Medical Insurance Bureau turned out | Medical device marketing is about to completely subvert

Medical Network March 23 News Medical Insurance turned out, medical device marketing is about to usher in the era of subversion.

Do not believe it, will!

With the gradual implementation of the State Council’s institutional reforms, the National Medical Protection Bureau was established. Some pharmaceutical industry experts told Sai Bolan that the drug (Consumables Reagents) Pricing, purchase payment, oversight of 'Super Medical Insurance Bureau' will soon be available.

The comprehensive implementation of multi-compound medical insurance payment reform focusing on pay-as-you-go payment will also accelerate the overall speed. This may completely change the doctor's diagnosis and treatment behavior, hospital consumables and reagents structure, and the drug and medical marketing rules will also be thoroughly subverted.

The traditional marketing model of companies that rely on rebates and wins won't have much time! It's just a matter of intoxicating the doctor's prescription pen with moneybags. That's what it's like. 'Wish you continue to be confused and continue to be unaware of your death.'

On March 20, the official website of the National Health and Planning Commission published the Notice on Consolidating the Results of Completely Relieving the Use of Medications to Deepen the Comprehensive Reform of Public Hospitals (Guowei Shifa No. 2018) (hereinafter referred to as the “Notice”). Some experts have revealed that this may be the last medical reform document in the name of the National Health and Family Planning Commission (Health Reform Office). Its importance is self-evident.

The “Notice” re-emphasizes that the reform of medical insurance payment methods shall be firmly promoted. The “Guideline for Further Deepening the Reform of Payment Methods for Basic Medical Insurance” of the General Office of the State Council (Guobanfa [2017] No. 55) shall be implemented to fully implement payment according to disease types. As the key multi-unit compound medical insurance payment method, in 2018, the country will uniformly identify more than 100 disease types and guide local governments to promote implementation. Advancing DRG payment pilots, improving per-headcount, multi-bed-day payment the way.

In fact, in order to control medical expenses and promote the reform of medical insurance payment methods, the National Health and Family Planning Commission, medicine On August 30, 2017, the Authority issued the Guidelines for the Management of Clinical Pathways in Medical Institutions.

By the time of issuance of the document, the cumulative number of clinical pathways has been published to 1,212, covering more than 30 clinical disciplines. Basic clinical realization, multiple disease coverage, and basically meet the needs of clinical diagnosis and treatment.

Some experts even told Cypress that with the increasing number of diseases with clear clinical pathways, it will be more and more necessary to include disease-paying diseases. In the future, 95% of medicines are expected to be covered. Case-based payment-based multi-payment methods.

Paying according to the type of disease will greatly change the behavior of the doctor's diagnosis and treatment compared to the medical insurance that has been implemented for a long time.

About the long-term payment of medical insurance services, China Pharmaceutical enterprise Niu Zhengqian, executive vice president of the Management Association, once wrote an analysis. Under the existing medical insurance payment mechanism according to the project, although it can mobilize the work enthusiasm of medical service providers to some extent, it is prone to doctors inducing demand and prompting medical institutions to provide excessive Medical phenomenon.

In the pay-by-project mechanism, as long as hospital For the medical insurance patients, the use of the medical insurance catalog can theoretically be included in the scope of medical insurance payment (reimbursement). Also, because the hospital had a 15% drug bonus (before 2015) or a private bargaining rebate in the past, sales of medicines became hospitals. The profit source.

In addition, there are violations such as giving doctors rebates. Naturally, doctors tend to use more drugs and use expensive drugs during the course of treatment.

In the pay-per-action mechanism, the doctor's kickback behavior is not in contradiction with the hospital's interests. On the contrary, the doctor's kickback behavior can also increase the hospital's revenue to a certain extent (more rebates, higher drug prices, higher drug prices, and higher hospital fees. There are many benefits, so it is difficult to generate endogenous incentives for the hospital to constrain the doctor's kickback behavior.

Constraints and auditing doctors' kickback behaviors seem to have become the subject of the Corrections Office, the Disciplinary Committee, the Health and Planning Commission and other competent authorities. The actual power of the hospital is not great, and the phenomenon of one eye closing one eye is widespread. It also caused drug companies. Reliance on rebates marketing chaos.

