Dentistry is now one of the busiest departments in the hospital, from children to the elderly, there are always a lot of people in front of the dental office.
Dental implants have become a beautiful landscape because of high-precision technology and ideal restoration results.
However, implanting a tooth often costs thousands or tens of thousands of yuan.
At the same time, with the aging of the domestic population, the potential demand for dental implants continues to grow, and the patient's cost burden is heavy.
But in recent days, following cardiac stents and artificial joints, dental implants, which are also high-value medical consumables, will also be purchased in a centralized manner.
The State Council executive meeting held on January 10, 2022 pointed out that it is necessary to gradually expand the coverage of centralized procurement of high-value medical consumables, and conduct centralized procurement at the national and provincial levels for orthopedic consumables, drug balloons, and dental implants that are of concern to the public.
This is the first time at the national level that dental implants should be included in the centralized collection signal, directly attacking the pain point of "expensive dental implants".
"Centralized procurement is extending to consumer medical care (such as dental implants)." Zhao Bing, the head of a consumer medical technology company, told reporters this way.
"Through purchasing with quantity, the price of dental implant consumables will be lowered first; secondly, the price of dental implant service will be managed from product promotion to service." He predicts that the price of the first price of dental implant centralized procurement will drop by a certain amount. at 60% to 70%.
In addition, some industry experts told the first financial reporter that the inclusion of high-value consumables such as dental implants in the centralized procurement is intended to squeeze the cost of the intermediate links. After the coronary stents and artificial joints entered the centralized procurement in the early stage, the average decrease It can reach more than 80% or 90%, and it is expected that such a high drop in dental implant consumables will also occur.
How to make huge profits from "mouth business"
Ms. Zou, who is in her 50s in Suzhou, Jiangsu, gradually encountered oral troubles. After "bypassing" three teeth ("bypassing" refers to fixed dentures, usually the teeth at both ends of the missing tooth space are ground smaller, as the foundation. In the second half of 2021, she had a tooth implanted in Suzhou.
"One-time payment in a private clinic costs 12,500 yuan, using implants imported from Sweden." She told reporters, "The same consumables cost 150 million yuan in a public hospital, and private clinics are relatively cheaper." She said .
Ms. Zou spent a lot of thought on various imported consumables. She felt that the price was indeed expensive, but the whole planting process was relatively smooth. After more than three months, the planting was completed, and there have been no complications.
The reporter visited a private dental hospital in Shanghai and learned that the current price of a dental implant ranges from 8,000 yuan to 15,000 yuan, which is similar to that of public hospitals.
According to the official website of West China School of Stomatology, Sichuan University, dental implants have many advantages, such as stable retention, high chewing efficiency, no wear on adjacent teeth, strong aesthetics, comfort and convenience, less trauma, and faster healing.
The consumables involved in dental implants can be divided into implant systems and restoration materials. The implant system includes implants, implant abutments, and crowns. The implant is the core component of the implant, providing support and retention for the entire implant system. Repair materials generally include oral repair membranes and bone meal for wound repair.
However, the reason why dental implants are expensive, according to Zhao Bing, is that the dental implant industry has several characteristics. The first is that the industry has insufficient competition and is dominated by foreign capital; the second is that compared with products, the cost of medical services is more valuable. high.
Dental implants require consumables such as implants and crowns.
Data from Guohai Securities shows that at present, dental implant products including European, American, and Korean dental products account for more than 93% of the Chinese market, and domestic dental implant products account for less than 7%. The industry is in a small and scattered state.
The world's major dental implant manufacturers include Dentsply Sirona, Straumann, KaVo Group, Zimmer Biomet, etc.
A Shenzhen dentist told reporters that the vast majority of implant consumables currently rely on imports; as for consumables such as dental crowns, although domestic products are gradually developing, some processing accuracy may still be inferior to imported ones.
In his view, the core technicians in the dental and medical device industry not only need to master the knowledge of medicine and mechanical automation, but also need to have multi-disciplinary knowledge reserves such as management, mechanics, and materials science.
Foreign stomatology has been leading the domestic development for many years, and many large companies have formed a systematic R&D system.
Therefore, in general, most doctors prefer to use imported consumables.
In terms of the profit of imported consumables, according to Zhao Bing's estimation, the gross profit margin of high-end European and American dental implant products is currently 60% to 70%; while the gross profit margin of low-end Korean dental products is only about 20%, and the gross profit of domestic dental implant products is only about 20%. The interest rate is 40%.
The above-mentioned dentist also told reporters that taking dental implants as an example, the cost of full-mouth implants can sometimes reach 50,000 to 600,000 yuan, and the cost of consumables may reach about 200,000 yuan.
However, in Zhao Bing's view, "For consumer medical industries such as oral cavity and medical beauty, the 'mountain' of cost lies in products and services, and services are the bulk, and channel costs are the third."
The above-mentioned dentists also said that, whether it is a clinic or a hospital, the cost of consumables is relatively small in the cost of dental implants, and most of the costs are surgery costs, service costs, etc.
According to the analysis report of Guohai Securities, in 2020, the total size of China's dental implant market is about 29.7 billion yuan, of which the implant market size is 3.1 billion yuan; the repair material market size is 2.85 billion yuan; the dental crown market size is 1.05 billion yuan; the remaining 22.7 billion yuan Yuan is the scale of products and services.
Prices drop by as much as 80%
The promotion of the centralized procurement policy is intended to reduce the cost of intermediate links, open up room for price reduction, cut off the gray interest chain in the circulation and use of medicines, and purify the field of medicine circulation.
