Centralized procurement, price reduction of heart stents to benefit the people (in-depth observation)
On November 5th, my country’s first centralized procurement of high-value medical consumables was opened in Tianjin. The object of this centralized procurement is coronary stents.
After centralized procurement, a total of 10 products of domestic and imported stents were selected, and the average price dropped from about 13,000 yuan to about 700 yuan, a decrease of about 93%.
It is expected that in January next year, patients will be able to use the selected heart stent.
Bracket supports new life
In my country, about 1 million patients with coronary heart disease are implanted with heart stents each year, and their quality of life is improved and improved due to the stent.
Hearing that the heart stent dropped to about 700 yuan, Li Qiang kept telling his son that he was "losing a loss."
The son hurriedly comforted him: "No loss, no loss. At that time, the three-vessel coronary artery infarction area reached 70%. If you don't do it, it will save your life!" After thinking about it, Li Qiang felt right. After all, it will be cheaper to put a stent in the future. .
At this time, more than a month has passed since Li Qiang released the stent.
Li Qiang, 59, lives in Henan.
He found symptoms of myocardial infarction during the physical examination of his unit in September.
At that time, the doctor left him in hospital.
Li Qiang said that he didn't feel it, it didn't hurt or itchy, but he didn't listen to advice and returned home.
That night, the doctor's wife and brother learned about it, so he hurriedly called to persuade Li Qiang to be hospitalized.
The son who worked in Beijing rushed back to Henan overnight, and the next day he took his father to the hospital for coronary angiography.
The results of the radiography showed that the heart had a large area of atherosclerosis, which required surgery to open up the blood vessels.
Since the operation could not be performed locally, his son took him to a large hospital in Beijing.
On September 18, Li Qiang was admitted to the hospital.
Coronary angiography showed that all three coronary arteries of the heart were blocked.
"70% of your blood vessels should be blocked at least five years ago." The doctor read the results and said a word.
Li Qiang heard it and felt a cold back.
Thinking about it carefully, in July and August of last year, one night I did feel heart-stricken. I lay down all night and got up the next day. It seemed that there was nothing wrong with me, so I didn't care too much.
After weighing in, Li Qiang chose to implant a stent instead of a bypass surgery because of "smaller wounds and better recovery."
A few days later, in two operations, Li Qiang was implanted with 1 and 5 stents, all imported stents.
Among them, 5 are two different brands of drug-eluting coronary stents, the unit prices are 17,000 yuan and 17,320 yuan respectively, and one is a platinum-chromium alloy degradable coating everolimus eluting coronary stent, the price is 18,800 yuan .
The total cost of Li Qiangguang's stent exceeds 100,000 yuan, plus the supporting balloons, catheters, guide wires and other consumables, as well as angiography, inspection, and surgery, the total cost reaches 220,000 yuan.
After reimbursement by medical insurance and supplementary insurance for serious illnesses, Li Qiang paid about 100,000 yuan.
This is a bit heavy for him.
On September 30, Li Qiang was discharged from the hospital.
Since then, he has taken 11 kinds of medicines every day, including diabetes medicines he took all year round, anti-thrombotic medicines after implantation of stents and other medicines.
After putting on the bracket, the son found that Li Qiang had changed.
Stop smoking, stop drinking liquor, and change the habit of not loving sports.
Today, Li Qiang counts his steps every day, carefully formulates his diet plan, and records blood sugar, blood pressure, and blood lipids.
"The chest is very comfortable after the stent is placed, and I feel refreshed. But it is really expensive, and I am afraid of re-stenosis. I have to quit smoking and drinking as required by the doctor and change my lifestyle. I hope that the follow-up visit will not deteriorate in a year." Li Qiang said. .
Du Jin from Inner Mongolia put the stent in Beijing Anzhen Hospital two years ago.
"Since then, my life has changed because of the bracket." Du Jin said.
Three days after being discharged from the hospital, Du Jin returned to his home in Hohhot, Inner Mongolia Autonomous Region, reported to the surgeon through the Good Doctor Online Internet platform, and uploaded his heart rate and blood pressure test results. He was relieved to go offline until the doctor returned "normal".
