reduce the total cost of disease cure But at present, medical insurance only participates in the determination of drug price and does not participate in the determination of medical service price It is lame medical insurance with only the responsibility of payment and no power of expense supervision Moreover, document 904 only seems to set the function of lowering the purchase price of drugs (rather than the patient's payment price) to complement the bidding, so as to enlarge the function of bidding again Now the trend is becoming clear 2 Use of negotiation mechanism Originally, negotiation mechanism is a good way to determine the price under the condition of market economy In addition to the planned economy, the market economy has a process of "asking all prices and paying back money on the spot" in determining the price of any commodity However, if the administrative power intervenes, it is clearly stipulated that the price can only be reduced or not increased, and only a certain percentage can be reduced or a smaller percentage can not be reduced This kind of negotiation can only be judged, without negotiation, and can not be regarded as negotiation at all It is a typical example of administrative power overthrowing mechanism 3 Setting of ceiling price This part is mainly aimed at poison, hemp and refined products The maximum price limit is an effective measure to prevent the false high price of drugs In addition to bidding, or exclusive products without competitors, administrative ceiling price will play a role 4 Producers and operators make their own pricing Originally, the enterprise's independent pricing is the proper meaning of the market economy, but the key is to see what kind of market environment and policy environment it faces: if there are few competitors, it is possible to form an exclusive monopoly or a price monopoly alliance of several seller enterprises Relying on the regardless mechanism of Medicine, the price of medicine will inevitably rise higher and higher; If there are many competitors and the bidding method is adopted, it is possible to form a buyer's price monopoly alliance in the opposite direction If the bidding mechanism is used, the drug price will inevitably be lower and lower; if the administrative power is forced to intervene, it will be divorced from the reality, no matter how much the price is, the price is wrong! And it is easy to induce corruption The second bargaining is the subversion of the above price formation mechanism No 904 document only stipulates four price formation mechanisms for five categories of drugs, but it does not specify who is the main body of price formation, nor does it specify whether the current prevailing second bargaining is feasible (which has been prohibited in the past) Then, according to the price determined by the above-mentioned formation mechanism, can medical institutions use the second bargaining to overturn? If it is the price formed by bidding, overturning is illegal; if it is the price formed by bargaining, overturning is dishonest If we agree with this kind of illegal and dishonest, in the pilot wave of second bargaining that is blooming all over the country, document 904 is not a question of effectiveness, but a question of ineffectiveness! According to logic, as long as there is a second bargaining, any price formation mechanism for the first time is a fake nonsense and a fool's errand! Since the second negotiation can negate the bidding price, it can also negate all kinds of prices formed according to document 904 No 904 document has no sanction effect on the blatant illegal second bargaining, and even avoids talking about I dare not think any more In a word, to implement document 904, we must first deal with the relationship between price formation mechanism, bidding and secondary price negotiation, so as to reflect its good original intention and play its expected role Therefore, it is suggested that: 1 Without authorization, the law should abolish the illegal intervention of administrative power on drug purchase Strictly abide by the bidding law, government procurement law, contract law and other laws and regulations Some illegal administrative obstacles, such as the complete cancellation of forced pricing, forced reduction of a certain percentage, forced designation of distributors, forced prohibition of some enterprises' permanent inability to sell in a certain region, forced non use of volume purchase (bidding) and forced use of volume purchase (second bargaining), etc The government only formulates rules of conduct to restrict the behaviors of all parties according to law, so that the market plays a decisive role in resource allocation and price formation 2 Cancel the bidding hosted by government departments, and the hospital or hospital consortium will become the main body of drug bidding In this way, first, we can really mobilize the enthusiasm of the hospital and transfer the functions of the government departments to the administrative supervision; second, we can integrate the first price negotiation (bid price) and the second price negotiation (hospital purchase price), take the reasonable connotation of "price negotiation" and discard the illegal mistakes of "second time"; Third, it can effectively implement the procurement with quantity, so that the final determination of the price is more reasonable 3 We should not allow bidding to dominate the world by increasing the proportion of drugs negotiated and priced Both parties have equal status in negotiation and pricing, and have full opportunity to express their own views and reasons It is easy for the buyer to compare the price, quality, efficacy, brand and reputation of the drugs sold by the seller (there may be several) and select the drugs with the most appropriate cost performance Negotiation also has the function of making the price gradually lower through bidding However, it has become a kind of administrative license to allow certain drugs not to enter into the negotiation Pharmaceutical enterprises can only choose the bidding with administrative compulsory provisions, and the choice of negotiation mechanism has become an extravagant hope The policy should be clear: as long as the purchaser or supplier has sufficient reasons to believe that the drug price is falsely high or low, and requires to enter into the negotiation, it should generally be allowed In the centralized purchase of drugs, the negotiation option should be at least equal before the bidding option 4 The formulation of documents and rules should be transparent and open Transparency is to be clear and clear, not vague, not inconsistent with the meaning of words, to allow questions, to allow defense Publicity is to let the society know all the rules and operation processes, to ensure that both sides have equal status, and to act in strict accordance with the law No market monopoly or administrative monopoly is allowed It's hard to find the obvious increase, can the hidden increase be avoided? Now there are several alienated phenomena of drug price that should be noted: first, the high cost of seeing a doctor has been alienated into the high cost of drugs, and the large prescription and large examination have escaped the condemnation of public opinion and the correction of policy; Secondly, the false high price of some drugs has been alienated into the false high price of all drugs, and the blind administrative price reduction has made some drugs abandon the standard, some drugs cut off the supply, and some low-cost drugs withdraw from the market; thirdly, the false high price of the final consumption of drugs has been alienated into the factory price, and the gray black corruption that should be investigated most has been muddled through; Fourth, various ways of price increase have been alienated into a way of price increase: it is a price increase (obvious increase) that the drug price of one yuan rises to two yuan, but it is also a price increase that the drug price of one yuan changes its face and enters the market with the new price of two yuan, and it is also a price increase that the drug price of one yuan disappears and is replaced by other drugs of two yuan Now the latter two kinds of price increases (dark price increases), especially the third kind, have begun to increase The reason why the national development and Reform Commission's nearly 30 administrative price cuts have no effect is that it can't go up in a dark way These four alienated phenomena lead to various reform measures to solve the problem of expensive medical treatment in the field of medical reform It can be predicted that No 904 document will not lead to an obvious increase in drug prices, but it is difficult to predict whether it can act according to market rules, curb administrative price pressure and reduce the withdrawal of low-cost drugs from the market, and prevent a hidden increase.