The average price of centralized collection of coronary stents has been reduced by over 90%. How to balance the price and quality has caused concern
After the medical device "moisture" is squeezed out
● A small coronary stent is behind the rapid development of innovation and medical security in my country's medical field.
Only development and innovation can exchange "bargaining power" and better protect people's health
● In this centralized procurement by the national medical insurance department, the main reason for choosing coronary stents to "surgery" first is that coronary stents are currently widely used in clinical applications and belong to a category of high-value consumables with relatively large "moisture"
● There is indeed a problem with domestic medicines and consumables, that is, if the government's centralized procurement price is not set, the price will be inflated; if the centralized procurement price is too low, quality problems and innovation stagnation may occur.
Therefore, think about how to find a balance between the two
□ Our reporter Zhao Li
□ Sun Yifei, our intern
Recently, a "Combination of Quotations from a National Organization for Centralized Purchasing of Coronary Stents" refreshed the price of coronary stents to a new low: the average winning bid was about 700 yuan.
The average price dropped from 13,000 yuan to 700 yuan-the first batch of national centralized procurement of coronary stents has set a shocking "floor price" in Tianjin.
Compared with 2019, the average price of the same product of the same company has been reduced by 93%.
Xinhua News Agency commented that a small coronary stent is behind the rapid development of innovation and medical security in my country's medical field.
As a cardiologist said, since the domestic stents were available, the price of imported stents has dropped from a sky-high price of 40,000 to 50,000 yuan to about 10,000 yuan.
After 20 years of development, the domestic stent has become the first and only high-end medical device in the domestic market that is dominated by domestic companies.
This is the premise for the shocking and low prices of this centralized procurement, and it also shows that only development and innovation can exchange "bargaining power" and better protect people's health.
The price of coronary stents has dropped significantly
Reduce sales gray space
On November 5, the national centralized procurement of coronary stents was opened in Tianjin.
There was no group bidding for 26 stent products from 11 companies, and the prices were fierce on the spot. None of the 10 selected products exceeded 800 yuan.
Jiwei Medical’s EXCROSSAL product won the lowest bid price, which is 469 yuan/piece.
The prices of the other winning products, from low to high, were Ericsson of Esun Technology, quoting 549 yuan; Firebird 2 of MicroPort Medical, quoting 590 yuan; GuReater of Lepu Medical, quoting 645 yuan; Medtronic's resolute integrity, quotation 648 yuan; Firekingfisher of Minimally Invasive Medical, 750 yuan; Helios of Jinrui Kelly, 755 yuan; PROMUS PREMIER and PROMUS Element Plus of Boston Medical, 776 yuan each; NOYA of Wan Ruifeihong, 798 yuan.
The price drop of this centralized procurement has exceeded the expectations of the National Medical Insurance Bureau.
According to the data provided by the National Medical Insurance Bureau, after this centralized procurement, the price of the stent dropped from an average price of about 13,000 yuan to about 700 yuan.
Compared with 2019, the average price of the same products of the same company has been reduced by 93%, the average price of domestic products has been reduced by 92%, and the average price of imported products has been reduced by 95%. Based on the amount of intended purchases, it is expected to save 10.9 billion yuan.
It is worth noting that mainstream products commonly used clinically by medical institutions are basically selected, covering more than 70% of the intended purchases by medical institutions.
Liu Zhaoping, a professor of cardiology at Peking University First Hospital, said that the bid-winning product basically covers the more clinically used stents, which can fully meet the clinical use and the needs of patients.
At the gathering site, a medical representative said that the price of eyelashes is more than that.
Sun Feng, a distinguished researcher of the International Research Center for Medical Management of Peking University, analyzed that the current centralized procurement quotation is only the price of a stent, and there is no service fee for doctors or hospital site fees. They are two different prices.
Sun Feng hopes that through this price reduction, the burden on patients can be reduced on the one hand, and the cost of medical services for doctors can be increased on the other hand, reflecting the value of doctors’ labor, allowing doctors to have a legitimate income, and reducing the gray space for coronary stent sales. It is conducive to improving the service quality of doctors, and is conducive to the healthy development of the medical equipment sales industry.
Zhong Dongbo, director of the Department of Medical Price and Bidding and Purchasing of the National Medical Insurance Administration, believes that this centralized procurement will not only help medicinal equipment companies reduce circulation costs, but also purify the industry ecology.
From a regulatory perspective, the requirements for product quality will not be relaxed.
"The intensity of supervision will only be stronger than in the past and will not be weakened." Zhang Tiejun, a member of the party group and deputy director of the Tianjin Medical Insurance Bureau, said that the products will continue to maintain the original quality standards and quality levels as in the past.
More clinical applications
Most moisture in circulation
Why can the price of coronary stents fall like a cliff?
An industry insider interviewed by a reporter from the Rule of Law Daily said that because the original price was too "moisture".
Some people describe the price of "moisture" in high-value medical consumables as a towel in a basin, "pour water when you pick it up, you don't need to squeeze it at all."
A reporter from the Rule of Law Daily randomly interviewed the public and found that people’s awareness of the term medical devices is not very high, but they believe that medical devices are as indispensable as medicines.
