While effectively ensuring that patients can afford high-quality medicines, some difficulties and blockages have also emerged
After the "soul bargaining", how to advance the centralized procurement of pharmaceutical consumables?
Reporter Wang Weiyan Yang Zhaokui
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With the promotion of the normalization of centralized procurement of pharmaceutical consumables, while effectively ensuring that patients can afford and use high-quality medicines, some difficulties and blocking problems have also emerged.
Experts pointed out that to further improve the quality of centralized procurement, the selected price must not only cover production costs, but also cover reasonable distribution costs and service costs associated with consumables.
Recently, a centralized procurement related to the price of dental implants has attracted much attention.
On January 11, the centralized procurement of dental implants opened in Chengdu. The average price of the selected products dropped to more than 900 yuan, an average decrease of 55% compared with the median purchase price before the centralized procurement. brought great benefits.
At present, dental implant consumables are not included in the scope of medical insurance reimbursement. This centralized procurement is also the first attempt to expand the centralized procurement of high-value consumables from the medical insurance field to the non-medical insurance field.
Centralized procurement, that is, centralized procurement with quantity, through linking quantity with price and exchanging quantity for price, constantly squeezes out falsely high prices, guides the prices of medicines and consumables to return to a reasonable range, and solves the problem of expensive medical treatment for the masses.
According to the latest data released by the National Medical Insurance Administration, at present, 7 batches of centralized procurement of drugs and 3 batches of centralized procurement of consumables, superimposed on centralized procurement by local alliances, have reduced drug consumption by more than 400 billion yuan.
With the advancement of the normalization of centralized procurement, while effectively ensuring that patients can afford and use high-quality medicines, some difficulties and blockages have also emerged.
A few days ago, at the "National State Forum: Normalization of Centralized Procurement and High-quality Development of Medical Care" seminar held by China News Agency, experts made suggestions to better promote centralized procurement.
Abandon "only low price" and improve the quality of centralized procurement
After the "soul bargaining" of centralized procurement of medicines and consumables, patients' medical burden continued to decrease.
In terms of centralized drug procurement, since 2018, focusing on common diseases and chronic diseases, the state has organized 7 batches of centralized drug procurement, involving 294 kinds of drugs, and the average price of 1,135 selected products has been reduced by more than 50%.
The proportion of patients using high-quality medicines in centralized collections has increased from 50% to more than 90%.
In terms of centralized procurement of consumables, the country has carried out 3 batches of centralized procurement in the two most concerned areas of inflated prices of consumables in cardiology and orthopedics. Among them, the centralized procurement of cardiac stents has been successfully continued in November 2022, and the average price of selected stents is 770. The average price of selected products in the centralized procurement of artificial joints and orthopedic spine high-value medical consumables has exceeded 80%.
Experts said that "cutting down" the price through centralized procurement is not "only low price theory", but to find a balance among multiple goals.
On the premise of squeezing out the price moisture, enterprises must also obtain reasonable profits without affecting the availability of related medicines and consumables, and without increasing the burden on medical insurance and patients.
How to further improve the quality of centralized procurement?
According to Wu Ming, a professor at the School of Public Health of Peking University, the next step is to further improve the centralized procurement rules based on clinical needs, with quality as the core and clinical value as the guide. At the same time, the selected price must not only cover production costs, but also cover reasonable costs. Circulation costs and consumables accompany service costs.
Wu Ming pointed out that although some drugs and consumables have passed the consistency evaluation at present, the effect in the actual use process is uneven. Therefore, it is necessary to establish an information management system for clinical consumables and a product and service quality evaluation system to avoid "bad money expulsion". Good money".
Improve logistics distribution and distributor selection
Circulation and distribution are important links in the completion of centralized procurement. During the discussion, experts unanimously mentioned logistics, transportation and service issues after centralized procurement.
Wu Ming found in his research that in the past, a third party managed the hospital's consumables inventory, including ordering, stocking, and timely replenishment, which was equivalent to providing "nanny service"; after the centralized procurement, the circulation link was greatly reduced, and many agents Withdrew, the material management services provided to the hospital were significantly reduced, and the distribution companies had no experience and ability, and only delivered goods without providing other services. This resulted in a mismatch between the supply and demand sides—the internal demand of the hospital was not transmitted to the supply companies in a timely manner , there will be management gaps in the short term.
Wu Ming suggested that it is necessary to define the responsibilities of all parties as soon as possible, establish corresponding incentive and supervision mechanisms, and clear the blockage points in the centralized procurement and circulation link.
Zhang Wei, deputy general manager of Sinopharm China Medical Devices Co., Ltd., also said that in order to better serve centralized procurement, it is necessary to pay attention to the role of large-scale distribution and distribution companies.
According to Zhang Wei, usually national medical device circulation and distribution companies will set up business network companies in various places and carry out tripartite logistics business for medical devices in order to realize the centralized procurement of products. However, separate declarations are required for storage and transportation across administrative regions. Regulators need to conduct approval according to their respective approval authority, which to a certain extent restricts the smooth flow of centralized procurement products in the circulation and distribution links.
He suggested that a multi-warehouse coordination system for centralized procurement, distribution and distribution enterprises should be established, and a multi-warehouse coordination mechanism for tripartite logistics within large enterprises should be explored on a national pilot basis.
Zhang Wei also suggested that the selection mechanism for distributors should be improved, including storage area, personnel qualifications, coverage area, registered capital, etc., to ensure safe and efficient distribution of centralized procurement results to medical institutions at all levels.
Encourage enterprises to take the road of innovation
The high-quality development of the medical industry is inseparable from innovation, and innovative pharmaceutical consumables have the characteristics of high investment, long cycle, and high risk. Enterprises must have expectations for high returns.
"Will new technologies and consumables be included in medical insurance in the future? At what time and under what conditions can medical insurance maximize social value and economic value? These all need to be considered." Yang Jianlong, deputy secretary-general of the China Medical Equipment Association, said that some domestic Equipment and consumables companies have invested heavily in research and development. If products enter the centralized procurement soon after they are launched, and the centralized procurement has long been based on "low prices" as the standard, corporate recovery costs and profit creation will be affected, which is not conducive to pharmaceutical innovation in the long run.
Yang Jianlong said bluntly: "I hope to have a flexible and precise policy. As a new technology, we can temporarily stop centralized procurement and medical insurance, at least wait until it is mature enough or have a good health mechanism value before entering medical insurance, and give new technologies a certain degree of freedom. market."
"How to ensure that enterprises can obtain due returns after high investment should be left to the market mechanism to solve." According to Su Jian, director of the National Economic Research Center of Peking University, the evaluation mechanism for hospitals and doctors should be further improved. The system pays more attention to the professionalism and innovative ability of doctors, rather than the number of papers.
However, in Wu Ming's view, a high rate of return does not mean that the company will definitely have the motivation to innovate.
"In the past, the price of pharmaceutical consumables in my country was very high and profits were high, but enterprises were not motivated to innovate, because they could make money lying down as long as they gave 'rebates'. Why should they take the road of innovation with extremely high risks?" Wu Ming believes that it is necessary to motivate To innovate, we first need to create a good market environment for medical innovation through reform, and centralized procurement has corrected market failures by greatly reducing the "rebate" space, forming effective innovation incentives, and the space vacated by centralized procurement can be used for R&D and innovation Products; centralized procurement of products with small profits but high sales. If enterprises want to obtain higher profits, they can only innovate.
The reporter noticed that at present, my country's top pharmaceutical companies are increasing their investment in R&D expenses, and the process of R&D and listing of innovative drugs is constantly accelerating.