From 13,000 yuan to 700 yuan, the rebate given by the medical representative is "one 2,000 yuan"
The indictment reveals the "mystery" of the price reduction of the heart stent
A few days ago, an indictment caused the heart stent to be pushed to the forefront again.
A medical representative clearly marked the price of the rebate for the heart stent. With the "rebate of 2,000 yuan each", more than 4,000 sets of heart stents were sold to a hospital in 11 years.
Heart stent profiteering "discounted to the ankle"
A few days ago, a rumors of incomplete models of heart stents in the top three hospitals in many places spread on the Internet.
According to the news, after the national centralized procurement of heart stents, incomplete models frequently appeared in hospitals in many provinces and regions.
The news also stated that according to the "China Cardiovascular Health and Disease Report 2019" statistics, my country will use 1.5 million heart stents a year.
If the heart stent is in a hurry, it means that many patients have to wait in line.
Officials directly use data to make Internet rumors self-defeating.
A reporter from Beijing Youth Daily learned that on September 6, the Joint Procurement Office for High-Value Medical Consumables of the National Organization disclosed the main status of the implementation of the results of the centralized procurement of coronary stents since January 2021: January to August 2021, the selected enterprises 1.98 million selected stents have been supplied from the factory, which is more than 1.8 times of the annual contracted purchase volume and 1.8 times of the actual use by the hospital.
After deducting the amount used by medical institutions from the factory, the number of circulation and inventory links reached 880,000, and the supply is sufficient.
The source of this series of turmoil has to start in November 2020.
At that time, the National Medical Insurance Administration organized a collection of heart stents.
At that time, the average purchase price of a heart stent in the hospital was 13,000 yuan, and the highest quotation among the companies participating in the centralized procurement was 7,000 yuan, and the final winning average price was 700 yuan, which was jokingly called "discounted to the ankle" by netizens.
This ultra-low price will inevitably cause some doubts from the public. For example, can a heart stent with a 95% price drop guarantee the quality?
In fact, according to Frostullivan's statistics, the average ex-factory price of domestic stents in 2019 is 3,000 yuan.
Based on the 78.06% gross margin disclosed by Lepu Medical, a leading company in the industry, the cost of a single heart stent is about 658.2 yuan.
Since the national centralized procurement price can cover the cost and expenditure of cardiac stent manufacturers and still leave a certain profit margin, why are there such rumors?
A bribery case leads to "medical corruption"
On the morning of September 23, the local court opened a hearing to hear the bribery case of Liu, the former director of the Cardiovascular Department of the People's Hospital of Lixin County, Bozhou, Anhui.
Liu received a total of more than 2.31 million yuan in rebates over the past two years, including more than 1.41 million yuan in rebates for medical consumables, mainly balloons and cardiac stents.
On the same day, an indictment published on the 12309 China Procuratorate revealed that a medical agent, Chen Moumou, paid a rebate of 8.243 million yuan to a hospital in Luoyang from December 2008 to January 2019. Prosecute.
According to the indictment, in order to promote the heart stents and supporting high-value consumables it represented, from June 2010 to February 2013, the defendant Chen Moumou used the “××” brand heart stents supplied by his agency for 2000 yuan each. The standard of 500 yuan per balloon will be returned to the cardiology department of a hospital for medical rebates.
From December 2008 to the incident, Chen was found to have sold a total of 4254 sets of stents and 3955 balloons through rebates.
The indictment discloses "rebate of 2,000 yuan"
A reporter from Beijing Youth Daily searched through the Judgment Documents website and found that from 2013 to December 2019, there were more than 3,000 bribery cases in the medical field.
In the process of investigating and handling cases, bribers and bribers often use conventions, unspoken rules and other excuses to justify their actions.
In these verdicts, many prosecutors sued the defendant for "bribery to the unit."
In many judgments, some department heads not only withdrew the deductions themselves, even took the initiative to "talk about the rebates", but also implemented the "rain and dew equalization" to redistribute the rebates in the department.
Among them, a criminal verdict of the Intermediate People's Court of Xianyang City, Shaanxi Province showed the above situation.