Since then, Du Jin consulted a doctor several times on blood pressure and other issues and followed up online.
Due to timely communication with the doctor and taking medicine strictly according to the doctor's instructions, Du Jin recovered well after the operation and had confidence in life.
In my country, about 1 million patients with coronary heart disease are implanted with heart stents each year, and their quality of life is improved and improved due to the stent.
The small stent supports the patient's new life.
Coronary heart disease, in layman's terms, is the obstruction or stenosis of the coronary arteries that transport nutrients to the heart, leading to symptoms such as angina pectoris and myocardial ischemia, commonly known as myocardial infarction.
The treatment of coronary heart disease mainly includes three methods: drug treatment, surgical bypass surgery and percutaneous coronary intervention.
Percutaneous coronary intervention is a heart stent intervention operation, which is mainly to place a coronary stent into the coronary artery through a catheter to support the narrowed part and achieve the effect of restoring smooth blood circulation.
In 1986, French doctors Jacques Peel and Ulrich Sigvat successfully performed the world's first coronary stent surgery.
Because of its short course of treatment, less trauma, remarkable curative effect and fewer complications, it is favored by clinicians and patients.
In clinical applications, cardiac stents have been continuously improved. From bare stents to drug stents and degradable stents, the materials continue to evolve and the performance is increasingly optimized.
At present, interventional heart stents have been recognized as a safe conventional treatment.
For more than 10 years after the birth of the heart stent, the heart stent used by patients in my country has been imported, and the price is extremely high.
In addition to the auxiliary materials and inspection costs during the operation, installing a bracket is like buying a car.
In 1999, my country finally produced its own heart stent, and the price dropped.
However, the unit price of imported stents is still 20,000 to 30,000 yuan, and many patients put more than one stent, and the heart stent is still unattainable.
In recent years, the prevalence of cardiovascular diseases in my country has been increasing, and the total number of cases ranks first in the world, and the number of patients requiring cardiac stents is increasing.
The "China Cardiovascular Disease Report 2018" issued by the National Cardiovascular Disease Center shows that the prevalence of cardiovascular disease in my country is on the rise, with 290 million patients.
In 2016, the mortality rate of cardiovascular disease in my country ranked first, higher than that of tumors and other diseases, with 2 deaths from cardiovascular diseases in every 5 deaths.
From 2013 to 2016, the average number of implanted stents in patients with coronary heart disease basically remained at about 1.5, and the case growth rate was 13%.
Due to the high price, many patients have given up on implanting heart stents and chose conservative medications.
For patients who give up implanting stents, blocked coronary vessels are like a time bomb, threatening their lives from time to time.
The "hard bones" under the medical reform
High-value medical consumables are different from medicines. There is no stable structure and it is difficult to design a system similar to the consistency evaluation of medicines.
November 5, 2020 is the day when the state organizes the opening of bids for centralized procurement of cardiac stents.
There are still two hours to leave the standard time, and many business representatives are already waiting anxiously outside the venue.
The seemingly peaceful venue is brewing huge waves of reform.
This is the first time that my country has carried out a state-level centralized procurement of high-value medical consumables with high prices.
High-value medical consumables are different from medicines. There is no stable structure and it is difficult to design a system similar to the consistency evaluation of medicines.
Although the amount is increasing, it is difficult to compare quality and price due to different standards, which brings difficulty to procurement.
The industry generally regards it as the "deep water zone" of reform and the hard "hard bone" of reform.
From April last year to November this year, the National Medical Insurance Administration conducted a lot of research and market analysis, encouraged local pilot projects, and clarified the principle of centralized procurement for one product, one strategy.
After screening, they found that a more mature technology and stronger alternative heart stent is more suitable.
Among them, the heart stent with the two characteristics of chromium alloy, rapamycin and its derivatives is clinically more advanced and has been identified as a centralized procurement product.
