Medical network - February 13 since February 9, issued by the general office of the state council concerning the further reform and improve the use policy for producing and distributing medicines of several opinions (countries do hair [2017] no. 13) files, the blue parker forward the first time the file content, official authoritative interpretation, expert comments and other content was highly attention by industry, this several days all kinds of folk interpretation analysis is to refresh, all kinds of information, becomes the focus of universal, but there are still a lot of very great influence on pharmaceutical enterprise key information, seems to be ignored by the industry, has failed to cause enough attention, today the blue parker picked out a communication with you.
▍ medicine policy loosening control: "the second negotiation" ban let go
Do hair [2017] no. 13 in the "countries" file, article 9 clearly put forward: "we will improve the mechanism of drug purchase. Payment in comprehensive health-care reform or make medicare drug payment standard, allowing public hospital in the provincial drug centralized purchasing platform (provincial public resources trading platform) combined with quantity, purchasing budget."
Experts participated in the policy-making process to match the blue parker said that this reform content of the file is a big breakthrough, equal to the past years, the national policy file level "no hospitals purchasing drugs secondary bargaining" "ban" big open, allowing the hospital combined with quantity, procurement budget, equivalent to a given around the hospital drug procurement negotiation can justly, which calls "secondary bargaining" legal rights.
At the same time, in full payment health-care reform or established medicare drug payment standard, allow independent negotiation purchasing medical institutions reform, it also demonstrated in the reform of the state council last month, head of the office held by the provincial health related to attend the "national health seminar" on leadership speech spirit.
The experts further to the blue parker says the kingdom is accord with the central spirit and related reform principles (particularly in terms of health care reform), make the market plays a decisive role in the allocation of resources and better give play to the role of the government, is the central require significant to push forward the reform of supply side structural principle.
In terms of price reform, the country of the highest rank of reform in 2015 issued a document, namely "found 28 [2015]," file "of the central committee of the communist party of the state council on several opinions to push forward the reform of the price mechanism" explicitly put forward: the price mechanism is the core of market mechanism, market decided to price is the key to plays a decisive role in the allocation of resources. In article 7 of the document of the second chapter on drug prices clearly put forward "to further improve the mechanism of the drug purchase, give play to the role of health charged fees, drug actual transaction prices mainly formed from competition in the market." Obviously, and gradually let go of the hospital independent negotiation (i.e., usually calls "secondary bargaining"), is in conformity with the central spirit of reform, is the trend of The Times, just, in the transition stage of reform and transition, the pharmaceutical enterprises of the need to prepare to meet, otherwise the market control will be very passive.
The blue note that parker hospitals purchasing drugs for the first time in a "secondary bargaining" formulation is in the official files in July 2010, the state ministry of health issued the "WeiGui wealth hair [2010] no. 2010" file "about specifications issued by the medical institutions and drug centralized purchasing work notice, the file article 36 requirements, purchasing and selling drugs medical institutions according to the contract, shall not be" secondary bargaining ". Strict review for drug purchase invoice, to prevent the procurement, WeiJia purchasing or channels for purchasing drugs from the rules.
This "ban" as the years of medical institutions and drug suppliers, the hospital will not be able to price negotiations, or call at random lower prices (lower than provincial procurement platform of the bidding price) of important policy basis.
Large files on drug bidding procurement, in 2015 promulgated by the state council "countries do hair [2015] no. 7" file, the general office of the state council on perfecting public hospital drug centralized procurement guidelines ", and the subsequent "countries who medicine ZhengFa [2015] no. 70" file is the national health and family planning commission on the implementation of the perfect public hospital drug centralized purchasing work notice guidance, although not in the file on whether "no hospital the second negotiation" to clear, but in October, national health development planning commission issued a "about public hospital medical into several problems in the centralized purchasing supplementary notice, clear requirements in the notice, put an end to correct illegal offline hospital procurement and in a variety of names that rebates, rebates, to set up the" concealed accounts "and other forms of secondary bargaining, in violation of the hospital and its principal heads to build system of questioning, accountability, depending on the circumstances give notification criticism, instruct its deadline to correct, downgrade removed, etc.
The personage inside course of study thinks, this is national file, to prohibit hospitals purchasing drugs "secondary bargaining" the most severe and specific requirements.
Over the past years, although at the national level file on the requirement of hospital the second negotiation is very clear, gave drug firms seem to be a "too-big-to-fail", but the purchasing drugs in hospitals around the actual operation level, many hospitals in drug purchase without authorization to bargain "secondary" there are a lot of, because of the policy level in the country is not allowed (not open), so for some of the "sneak", dare not too obvious, but as "countries do hair [2017] no. 13" file, give the hospital drug procurement bargain "secondary" legal right, there is no doubt that the country hospital "secondary bargaining"'s enthusiasm will be "high", drug firms how to meet, need to be ready.