For example, the centralized procurement of high-value consumables led by the state in the early stage has carried out two batches, among which the average price of the selected coronary stents has been reduced by 93%, and the average price of the selected artificial joints has been reduced by 82%. cost.
Some experts said that the expected decline in the price of dental implant consumables can also be compared to the decline in the price of coronary stents and artificial joints.
The above-mentioned dentists revealed to the first financial reporter that dental implant-related consumables have gone through many agent links from manufacturers to terminal medical institutions. The price sold by agents to hospitals will be higher than that of clinics, because the hospital still needs to bid. , to take care of all aspects of the relationship, etc., which also helped increase some costs.
Chen Hao, director of the Drug Policy and Management Research Center of Tongji Medical College of Huazhong University of Science and Technology, told reporters that the current business models of drugs and consumables are different. The two-invoice system has not been fully implemented in the industry, and the consumables industry is a layered agency, resulting in a lot of unreasonable expenses.
He believes that once the centralized procurement of dental implants is advanced, the intermediate circulation links can be reduced, and a large amount of intermediate costs can be squeezed out.
In addition, centralized procurement will have a great impact on the dealers of dental implant consumables, who face being shuffled (eliminated) out of the market.
In the field of dental implant consumables, although foreign investment is still dominant, and it is difficult to replace domestic products in the short term, centralized procurement can still drive the price of related products to a substantial reduction.
The above-mentioned dentists believe that the price of related consumables will drop after dental implants enter the centralized collection. However, since the cost of dental implant surgery cannot be underestimated, it remains to be seen how much the overall decrease will be.
When will the "freedom of dental implants" come?
Previously, the sales market of drugs and high-value consumables promoted at the national or local level was mainly concentrated in public hospitals, and many of them belonged to the scope of medical insurance payment. Specifically, public hospitals were used as incisions. Determine the selection rules for bidders.
Different from this situation, the dental medical service industry has a relatively high degree of privatization, and the private sector dominates in terms of market share and the number of medical institutions.
According to the data of the National Health and Medical Commission, as of the end of 2019, there were about 885 dental specialty hospitals in the country, and among the dental specialty hospitals, there were 723 private specialty hospitals, accounting for 81.69%.
According to Tianyancha data, there are currently 1,239 companies whose business scope includes "oral implantation".
For consumables related to dental implants, more sales markets are still in private medical institutions, and they are mainly at their own expense.
From this perspective, will there be obstacles in promoting centralized procurement in an industry dominated by private medical institutions?
Chen Hao told reporters that the centralized procurement led by the state is more inclined to the scope of medical insurance payment, and it also involves the volume of reports.
Therefore, it may be challenging to promote the centralized procurement of dental implants nationwide, but it can be carried out at the provincial level. In the past, the centralized procurement of alliances explored in some places has encouraged the participation of non-public hospital systems and social pharmacies.
Zhao Bing believes that once the national centralized procurement of dental implants is implemented, the sharp price reduction of dental implants in public hospitals will force private hospitals to reduce prices.
He further introduced that (after centralized procurement) private hospitals should also have related products and models.
"It's like now that both public and private ophthalmology hospitals can use medical insurance to reimburse lenses for cataract surgery, but the specific reimbursement plan has not yet been announced. What can be confirmed now is that the procurement of dental implants will definitely be implemented, which is in line with the national plan. The general direction of mining remains the same.
In Chen Hao's view, private dental hospitals actually have a strong incentive to participate in centralized procurement. If there are many participating institutions, a strong bargaining party can be formed and the cost of purchasing consumables can be reduced.
Dental implants will involve different consumables such as implants and implant abutments. Centralized procurement can be carried out in the form of packaging for heart stents, artificial joints and other consumables.
At present, there are already places trying to incorporate dental implants into centralized collection.
In November 2021, the Sichuan Provincial Pharmacy Bidding and Procurement Service Center issued a notice on filling in the historical procurement data of oral medical consumables. Planting repair accessories, etc.
The notice shows that this is the centralized procurement of the inter-provincial alliance oral implant system led by the Sichuan Provincial Medical Security Bureau. All public medical institutions (including military medical institutions, the same below) that carry out oral implant surgery should participate, and other public medical institutions should participate. Institutions and medical insurance designated social medical institutions will participate voluntarily in accordance with relevant regulations.
However, as dental implants enter the centralized collection, it is unlikely that they will be included in the scope of medical insurance reimbursement.
As early as September 22, 2021, the National Medical Insurance Bureau made a clear statement in reply to the "Suggestions on standardizing the cost of dental implant materials and including their treatment and service costs in medical insurance" put forward by Li Xiaoli, deputy to the National People's Congress. The exclusion method manages the payment of consumables, and stipulates the items that the basic medical insurance does not pay and partially pays.
The medical insurance departments of all provinces (autonomous regions and municipalities) organize and formulate the catalogues of basic medical insurance consumables and diagnosis and treatment items in their respective provinces according to the actual situation such as the development of medical technology and the operation of medical insurance funds in their respective regions.
Due to the differences in economic development and medical technology levels in different regions, the scope of specific projects included and the level of payment are also different to some extent.
According to the regulations, at present, all provinces (autonomous regions and municipalities) do not include glasses, dentures, artificial eyes and other appliances into the scope of basic medical insurance payment.
"The Medical Insurance Bureau promotes the centralized procurement of dental implant-related consumables, not to intervene from the perspective of medical insurance payment, but from the perspective of price management and the perspective of accepting agency entrustment." Chen Hao said.
(At the request of the interviewee, Zhao Bing is a pseudonym in the text)