It is precisely because of the low awareness that people often have no idea about the expensive equipment.
In the age when the medical reform has not yet set sail and the medical system is not yet sound, the asking price of equipment is too high compared to medicines.
In recent years, a number of corruption cases in the medical field have been exposed one after another, revealing a "black interest chain" in circulation-from manufacturers, intermediate distributors to related doctors, all may be a link in the chain.
For example, a certain department of a hospital has illegally accepted supplier rebates for many times in accordance with the proportion of domestic consumables 30%, imported consumables 25%, joint spine consumables 20%, and trauma consumables. Patients and medical insurance funds will pay.
Taking coronary stents as an example, the most effective treatment for coronary heart disease is PCI (percutaneous coronary intervention) surgery.
The small and delicate coronary stent is the most critical consumable in this operation.
The basic principle of PCI surgery is to implant a stent into the coronary artery to stretch the artery wall to restore the blood flow.
"China Cardiovascular Health and Disease Report 2019" shows that the number of cardiovascular patients in my country currently reaches 330 million; from 2009 to 2019, the number of coronary heart disease (PCI) operations in China has grown from 230,000 to more than 1 million. The annual growth rate is 10% to 20%.
Huo Yong, vice chairman of the Chinese Cardiovascular Health Alliance, once disclosed a set of data: In 2018, the total number of coronary heart disease interventional treatment cases in mainland China reached 915,256, an increase of nearly 160,000 cases from 2017, and a compound growth rate in the past five years. As high as 15.03%.
With the rapid increase in the number of interventional cases of coronary heart disease, people have put forward higher requirements for coronary stents.
The price of domestic stent is about 8,000 to 12,000 yuan; the price of imported stent is about 18,000 to 20,000 yuan.
Although stent surgery can be partially reimbursed in recent years, the cost is still relatively high for rural families.
A number of cardiovascular experts told the reporter of the "Rule of Law" that the current production process of domestic stents is completely comparable to imported stents. Therefore, most doctors will recommend that patients use domestic stents, unless the type of stent required by the patient is special or the doctor requires it. Only imported brackets will be used.
"This time the national medical insurance department's centralized procurement, the main reason for choosing coronary stents to "surgery" is that the current coronary stents are widely used in clinical applications and belong to a category of high-value consumables with a relatively large "moisture"." Peking University Professor Wang Yue of the School of Medical Humanities said in an interview with a reporter from the Rule of Law Daily.
It is understood that the cost of coronary stents is not high, and most of the "moisture" is concentrated in the circulation link at a price of more than 10,000 yuan in medical institutions.
Zhong Dongbo once told the media: "Although the average price of coronary stents is 13,000 yuan, the actual packaged price for agents is only 2,000 yuan, and the middle part is entirely the circulation cost. Now we have a large number of direct procurement manufacturers, With a clear expectation of use, pharmaceutical companies can eliminate the need for promotion. This money is saved, and the company still has a fair and reasonable profit margin, and it may be higher than the general industry."
Liu Xin, director of the Medical Law and Ethics Research Center of China University of Political Science and Law, also explained: “The phenomenon of inflated prices of medical devices is more common. The amount of medical devices is small and the price is marketed, so it is more of a problem in the circulation field. Supply and demand of medical devices There is a one-way relationship, and there is no problem of market choice. Because after medical equipment enters the hospital, the hospital needs to use the equipment when performing operations on the patient. Generally, the equipment from one or two manufacturers in a hospital is great."
"The manufacturer produces a certain kind of medical device, wholesales through the middleman, and finally enters the hospital. Therefore, in the middle link, the hospital's markup price can be restricted, but other middle links can basically not be restricted. And now there are many middle links, and every link In the price increase, many manufacturers may adopt some improper means to market, so the price will go up, and then a phenomenon of high prices will be formed." Liu Xin said.
Innovative products to close the gap
Domestic alternatives squeeze out water
It is worth noting that there is more than one type of expensive high-value consumables for coronary stents. Why will coronary stents become the "pioneer" in the collection of national consumables?
The answer to this question implies a key logic of the medical device industry: domestic substitution.
According to industry insiders, the market share of domestic stents now exceeds 75%. Four head companies, Lepu Medical, Minimally Invasive Medical, Jiwei Medical and Sino Medical, occupy most of the market, and their proportions are quite stable.
But at the same time, most medical devices and consumables are currently facing the technology monopoly and patent control of foreign companies, and there is basically no right to choose whether it is at the regulatory level or downstream procurement.
For specialized consumables in high-precision fields such as neurointerventional instruments, surgical robots, and artificial joints, the ratio of domestic and imported materials is almost inverted.
In addition to consumables, the field of high-end medical equipment is also monopolized by foreign companies. 80% of the CT market, 90% of the ultrasonic instrument market, and 90% of the magnetic resonance equipment are occupied by foreign brands.
High-performance MRI systems and high-end CT machines usually cost more than 5 million yuan, and high-performance equipment means clearer images. In the diagnosis of tumors and other diseases, a higher definition means that a more detailed human body can be seen Organize information.
