What does the 93% average price cut for centralized coronary stents show?
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After the price of the stent was strongly lowered by the National Medical Insurance Administration, another voice came out.
At a press conference held by the Medical Insurance Bureau, some media asked such a question: "Is the quality guaranteed for such a cheap stent?"
Similar problems have actually appeared in the previous rounds of national drug procurement.
"Is the antihypertensive drug of 0.07 yuan a piece reliable?" "Imported antihypertensive drugs are reduced to 0.6 yuan, will the quality be the same?" In fact, these questions have been raised in the volume purchases that have been implemented. One answer.
On November 5, the country's first centralized procurement of high-value medical consumables.
The lowest price reported on the market was Shandong Jiwei. The original price of the bracket was 13,000 yuan. Shandong Jiwei offered the lowest price of only 469 yuan.
Compared with 2019, the same products of the same companies fell by an average of 93%.
On that day, one of the most popular paragraphs on the Internet said that "you can buy 6 bottles of Moutai yesterday with one holder, and you can buy 6 holders for one bottle of Moutai today."
After the price of the stent was strongly lowered by the National Medical Insurance Administration, another voice came out.
At a press conference held by the Medical Insurance Bureau, some media asked such a question: "Is the quality guaranteed for such a cheap stent?"
Similar problems have actually appeared in the previous rounds of national drug procurement.
"Is the antihypertensive drug of 0.07 yuan a piece reliable?" "Imported antihypertensive drugs are reduced to 0.6 yuan, will the quality be the same?" In fact, these questions have been raised in the volume purchases that have been implemented. One answer.
Most companies quoted a price of more than 700 yuan
As far as the stent is concerned, its production cost is actually very low.
The listed company Sino Medical has disclosed the gross profit rate of major domestic stent companies: Lepu Medical 79.28%, Parkson International 83.46%, and Minimally Invasive Medical 70.21%.
A bracket with an ex-factory price of 3,000 yuan, the actual production cost is less than 600 yuan.
In this centralized procurement, most companies quoted a price of more than 700 yuan. In fact, they have fully considered the cost and profit level of the company.
Many companies adopt an agency sales system, and the ex-factory price is much lower than the terminal selling price. The price difference in between is the space for various dealers to "activate".
Today, this part of the space is completely squeezed, even the ex-factory price of the company has to be drastically reduced, and there is no guarantee of 80% of the net profit.
Enterprises make profits and patients benefit, which in itself is the original intention of the country to purchase in quantity.
Reasons for the high price of the bracket
Around 2010 is the last golden age of foreign brand vascular stents.
The China Price Association conducted an analysis that year. The high-end medical devices such as stents are expensive, mainly because of the "many intermediate links." The stents are sold from the factory or imported to the hospital and sold to patients at an average price increase of 2.28 times.
In fact, the China Price Association did not say thoroughly: the so-called "intermediate links" are just deliberately created by dealers to avoid excessive single profits, because if the increase rate of each invoice exceeds a certain percentage, it may be investigated by law enforcement agencies.
In order to raise the price, only to set up more intermediate links.
Keep the purchase price as low as possible and encourage doctors to sell privately. This was the typical "promotion" method of medical device companies in that era.
At a cardiovascular academic conference in 2011, domestic cardiologist Hu Dayi bombarded the abuse of stents: 12% of patients were over-treated, and 38% of stents were either putable or not putable.
At this meeting, the cost of the bracket was disassembled one by one.
A heart stent with an ex-factory price of 3,000 yuan is sold to the hospital for 11,500 yuan, which doubles the price of the hospital to 27,000 yuan for patients; while the same imported stent, with a CIF price of 6,000 yuan, becomes 23,000 yuan at the hospital. , Hospitals sold around 38,000 yuan.
At that time, there was no provincial bidding for high-value consumables, let alone centralized procurement nationwide.
Hospitals are the main source of high-value consumables such as stents.
Which one to use or not to use is basically the decision of the vice-president and the director of the equipment department of each hospital in charge of procurement.
In addition to the dealer’s profit, it can be imagined how much money the patient really spends on the "stent" product when installing an imported stent worth nearly 40,000 yuan.
This seemingly unreasonable situation has its "reasonable" internal logic behind it.
In many developed countries, stents are cheap, but doctors’ surgeries are expensive.
Statistics show that in 2006, the average cost of a stent implantation operation in the United States was US$15,000.
In 2020, the domestic stent installation requires cardiac angiography, stent implantation, ICU ward 6 days after surgery, and general ward 7 days after surgery. These costs plus surgery and medication during hospitalization will add up to a total of about 20,000 yuan. RMB.
The labor value of doctors, the cost of using various monitoring equipment, the cost of medical services and the cost of medicines, all of which add up, are still less than the money of a stent.
If doctors fail to obtain their due value in medical services, they may seek compensation from other channels.
China's medical industry needs to be clean and upright
After the centralized procurement of stents, Zhong Dongbo, Director of the Medical Price and Bidding and Purchasing Department of the National Medical Insurance Bureau, said in an interview with the media: "After a lot of research and analysis in the early stage, the Medical Insurance Bureau expects the lowest price this time may be 500 to 600 yuan. This price is based on a comprehensive cost investigation. Moreover, the Medical Insurance Bureau also referred to the financial statements of listed companies and finally reached a conclusion."
Let medical technology reflect its due value is the core of the next public hospital construction and management reform.
The essence of medical care is that doctors achieve the purpose of treating patients through equipment, instruments and medicines. Without the wisdom of doctors, equipment and medicines are just a bunch of furnishings.
What we are doing now is to return the value of wisdom.
The ongoing DRGs (DRGs) may be the most appropriate way to realize the value of doctors’ wisdom.
Zhong Dongbo clearly mentioned: "In areas where DRG payment has been implemented, the payment standard will not be lowered, and the balance will be left to medical institutions to encourage the use of bid-winning products; where DRG reform has not been implemented, 50% of the medical insurance balance will be allocated to medical care. Institutions provide performance rewards."
This means that the total amount of medical insurance payments for stent surgery will still be fixed, and the cost of the stent will drop, and the extra part can be distributed to doctors in the form of bonuses.
Doctors with reasonable income from the sun will certainly be better than private gray transactions.
The rounds of purchases of medicines and consumables with volume, I believe it can bring a clean and upright atmosphere to the Chinese medical industry!
Wang Zhuoming