▍ medicare payment reform fall to the ground, "the second negotiation" area
File said, of course, is "in full payment health-care reform or established medicare drug payment standard region", it needs to look at the file the demands on health care reform, as well as health care reform is how the upcoming file.
"Countries do hair [2017] no. 13," article 16 the requirement of the file, attach great importance to the role of health standard behavior and cost control. Strengthen the medical insurance fund budget management, vigorously promote the reform of medical insurance payment methods, fully implementing is given priority to with the macro-reforms, capitation payment, pay by bed, and other payment method of combining the compound payment method, reasonable medical insurance payment standard, the drug supplies, check assay by medical institutions such as income into cost, make active regulating medical behavior of medical institutions, reduce running cost.
As for the reform of medical insurance payment mechanism, the blue parker here temporarily not make analysis (but a very significant effect), only to file the proposed "reasonable payment standard, such as drug supplies, examine the by income into the cost of medical institutions, encourage active regulating medical behavior of medical institutions, to reduce the running cost" to say a few words, about health care medicine pay the standard formulation and implementation, to some extent, is still based on the existing billing system (pay by project) to a policy on the basis of the arrangement.
About payment standard health care drugs policy "about pay of insurance of primary medical treatment drugs standard rules of guidance" country people club department has already been drafted, only to be released satellite, media information disclosure has a lot.
According to the media disclosure, file about the use of payment standard, divided into three conditions:
One is the fixed-point medical institutions and drug of the actual sales price is equal to the payment standard, and ginseng protect personnel to pay medical insurance fund standard pay for foundation;
Secondly, the medical establishment that decide a dot medicine pay the actual sales price is lower than standard, the standard for the medical insurance fund to pay for basic pay, ginseng protect personnel to pay on the basis of the actual sales price;
Third, according to the standard stipulated by the generic names of pharmaceuticals, the medical establishment that decide a dot to ginseng protect personnel to sell drugs price higher than the payment standard, pay medical insurance fund is to pay the standard as a benchmark, in patients with clinical required, under the premise of informed consent, ginseng protect personnel to the actual sales price as a benchmark, personal allocation proportion pay according to the regulations of the health care.
Assume that a certain drug payment standard is 100 yuan (assuming the price is also one of the few), reimbursement medical insurance fund pays 80%, ginseng protect personnel individual pays 20%, for example, the first kind of situation is not to say, in the second case, if the hospital drugs after bargaining actual purchase price is 80 yuan, the medical insurance fund to pay 80 yuan, ginseng protect personnel to pay 16 yuan, namely medical institutions actually received 96 yuan, 16 yuan can surplus; In the third case, if the drug companies with high quality make us separate pricing, resolute don't reduce the price, purchasing medicine hospital actual price is 150 yuan, is still only pay medical insurance fund 80 yuan, ginseng protect personnel to pay 30 yuan, namely actually received 110 yuan of medical institutions, hospitals need hole 40 yuan.
Attention the pharmaceutical enterprises, through the above analysis, it should be clear, if the payment standards implementation, the hospital the second negotiation open up, in this case, the hospital each bargaining each scored a dollar, is almost a dollar of net income (of course, in accordance with the payment proportion calculation), driven by the interests of the hospital the second negotiation power?
If the hospital road bargaining bargaining, as drug firms, is cut or not? Have learned, at present in some places, there have been, if not rebate hospital is not receivable, or hospital directly according to the open ticket prices 90% or even lower in remittance, regardless of the other.
Policy question is, when medicare payment standard, step by step all over the country, after the hospital area began the second negotiation, drug firms do? Is directly reduce the open ticket, or through the rebate form disguised to lower prices (like a response to the sanming)? If taking the form of rebates to lower prices, rebates part of the paper how to deal with (do account, unless the hospital to make out an invoice)? If the accounting treatment is to avoid trouble, directly take the price of make out an invoice (in line with national policy).
Problem, however: according to the national people club department ministries such as the upcoming "about pay of insurance of primary medical treatment drugs standard rules of guidance, the provisions of the health care drugs payment standards based primarily on drugs factors such as the actual market transaction price, quantity, make, can also explore the introduction of similar prices compared to other areas, the reference drug, drug economics evaluation factors and measures, such as by weighted average, median or quantile calculate way, such as the average price of corresponding product rules, and on this basis, determine the pay standards. Take the rebate form allows to hospital, it is legal bargain "secondary" enterprise accounting is difficult to deal with, to take the form of direct reduction of make out an invoice price concession to the hospital, are faced with is to "reduce the risk of payment standard".
Drug firms difficult ah, excuse me each corporate executives, especially bosses, who is in charge of marketing, do you think? Pharmaceutical companies, it seems, the original marketing rules could really doesn't work! |
