1. Hospitals in the supply chain
Hospitals as the main provider of medical services, but also the main consumer of medical products, so the hospital is both the seller and the buyer, and it is even more dominant in the health care supply chain. In terms of raw material markets, hospitals are on the demand side, and healthcare companies are the providers of medical products and produce and sell them through near-perfect competition. Since hospitals dominate the use of medicines and medical equipment, they are unquestionably the dominant buyer in the buyer's market. In order to market their products, medical companies have to sell their products to hospitals. At the same time, in the medical service market, the hospital is the provider of medical services, due to the information inequality of patients passively receive medical services, the patient to carry out what kind of treatment or take what kind of drugs are doctor-led. Therefore, hospitals inevitably also become the dominant subject of the seller's market. Therefore, hospitals with dual dominant subject status play a dominant role in the healthcare supply chain, which ultimately determines the sales of pharmaceutical products in the market. As a result, medical product manufacturers take hospitals as their main sales targets and try every possible means to promote their products. This will inevitably appear commercial bribery, hospitals have become its main target of bribery, resulting in increased intermediate costs of product sales, leading to inflated prices of medical products.
2. The current situation and problems of China's medical supply chain
From the current situation of China's pharmaceutical supply, the medical supply chain is generally distorted. First, the intermediate links of the medical supply chain transaction costs are too high, triggering the inflated end price of drugs; second, too much government intervention leads to the failure of the pharmaceutical market, resulting in the reduction of the price of drugs to the government as long as the enterprises are biased towards setting high prices for drugs; third, pharmaceutical companies are reluctant to invest in the research and development of new drugs, but mainly focus on drug distribution, but pharmaceutical companies are very willing to the original drug into new drugs; fourth, compared with supply chains in other industries, the healthcare supply chain does not emphasize demand management, user customization, inventory management and the use of information technology; fifth, compared with other markets, due to the system, there are multiple market structures in the pharmaceutical market i.e., monopoly and perfect competition coexist. At present, there are more than 6,000 drug manufacturers in China, which are already in a state of complete market competition in the production field, but in the consumption segment, 85% of the drugs are still controlled by medical institutions lock, stock, and barrel, and the medical units are the dominant subject of both the buyer's market and the seller's market, because the people are passive in using the drugs, and they must listen to the advice of medical units. Hospitals in the drug retail market is almost in a monopoly position and position, while the pharmacy is in a fully competitive situation, that is, there are two channels of drug distribution, one is in a monopoly situation, the other is out of the hospital in a fully competitive situation. In summary, China's medical supply chain there are more problems, mainly in the following three aspects:
2.1 in the flow of information, China's pharmaceutical supply chain information is not smooth, in the flow of information, China's pharmaceutical supply chain information is not smooth, not centralized more dispersed. Information "scattered" is manifested in: medical product manufacturers and logistics distribution centers, medical product manufacturers and medical product wholesalers, medical product manufacturers and medical product wholesalers, hospitals and suppliers (medical product manufacturers, medical product wholesalers) between the regularity of information transfer is poor, and the lack of **** enjoy. Information transfer between customers and wholesalers is accomplished by traditional means such as telephone. Information is slow and distorted, not easy to recover and even less easy to keep. At the same time, there is also a mismatch of information. First, there is information asymmetry between hospitals and patients. It is manifested in the fact that patients are unable to predict the content, quality and measurement of medical services in advance, and even after the fact many of them are also unable to measure. Patients can only passively receive medical services from doctors, and are rarely able to make active choices. Second, there is information asymmetry between patients and health service financing organizations. Third, information asymmetry between hospitals and regulators. In particular, in some regions, excessive government intervention has resulted in hospital equipment and drug purchases that do not meet clinical needs, and hospital administrators are complaining.
2.2. In terms of capital flow, there is widespread commercial bribery in China's pharmaceutical supply chain, resulting in high intermediary costs and serious spillover of capital flow. As mentioned earlier, the dominant position of hospitals in the medical supply chain has forced medical product manufacturers to launch new medical products or increase their market share through unfair competition. The improper spillover of medical funds not only fails to promote the development of new medical products, but also makes the marketing of medical products a hotbed of commercial bribery. It has been reported that the hospital commercial bribery crime site, the form of crime is concentrated, stable, the case occurs in the purchase and sale of drugs, medical equipment, the form of more in the procurement of drugs and medical equipment in the process of receiving or requesting the buyback of drug dealers; the nest series of outstanding cases, the field of medicine business is wide, involves a lot of departments, is a network of distribution, once there is a crime occurs, is often a nest series of crimes. 2003, Hangzhou, a hospital buyers and the director of the pharmacy department, because of the purchase of new medical products, or to make the market share of medical products. In 2003, a purchasing agent and a director of pharmacy department of a hospital in Hangzhou were sentenced to 17 and 14 years of imprisonment, respectively, for accepting favor fees from pharmaceutical representatives in drug procurement. This situation is widespread and has become an unseen and invisible income for doctors. The unorthodox spillover of capital flow not only fails to prompt the expansion and reproduction of medical product manufacturers, but also makes hospitals enter a vicious circle of chasing profits and neglecting quality. In the long run, it is bound to affect the long-term development of the hospital.
2.3. In terms of logistics, the monopoly position of hospitals and policy-oriented medical products supply chain logistics efficiency, and efficient third-party logistics in the pharmaceutical supply chain does not have a foothold. Third-party logistics is a service provided by intermediaries in the logistics channel, intermediaries in the form of a contract within a certain period of time, to provide all or part of the logistics services required by the enterprise. It is not only able to centralize the owners to optimize the allocation of resources; cost savings, reduce capital backlog and additional expenditure; reduce inventory and help to enhance the corporate image. At present, after a certain amount of national control and dredging, China's drugs from the manufacturer to the hands of patients, need 2-3 links (previously required 4-6 links), some products can be supplied directly from the manufacturer of hospitals, which greatly saves the circulation costs, but also reduces the loss of drugs in circulation. However, these circulation links still exist redundant phenomenon, and some circulation company's market coverage, quality of service are lower, restricting the pharmaceutical supply chain efficiency to further improve.