The strongest deduction in history: big data measures the outcome of drug price reform in 2015

Source: on April 28, 2015, Ren Guanghui of new health sector, China's drug virtual high did not come from pharmaceutical factories, nor from the circulation of intermediate links, but from the medical management system, the source of which was hospitals At the beginning of 2015, the provincial drug bidding procurement led by the health and Family Planning Commission started from Hunan, followed by Zhejiang, Anhui and other places There are two major characteristics of bidding in 2015: first, great determination to bargain and high price reduction; second, procurement with volume and legalization of secondary price negotiation of medical institutions These two points are intrinsically linked China's drug virtual high does not come from pharmaceutical factories, nor from the circulation of intermediate links, but from the medical management system, the source of which is hospitals First of all, we need to understand the revenue sources of China's public hospitals, mainly from three parts: drug revenue, diagnosis and treatment service revenue, and government financial investment There is a relationship between the three Cutting off drug income necessarily means increasing diagnosis and treatment income, or increasing government subsidies Secondly, we must understand the price structure of Chinese drugs, including the ex factory price, wholesale price, bidding price, and the markup based on 15% of the bidding price of the hospital In 2015, the health and Family Planning Commission will make zero price difference in public hospitals in Jiangsu, Anhui, Qinghai and Fujian In Anhui Province, for example, on April 1 this year, 15% of the drug mark up was completely cancelled, and more than 100 medical institutions above the second level in cities were included in the reform This means that hospital operating revenue will be reduced by 15% So how much is that 15%? The scale of drugs in Anhui Province is about 35 billion, and the hospital sales are 28 billion, accounting for 80%, 15% of which is 4.2 billion So there was such a report: "Wuhu unified three pharmaceutical commercial distribution, all products unified to give up 30 points, including 15 points for hospitals, 5 points for drug control centers, and 10 points for commercial distribution companies." This news means that 42% of the decrease also comes from the drug This is why the increase in the reduction of bidding will lead to the second bargaining of medical institutions If, as in Hunan, the bidding is reduced by 15%, the manufacturer will have to provide 15 more points So if two 15% can reduce the price of drugs by 27.8%, can patients reduce the corresponding burden? This requires careful calculation Situation 1: the table above shows the possible results before and after the price reduction of a hospital with an annual revenue of 500 million RMB The price band is divided into three grades: high, medium and low The average decline of high price drugs was 27.8% (equivalent to two 15% declines), and the overall unit price level could be reduced by 30% However, due to the fact that it is difficult to implement the government led volume procurement, the clinical medication tends to use the medium and high-grade drugs, and the price level of the medium and low-grade drugs is increased As a result, although the unit price level is decreased, the overall cost is only reduced by 3.8% Some people will ask, manufacturers, especially high price brand manufacturers, will give another 30% profit? This problem depends on the mid-range products whose price level has risen Under the condition of commitment, the gross profit of these products can reach 70% or higher, 20% to the hospital and drug administration, and 50% or higher to the dealers This model will bring two risks First of all, it will greatly increase the consumption of middle-class drugs, increase the burden of patients using low-cost drugs, and lead to group events There is the same logic in Chongqing's uremic patients' march on the streets, except that it is the adjustment of medical service cost, which is more sensitive than drugs The second risk of this model is the massive use of low-quality generic drugs Since more than 80% of China's generic drugs have not been evaluated by the quality consistency of generic drugs, there are not only problems in the efficacy, but also harmful to the body This quality problem is sometimes fatal for patients with some diseases Scenario 2: according to the annual growth of 9% of the national average number of diagnosis and treatment in 2013, the drug consumption scenario 2 is closer to the reality With the rapid development of Chinese society, the aging population and the change of life style lead to the high incidence stage of diabetes, hypertension, cardiovascular and other chronic diseases, the increasing number of reimbursed diseases and the increasing proportion of reimbursements, as well as the backward concept and system of disease prevention and management, the growth of hospital diagnosis and treatment volume is rigid From the driving mechanism of scenario 1, it is not difficult to infer that hospitals and doctors still prefer high priced drugs in terms of medical quality and economic income, resulting in a possible increase in drug costs of 12% when the average unit price drops by 30% Next year's bidding drug price may be cut by another 20%, but the drug cost will rise, falling into the vicious circle of price management of the former development and Reform Commission: the lower the drug price, the higher it will be What's more, this mode will also lead to bad money expelling good money There is no good medicine available in the market and no medicine available for low-income patients Of course, the situation in each province is not the same For example, Fujian added a drug proportion index As we mentioned earlier, if there is no effective financial input, the proportion of drugs will come down The most likely result is that the service and inspection costs will come up again It is the interests and health of patients that are likely to be directly damaged There are three main ways for hospitals to make up for the decrease of revenue caused by bidding price reduction and zero price difference: secondary price negotiation, pharmacy trusteeship, and increasing service price, which will involve the adjustment of drug and service price structure We just listed two of the results above A well run hospital can still substantially increase its income, and a poorly run hospital cannot make ends meet The quality is only for the hospital, and the whole process is not aimed at the KPI of patients, such as the proportion of self payment of patients, disease control standards, etc That is to say, the interests of patients are not guaranteed by mechanism To sum up, zero price difference is not equal to reducing the drug price, reducing the drug price is not equal to reducing the drug cost, reducing the drug cost is not equal to reducing the medical cost, reducing the medical cost is not equal to reducing the medical burden of the common people Reducing the burden of medical treatment is the goal of our medical reform The result of drug price reduction in 2015 is doomed to run counter to the goal of our health care reform.