Annual savings of more than 800 million yuan in medical supplies costs | Cross-regional joint procurement into a trend?

According to the medical website on June 4, the joint procurement of Beijing, Tianjin, and Hebei can save the cost of consumables for the public hospitals in the three places by more than 800 million each year, a drop of 15%. With the exception of the Beijing-Tianjin-Hebei Province, there are currently three provinces in China, ten in the western provinces, and Shanghai. Joint procurement of large medical consumables or medicines, such as Jiangsu, Zhejiang, and Zhejiang, has become a trend through cross-regional joint purchasing. By reducing the prices of medicines and consumables by means of quantity and price, although the price of medical equipment can be reduced, the joint procurement model still has Many problems need to be solved.

A certain type of cardiac pacemakers of Medtronic, the former medical institutions in Beijing purchase price is generally 55,000 yuan, the current reference price is 44,000 yuan, the price is reduced by 11,000 yuan; Abbott a bracket system original purchase price is generally 19,250 yuan, now with a reference price of 13,800 yuan, the price has dropped by nearly 6,000 yuan. The Beijing-Tianjin-Hebei Tri-Bill Commission introduced the results of joint procurement of medical consumables in the three places at a press conference held on May 30th.

It is reported that this joint procurement involves six types of related products such as intracardiac stents, cardiac rhythm management, and artificial joints. If this is compared with the total purchases of these six categories of products in 2016, this joint procurement Each year, the public hospitals in the three places can save more than 800 million in consumables costs, a drop of 15%. The joint procurement results will be formally implemented on June 30 this year.

Wang Jianguo, director of Tianjin Municipal Health and Family Planning Commission, introduced that at the end of 2016, the Sanweiwei Planning Commission signed the "Beijing-Tianjin-Hebei Public Hospitals Medical Consumables Joint Procurement Framework Agreement" in Beijing, and started the first batch of medical consumables in the public hospitals of Beijing, Tianjin, and Hebei. Joint procurement work.

Through the establishment of the Medical Consumables Joint Procurement Working Group, the three places have established a unified procurement platform for medical consumables, established a unified review expert database, and jointly selected the procurement catalog for medical consumables.

health Click here to view the first batch of medical consumables procurement joints of Beijing-Tianjin-Hebei Public Hospital issued by the Sanweiwei Planning Commission in September 2017 purchase The implementation plan (hereinafter referred to as the 'plan') found that the Sanweiwei Planning Committee jointly formed a review expert to negotiate with the manufacturer, or entrusted hospitals, hospital groups, medical insurance agencies, etc. to negotiate with the company.

It is worth noting that the "Program" wrote that 'at the premise of no more than the provincial procurement of the provincial level or the historical purchase price of the Beijing-Tianjin-Hebei prefecture, the price negotiations with the production enterprises will determine the 'negotiation reference price'. Negotiate the reference price' and implement dynamic adjustment. In principle, adjust once every six months. In the next cycle, the 'negotiation reference price' is based on the price data collected by multiple parties, combined with the transaction price of the previous cycle. This is a price reduction. process.

In the process of actual procurement, each hospital shares the same results with other hospitals on the premise of not higher than the 'negotiation reference price', and the similarity is lower. This is another process of price reduction.

According to the press conference, the Beijing-Tianjin-Hebei region conducted the historical data collection and collection of the six major varieties involved in the procurement. The medical institutions in the three regions collected and used clinically during the period from January 2016 to June 2017 were collected. Six categories of related products, and find out the lowest price for each product, namely the 'lowest historical purchase price of Beijing, Tianjin, and Hebei'. On this basis, the Sanweiwei Planning Committee adopts bids for the six major categories of medical consumables, respectively. Different centralized procurement methods, such as centralized procurement work in batches, form a unified product transaction price in Beijing, Tianjin, and Hebei, and the procurement results will be jointly implemented in public hospitals at Grade 2 or above in Beijing, Tianjin, Hebei, and be implemented in the procurement catalog. The full variety of online purchases.

In February last year, the General Office of the State Council issued the “Several Opinions on Further Reforming and Perfecting the Policy for the Production, Circulation and Use of Pharmaceuticals”, proposing to further increase the participation of medical institutions in the centralized procurement of pharmaceuticals and encouraging cross-regional and specialty hospitals to jointly purchase. Since then, The emergence of regional purchasing alliances.

Not long ago, based on the “Jinan Public Hospital Drug Purchase Consortium”, Shandong Province, in conjunction with Qingdao and Weihai, established a cross-regional public hospital drug procurement consortium. The consortium recently conducted a joint bargain purchase of the first batch of drug shortages. , 21.3% lower than the Shandong Province's linked price.