The recruitment rules are designed to recruit and purchase according to the product registration certificate, and the medical institutions will independently report the volume, exert the scale effect and linkage effect of concentration and volume, and allow enterprises to reduce prices independently.
At 10 o'clock in the morning, the company declared the product price information to open the bid.
According to the rules, the finalist price must be less than 1.8 times the lowest declared price in the market, and the price higher than 1.8 times the lowest declared price must be less than 2,850 yuan.
The fuse price of 2850 yuan comes from the lowest declared price in the volume purchases in Jiangsu Province last year.
The reason for determining the declared price range is because the National Medical Insurance Bureau found in the preliminary investigation that the price of drug-eluting stents in my country is higher than that of other countries in the world.
In some countries, without centralized procurement, the price of the bracket of the same brand is about 2,000 yuan, and the price for centralized procurement with volume is reduced to 1,000 yuan or even lower.
Under the meticulous design of rules, price becomes the only weight to compete.
Under the power of the national-level concentrated volume effect, the selected products have all quoted prices below 1,000 yuan, mostly at a price of more than 700 yuan.
A drug-coated stent system (rapamycin) reported the lowest price of 469 yuan.
This product was previously priced at 13,300 yuan and was approved for listing at the end of 2017.
Why are such advanced products willing to drop from more than 10,000 yuan to 469 yuan?
In this regard, the person in charge of the Blue Sail Medical Group stated that the centralized procurement clarified that the market usage is very attractive. The hospital needs to purchase 100,000 pieces. After winning the bid, it will receive no less than 10% of the remaining amount. The market usage is expected to increase. .
Coupled with supporting policies such as prepayment of medical insurance, shortening the settlement cycle, and ensuring hospital use, this has given companies clear expectations.
"This means that the original sales and distribution models will have subversive changes, the cost of sales of enterprises will be greatly reduced, and the operational efficiency will be improved." The person in charge believes that the country's centralized procurement with a large amount is a way to deepen medical reform. Milestones, while reducing the burden on patients, help standardize the industry environment and reconstruct the industry ecology, allowing companies to concentrate on doing business well.
"Centralized procurement with volume is not a separate policy, but a mechanism. It is organized by the state, and the medical insurance, health, quality supervision and other departments work together. For example, the whole process of strengthening quality supervision, medical insurance budget balance hospital retention, and assessment of hospital usage Enterprises are found to have kickback cases that will affect centralized procurement, ensuring that the prices selected in centralized procurement fall on the ground, so that the people can really use high-quality products at a better price. At the same time, the pharmaceutical industry is forced to reform itself, cut unreasonable circulation costs, and shift its focus. Research and development and innovation." said Zhong Dongbo, director of the Department of Medical Price and Bidding and Purchasing of the National Medical Insurance Administration.
Ying Yazhen, vice president of the National Medical Insurance Research Institute, said that this is the market guiding role of centralized and volume purchases, which lowered prices and gave companies clear expectations.
Only by choosing reasonable profits and bidding farewell to price distortions can we win the market.
The price of the bracket does not degrade
According to the registration certificate to recruit buyers to ensure the stability of product quality.
Synchronously adjust the price of medical services to mobilize the enthusiasm of medical staff
Li Qiang did the calculation. Of the 6 brackets he used, 5 of them were selected for a price reduction, and the remaining one could be replaced by the selected product.
Li Qiang said that when putting the stent, it is impossible to think that the stent can be reduced to about 700 yuan.
However, he was also very puzzled: After the price of the bracket is reduced, will the quality be reliable?
In fact, one product, one policy is to ensure that price reduction does not degrade quality.
In the centralized procurement of cardiac stents, the procurement is recruited according to the registration certificate to ensure the stability of the product quality, and the medical institutions independently report the demand.
"Compared to the centralized procurement of medicines, this is an innovative point in the centralized procurement of cardiac stents. The use after the selection also gives medical institutions great autonomy, ensuring that the selected products are suitable for clinical needs and ensuring product quality." Chang Feng, a professor at China Pharmaceutical University, commented.