According to the verdict, Niu, the director of the cardiology department of a hospital who was the bribery party, said that in the second half of 2008, when the hospital was able to perform hundreds of stent operations, the defendant selling heart stents found him and said that he would provide them to the department. Medical support", according to the regulations.
Niu further explained that the so-called "medical support" is the rebate paid to the department, and the industry rules are the unspoken rules of the industry. The rebate is basically 10% of the price of the stent.
According to the agreement at the time, the rebate for a domestic brand bracket is 1,500 yuan, and an imported brand is 2,000 yuan.
The director of the department is responsible for talking about the rebate, and the deputy director and deputy chief physician of the department are responsible for the specific operations.
As of the incident, the department received more than 700,000 yuan in rebates for the heart stent, and the deputy chief physician in charge of the practice had received the most bribes.
The verdict showed that the rebate rates for medical devices such as heart stents and other medical devices sold to hospitals are surprisingly consistent, some are 10% or 20%, and some are "2,000 yuan."
In addition, in order to allow patients to choose their own company's products when doing cardiac stents, the company's medical representatives not only give rebates, but also invite relevant hospital personnel to go out for "inspection and study."
Rectify
Multi-sectors join forces to combat medical corruption
"The rebate has become a stepping stone for pharmaceutical companies to enter the hospital. As long as one is delivered, the rest must keep up." Some industry insiders said.
Pharmaceutical companies have even included the bribes in the sales costs of medicines and medical devices, flattening their accounts with advertising expenses, travel expenses, office expenses, etc. These "costs" need to be paid by patients.
A relevant person in charge of a hospital once revealed that once the receipt of rebates and property becomes an unspoken rule and industry ethos, medical staff will lose their medical ethics, even violate disciplines and laws, and ultimately increase medical expenses, increase the burden on patients and medical insurance funds, and aggravate the conflict between doctors and patients.
Relevant departments did not let this gray product go.
Centralized procurement of medicines and medical equipment is one of the ways to cut ash production.
Allowing centralized procurement of drugs and medical equipment in quantities has changed the previous situation where the “life and killing powers” of drugs and consumables were all controlled by the hospital staff. At the same time, the intermediate links were reduced, the company's sales costs were reduced, and the ex-factory prices were closer to the terminal prices. Let the people really get benefits.
In response to the rebate trend of drugs and medical devices, the Central Commission for Discipline Inspection and the State Supervision Commission has also frequently issued documents to explain the case.
According to incomplete statistics from a reporter from the Beijing Youth Daily, since 2020, the website of the State Supervision Commission of the Central Commission for Discipline Inspection has released news eight times, requesting a thorough investigation of medical corruption.
On April 27 this year, the Medical Administration and Hospital Administration of the National Health Commission issued a new "Notice on Printing and Distributing the Main Points of Correction of Unhealthy Practices in the Field of Medicine Purchase and Sale and Medical Services in 2021".
Nine departments including the National Health Commission, the Ministry of Industry and Information Technology, the Ministry of Public Security, and the Ministry of Finance jointly issued the "Key Points for Correcting Unhealthy Trends in the Field of Pharmaceutical Purchase and Sales and Medical Services in 2021" to address the new round of unhealthy practices in the field of pharmaceutical purchases and sales. The focus of rectification has been clarified.
The National Medical Insurance Bureau previously issued the "Guiding Opinions on Establishing a Credit Evaluation System for Pharmaceutical Prices and Recruitment", requiring all localities to establish and implement a credit evaluation system by the end of 2020. Pharmaceutical companies involved in seven types of untrustworthy behaviors such as pharmaceutical commercial bribery will be included in the untrustworthy "blacklist".
In the 2020 version of the list of medical prices and untrustworthy items in recruitment, "In the purchase and sale of medicines, rebates or other illegitimate benefits given to medical institutions of all levels and types, centralized procurement institutions and their staff" rank first in the main untrustworthy circumstances.
On September 28 this year, the National Medical Insurance Bureau announced the results of the "serious" and "particularly serious" untrustworthy evaluations of price recruitment credit evaluations (first issue of 2021).
Of the five companies notified, three have been "blacklisted" because of their involvement in medical bribery cases.
Text/Reporter Zhang Xin Co-ordinated/Yu Meiying