Paying according to the type of disease is a kind of lump-sum system. The medicines used by the hospital for the medical insurance patients in the course of diagnosis and treatment have become the hospital's cost, and the sales of medicines are no longer the source of the hospital's profits.

According to Zhu Hengpeng, director of the Center for Public Policy Research of the Chinese Academy of Social Sciences, doctors are entitled to residual claims and residual control rights under the payment of diseases. This is the principle of 'reserving balances and overspending'.

In other words, under the payment of disease, each disease type is pre-set with a certain amount of reimbursement, which is saved by the hospital itself. If the hospital is overspending, it will have to pay for itself. Obviously, the hospital will not do business for losing money. .

In this way, what the doctor considered was not to pass through more inspections and make more drugs, but to save the cost of medical treatment. After all, under the payment of diseases, doctors save money in the course of treatment and instead make money for themselves and the hospital. Now.

Under this payment mechanism, if the doctor continues to have a rebate after the cost of the disease is covered, the hospital’s revenue will be directly damaged. If the rebate is more than necessary, it will lead to high drug prices, thus reducing the cost of the hospital within the package cost. 3. The proceeds, the doctor's kickback behavior and the hospital's interests are contradictory and antagonistic.

Then, in the past, the behavior of the hospital's kickback behavior for doctors was changed: "One eye closes one eye."

Under the new medical insurance payment mechanism, the hospital has an endogenous incentive to restrain the doctor's kickback behavior, and will inevitably change the assessment rules of the department (doctor). Under the new hospital assessment rules, the doctor's rebate behavior is very limited. It may be that the past 'climbing office' has become a 'clinic section chief'. It is difficult to get a doctor's kickback behavior, such as correcting the wind, but it is not too difficult for the director of the department to administer the kickback.

Some people will ask questions, doctors do not take kickbacks, okay? The doctor's income is too low, and some doctors even gray income accounted for a large proportion of their income. In fact, doctors may not get a rebate may be higher income.

In addition to the reform of the medical insurance payment method, the "Notice" also proposes to expand the pilot reform of public hospital pay system.

The “Notice” calls for active pilot work to explore and establish a public hospital salary system that is adapted to the characteristics of China’s medical industry, and to mobilize the enthusiasm, initiative, and creativity of the medical staff to lay the foundation for the development of public hospitals.

In addition to the “Notice” mentioned in the “Notice” of public hospitals, more than a year ago, relevant departments have issued documents several times to promote the pilot reform of the public hospital's pay system.

Then, in January 2017, the Ministry of Human Resources, the Ministry of Finance, the Health and Development Commission, Chinese medicine The administrative bureau issued the “Guiding Opinions of the State Administration of Traditional Chinese Medicine of the National Health and Family Planning Commission of the Ministry of Finance of the Ministry of Human Resources and Social Security on the Pilot Work for the Reform of the Public Hospital Pay System”, which officially set off the tide of pilot reform of the public hospital pay system.

On the 9th of the same year, the State Council executive meeting pointed out that it is necessary to improve the public hospital remuneration system and require the human resources and social security department to take the lead in formulating programs to expand the pilot reform of the public hospital remuneration system and promote the establishment of an incentive mechanism for more work and more rewards.

On December 12, 2017, the four ministries and commissions including the Ministry of People and Social Affairs and the Ministry of Finance issued the “Notice on Expanding the Pilot Program for Public Hospital Salary System Reform”.

In February 2018, at the National Health and Family Planning Working Conference, the reform of the remuneration system was listed as one of the top ten health and family planning priorities in 2018.

During the two sessions, the Prime Minister stressed in the government work report that it was necessary to deepen the comprehensive reform of public hospitals, coordinate the promotion of medical prices, personnel remuneration, medical insurance payment reform, improve the quality of medical and health services, and make great efforts to solve the problem of medical treatment for the general public.

Can a doctor's legal income be raised? Can he be raised to a higher level than gray income?