At 10:48 on November 5th, when Zhang Tiejun, deputy director of the Tianjin Medical Insurance Bureau and director of the Joint Procurement Office of High-Value Medical Consumables of the National Organization, announced the results of the proposed selection, three clinical experts stretched their brows.
"Of the top 10 commonly used coronary stents, 7 were selected. These products are mainstream products commonly used in hospitals and there is no problem of adapting to alternative products." said Yang Weixian, vice president of Fuwai Hospital, Chinese Academy of Medical Sciences. It has been used for more than 5 years, some of which have been used for more than 10 years, and its safety and effectiveness have been clinically verified.
According to one company, the heart stent is a highly regulated medical device. Any changes in the main raw materials, production processes, and technology will require a "type inspection" by a third-party national testing agency and an "application change" by the China Food and Drug Administration.
And each bracket has a unique identification number, and all products can be traced throughout.
"Heart stents are products that are implanted in the human body, just like human organs. They must not be sloppy. No matter which company, it cannot have a fluke on this principled issue." The person in charge of the company said.
On November 11, the State Food and Drug Administration issued the "Notice on Strengthening the Quality Supervision of Coronary Stents in National Centralized Purchase", requiring local governments to strengthen supervision to ensure the quality and safety of centralized procurement of coronary stents.
Enterprises should establish and improve the product traceability system of coronary stents, and do a good job in product recall and traceability.
All local drug regulatory authorities shall conduct a full project supervision and inspection of selected companies at least once a year, and strengthen the monitoring of adverse events of coronary stent products.
Some people are worried, will the substantial price reduction of heart stents affect the hospital's income?
Will other costs increase for patients undergoing surgery?
In 2019, my country has fully implemented a zero markup policy for consumables. When the markup policy was cancelled, all regions adjusted the price of medical services simultaneously. The cost of medical institutions and the value of technical labor were reflected by adjusting the price of medical services.
At present, there are at least 3 charging items for coronary stent surgery, coronary angiography, balloon expansion, and stent placement.
Take Beijing as an example. Coronary angiography is 1,000 yuan, balloon dilation is 1,350 yuan, stent placement is 3,300 yuan, a total of 5650 yuan, not including other examination and treatment income.
At the same time, in order to further mobilize the enthusiasm of medical institutions, the medical insurance department clearly allocated a portion of the surplus costs of centralized medical insurance to medical institutions.
This means that the reduced price of heart stents will not have an impact on hospital income.
After the price of the stent is reduced, the patient's total burden will also drop significantly.
According to estimates, if the stent is implanted in the employee medical insurance and resident medical insurance patients, the personal out-of-pocket expenses will fall below 2500 yuan.
In order to encourage medical institutions to use the selected heart stents, the United Procurement Office has formulated relevant guarantee measures for the implementation of subsequent purchases, such as the annual medical insurance budget balance of some medical institutions can be retained.
Tianjin Chest Hospital ranks fourth in the country in terms of cardiac stent usage in one year.
Dean Guo Zhigang believes that the decline in the price of heart stents will not only have no impact on hospital income, but also enhance the image of the hospital, increase patient trust, and improve the doctor-patient relationship.
The central procurement of heart stents is expected to save 10.9 billion yuan.
Experts suggest that all regions should take advantage of the space and opportunity for the implementation of centralized procurement results to support the reform of the medical staff salary system and the reform of the hospital compensation mechanism, mobilize the enthusiasm of medical staff, and better ensure the implementation of the centralized procurement results.
Zhong Dongbo revealed that my country will summarize the good experience of centralized procurement of coronary stents, and start to screen products that are used in larger quantities, higher prices, more falsely high moisture, and more people's attention, as the next concentrated purchase of products.
In accordance with the method of one product, one policy, adequate technical analysis, market research, expert demonstration, and appropriate centralized procurement rules shall be formulated.
It is expected that they will be developed one by one at maturity, and the main varieties that account for a relatively high purchase amount and are suitable for centralized procurement will gradually be included in centralized procurement, so that the masses can use higher quality and lower price products.
Our reporter Li Hongmei