With the exception of Beijing, Tianjin and Hebei, currently there are three major medical consumables or drug procurement alliances in Sanming, the western provinces, and Shanghai, Jiangsu, Zhejiang, and Zhejiang. Cross-regional joint procurement has become a trend, and medicines have been reduced through quantitative pricing. Supplies prices.

At present, the modes of joint procurement of domestic drugs and medical consumables can be broadly classified into three types. One is the mode of joint procurement of Beijing, Tianjin, Hebei and the ten provinces and regions in the western region. One is GPO procurement, and the other is Sanming. A looser cross-regional purchasing alliance composed of cities and counties.

As an internationally accepted drug procurement model, GPO has been applied in the United States and other countries. The earliest exploration began in China in 2005. Pilots were implemented in the implementation of comprehensive pharmaceutical reforms in Minhang District, Shanghai. Later, cities such as Penghu and Shenzhen began to follow suit.

The GPO is a third-party intermediary organization that collects hospital needs to conduct product bidding and procurement, and this third-party procurement model is highly controversial in the country.

In April 2017, the National Development and Reform Commission determined that Shenzhen violated the Anti-Monopoly Law in the trial of GPO procurement reform.

According to the notice of the National Development and Reform Commission, there are three major violations in Shenzhen, one of which is to allow only one group procurement organization to provide pharmaceutical group procurement services. In August 2016, when Shenzhen City selected the GPO organization for public medical institutions, only Shenzhen Haiwang Group's subordinates' The whole drug network, a successful bidder, was considered to have restricted market competition, leaving other operators who are able and willing to provide drug group procurement services to be excluded.

In addition, the procurement model defines public hospitals in Shenzhen, and drug manufacturers use the services provided by Quantum Pharmaceuticals. Including the restriction that all public hospitals in Shenzhen can only pass Quantum Pharmaceuticals, and other qualified group procurement organizations cannot be selected. It is also not possible to purchase on the provincial-level pharmaceuticals centralized procurement platform. In addition, disguised restricted pharmaceutical manufacturers can only sell medicines in the catalog to Shenzhen Public Hospital through Quantum.com Pharmaceuticals, which cannot be sold through the provincial-level pharmaceutical centralized procurement platform and destroy pharmaceuticals. Market normal competition order.

In addition, Shenzhen also limited drug distribution companies to be appointed by Quanxi Pharmaceutical, which violates the “Guidelines for Perfecting the Centralized Drug Procurement in Public Hospitals of the State Council,” which stipulates that pharmaceutical manufacturers should independently choose and distribute companies.

Chen Wei, a researcher at the Center for Drug Policy and Management at Tongji Medical College of Huazhong University of Science and Technology, once stated that the procurement of GPOs in the United States is in a completely market-oriented environment. In order to prevent incomplete competition or monopoly, the government has made many restrictions on GPO procurement, such as the same hospital. There should be more than one GPO available, prohibiting medical institutions from purchasing for a single GPO to form an effective competitive market.

For the current domestic drug procurement model, Wang Hongzhi, an advisor at Peking University, told health points that these models have advantages and disadvantages. At present, the space for secondary bargaining in hospitals still exists. The key to the problem is not to increase the concentration of buyers. It is the establishment of a system that allows the buyer to lower the price, so as to increase the enthusiasm of the hospital for bargaining and realize the linkage between the three doctors.

According to Zhu Hengpeng, deputy director of the Institute of Economic Research of the Chinese Academy of Social Sciences, the government-led procurement alliance will have some problems. 'The GPO model is best for the hospital to spontaneously form a coalition.' Zhu Hengpeng told health points that hospitals' secondary bargaining should be allowed, but The current institutional mechanism causes the secondary bargaining to operate in secret. Avoiding this phenomenon can only be achieved through the reform of the Medicare payment system.

Wang Hongzhi believes that cross-regional joint procurement may be able to squeeze out high prices, but by increasing buyer concentration, it is easy for the buyers and sellers to lose balance in their power. This leads to low prices, which dampens the enthusiasm of the company's innovation and seriously leads to product withdrawal. City. Some people in the industry pointed out that drug It is necessary to have a reasonable profit margin to promote the healthy development of innovative drugs. Therefore, under the joint procurement model, the criteria for the price reduction of pharmaceuticals and consumables should be properly established.

The Sanming Alliance encountered Waterloo in early 2017. enterprise Not quoting, some companies quoted higher than the Fujian provincial price, so that the Fujian Provincial Drug Purchase Center interviewed some companies. Some companies said that the complexity of the members of the Sanming Alliance, distribution costs, different payment cycle, and some The rise in prices of pharmaceutical raw materials has caused concerns about companies participating in quotations.

Wang Hongzhi believes that hospital Procurement methods should not be applied across the board, and they need to be classified and implemented. For patents and exclusive drugs, the bargaining power can be increased by increasing the degree of concentration of buyers, and for most drugs, it is appropriate for the hospitals to purchase their own products.