A senior person in the pharmaceutical industry analyzed that if a doctor takes a drug rebate, it is assumed that the drug's rebate ratio is 25% of the price of the drug. Then, for every 100 yuan in rebates, the doctor may increase the medical expenses by 400 yuan, that is, if the doctor With a small rebate of 100 yuan, you can save 400 yuan. Suppose that the medical insurance payment agency uses the saved 400 yuan and 200 yuan as an incentive to reward the doctor legally. This can save 200 yuan in health insurance costs.

That is, as long as the doctor's compensation incentive mechanism is designed properly, it is entirely possible to obtain no rebates, legal income is higher than the gray income, and medical insurance can also greatly save costs.

Pharmaceutical companies, noted that the compensation incentives for doctors are changing.

Doctors' diagnosis and treatment behaviors are the direct motives for the formation of hospital drug structures. For a long time, under the stimulation of high drug rebates, drugs used by medical institutions are still dominated by high-value drugs, while drugs with lower bid prices are It is difficult to use for patients.

According to Sebast Blue, many years ago, the reason behind this phenomenon was pointed out by Niu Zhenggan, executive vice president of the Chinese Pharmaceutical Enterprise Management Association. The unreasonable health insurance payment mechanism did not play a role in restraining incentives and drug addition control policies. , Resulting in the phenomenon of "rebate and bribery" in the hospital with high drug prices, purchases and sales, etc.

Under the pay-per-fund medical insurance payment mechanism and drug price mark-up control policy, the normal price competition mechanism of drugs fails, and whoever has a large rebate will have a large sales volume. This in turn forces drug manufacturing companies to establish 'high pricing, dark rebates'. The marketing system, to carry out the recessive deformity trading competition with the rebate as the main means.

At the same time, under the constraints of the past two major game rules: low-cost medical service regulation and drug addition control, most hospitals are not satisfied with a 15% drug yield bonus, and they will provide pharmaceutical companies with their own services through various means. A variety of 'services' or 'rebate points', allowing doctors and other related personnel to receive cash rebates from pharmaceutical companies.

However, after the implementation of the multi-insurance payment mechanism reform based on the disease-oriented type, the medicines are changed from the profit center to the cost in the hospital, and the medical use structure of the medical institutions will fundamentally change.

In the hospital under the constraints of the reform of medical insurance payment, change the assessment rules of the department (doctor), doctors will change from the pursuit of rebates in the past to the pursuit of cost-effective drugs, cheap and good medicine, will be favored.

The current high-priced drugs will be replaced by cheap drugs and cost-effective drugs.

Under the contract system such as disease type, the more doctors save the hospital, the more likely it is to obtain more rewards, and when the legal reward is greater or equal to or slightly less than the rebate, there is no incentive to get a rebate. Will be forced by the hospital, the real supervision given by the department.

Pharmaceutical production and marketing companies do not need to adopt the “high pricing, dark rebate” illegal marketing model in the marketing process. Drug production and operation order will return to normal. The competition between each other is no longer a commercial bribe competition, but quality, price , Service, efficiency, management competition, the competitive environment of pharmaceutical companies will fundamentally change.

With the establishment of the National Medical Insurance Bureau, the acceleration of medical insurance reform, the gradual establishment of the doctor's compensation incentive mechanism, the traditional competition rules of pharmaceutical companies will be completely subverted.

Please note that the reform goal set forth in the 'State Administration Document No. [2017] No. 55' is to fully implement multi-factorial and multi-payment payment methods based on disease-based payments. All localities must select a certain number of disease types to pay according to the type of disease. , The state selects some regions to carry out DRGs payment pilots, and encourages various localities to improve per-headcount, bed-day and other payment methods.

By 2020, the reform of the medical insurance payment system will cover all medical institutions and medical services, and nationwide implementation of a variety of multi-combined medical insurance payment methods that adapt to different diseases and different service features will reduce the proportion of payment by project.

Remember: By 2020, the reform of the health insurance payment system will cover all medical institutions and medical services. The time pressure is urgent, and it must be transformed. In the past, the marketing mode of winning by rebates was really not much.

Note: This reference to "reform Medicare payment mechanisms to subvert the pharmaceutical market competition rules", author: Yang colorful cow is dry