A gap of dozens of pixels can affect the doctor's diagnosis of the disease.
“At present, most consumables in our country can be made in China. Although there is still a certain gap in the quality of domestic and imported products, it is not entirely necessary to rely on foreign products. Perhaps only some consumables need to rely on foreign products. But in recent years, companies should indeed More attention is focused on product innovation rather than product promotion. Companies must reduce costs through product innovation and narrow the gap between their products and imported products.” Wang Yue said, but it does not affect the pure pursuit of the lowest price. Because medicines and consumables are too special and related to human life safety, the quality of domestic medicines and consumables is uneven.
In recent years, relevant state departments have introduced a series of policies to try to squeeze out the "moisture" of high-value medical consumables.
In Liu Xin's view, it is still difficult to squeeze out the "moisture" of high-value medical consumables, but it is not too difficult.
"The problem now is to restrict hospitals, especially the scope of medical insurance. The behavior of the National Medical Insurance Bureau this time can effectively squeeze out the'water', lower the price, and form a virtuous circle." Liu Xin said, " From a certain perspective, in the past, the health administrative department and the drug regulatory department may even be a benefit-sharer, so they will not promote the process. Now because the medical insurance funds are involved, the medical insurance department has to move the cake."
Liu Xin believes that this centralized procurement with volume is a good sign, and through some administrative intervention, the "water" may be squeezed out.
Standardize the development of medical devices
Price and quality are well balanced
After the bid price of coronary stents was exposed, some stent manufacturers immediately stated to the media that coronary stents are no longer high-value consumable products, and even bluntly said that “the original in-hospital coronary stent market was about 12 billion yuan, but this time Volume purchases, the market size has dropped to less than 1 billion yuan. In the next 5 years, this market may no longer have innovative products. Volume purchases have squeezed out the industry’s “moisture”, and today’s “floor prices” have not remained. Create a certain amount of innovation space".
In this regard, Liu Xin expressed his disapproval, “The price of medical devices is so high that it is not that the right holders of medical devices enjoy the price. From the perspective of rights protection, the stent is the same as other patented products, and the patent protection period has passed. In the future, anyone can produce. From this perspective, it has nothing to do with invention and creation. As long as there is a patent protection mechanism, some people will invent and create.”
Wang Yue puts forward another view: "The reduction in prices brought about by centralized procurement may result in the failure to guarantee the reasonable profits of enterprises’ innovative R&D. The government collects a large number of purchase orders and exchanges prices for quantities. Enterprises often cannot deal with such horizontal groups. Procurement is either out of the market or promises a low price."
Wang Yue further analyzed that the current chaos in the industry is mainly commercial bribery, etc. The purpose of centralized procurement is to reduce unreasonable costs.
But objectively speaking, the reduction in prices brought about by centralized procurement may result in the failure to guarantee the reasonable profits of the company’s innovative R&D. Therefore, centralized procurement may not be the best procurement method, but now we can’t think of a better solution. So this is a second best choice.
"Perhaps with the popularization of Internet drug and consumable sales, it may gradually change from centralized procurement to decentralized procurement. When the inflated prices of drugs or equipment are suppressed in a short period of time, it may be possible to transition from centralized procurement to decentralized procurement. Ways to find the best and reasonable balance of prices." Wang Yue said.
Wang Yue believes that there is indeed a problem with domestic drugs and consumables, that is, if the government's centralized procurement prices are not set, prices will be inflated; if the centralized procurement prices are too low, quality problems and innovation stagnation may occur. .
Therefore, we must think about how to find a balance between the two.
Liu Xin believes that there are two aspects worthy of attention to the road to the future of high-priced medical devices:
First, the hospital must return to public welfare. The government-sponsored medical institution is a non-profit medical institution, but these medical institutions are now making profits under the banner of non-profit, because if the hospital does not make a profit without government input, There is no way to pay employees, so the government has to provide subsidies for the medical industry.
Second, some other participation mechanisms can be used to restrict the circulation and production links, such as the procurement of quantities by the drug regulatory department.
Wang Yue’s suggestion is that in addition to administering bribes, it is also necessary to administer bribery. “The new Practicing Physician Law establishes a life-long ban on physicians. If it is because of commercial bribery that has been administratively punished and investigated for criminal responsibility, it will not be Register as a doctor again. Once the license is revoked, it will be revoked forever and you can no longer engage in this industry.”
Wang Yue also mentioned that the current income and remuneration of medical staff are polarized, with the high being very high and the low being very low.
The income gap between medical staff should be substantially reduced, especially the income gap between general practitioners and specialist doctors.
"It is also necessary to encourage direct sales of enterprises, and even require manufacturers to direct direct sales. No agency system is allowed. The current drug and consumable distributors should be turned into distributors. The moral hazard and legal responsibilities of all circulation links should be transferred to the manufacturing enterprises through direct sales. , Production companies generally dare not implement commercial bribery." Wang Yue said.
In addition, Wang Yue also suggested that a company blacklist system should be established to include the production and operation companies involved in bribery on the blacklist and prohibit sales within a few years.