Policy goals and means do not match, is the centralized bidding procurement of drugs in trouble
State medicine and health management departments to develop a centralized bidding procurement system of drugs, one hopes that through the system, the bidding way to solve the problem of "high prices of medicines"; the second is the hope that through the open bidding process, to realize the hospital drug procurement process. Secondly, it is hoped that through the open bidding process, the hospital drug procurement process of "sunshine", to rectify the unethical practices in drug procurement.
However, the centralized bidding and purchasing system for medicines has been controversial since its implementation because of the difficulty of balancing the interests of drug manufacturers and medical institutions. Drug manufacturers complained that the number of drug tenders is too many, too many organizations, companies have to travel around to participate in the bidding, adding to the burden of the enterprise, and even appeared in the drug manufacturers won the bidding hospitals instead of the decline in the amount of goods "dead bid" situation. Medical institutions after a brief hesitation, began to take advantage of the centralized bidding in a favorable position, squeezing the profit margins of drug production and distribution enterprises, thus threatening the development of the drug production industry, so that the centralized bidding and procurement of drugs system is in a dilemma. 13 pharmaceutical industry associations to petition the incident is a centralized reflection of this contradiction.
Experts estimate that China's drug prices constitute only 30% of the production sector, 40% of the wholesale sector, 30% of the retail sector. Centralized bidding and purchasing of drugs to reduce the circulation link, to reduce the price of drugs have a certain positive effect. But the reason for the high price of drugs is not only the circulation of the number of problems, more importantly, the problem of the pharmaceutical system.
First of all, the lack of competition in the sale of drugs in medical institutions, resulting in high drug prices. At present, the medical institutions are the main channels of drug sales in China, accounting for 80% of the share. Most of the drugs are consumed by doctors' prescriptions, and in the absence of transparency of doctors' prescriptions, patients do not have any choice but to accept the high prices of medical institutions.
Secondly, the compensation mechanism of "medicines for doctors" "legitimizes" the higher price difference of medicines for medical institutions. Due to the limited government funding, coupled with the generally low pricing of medical services in China, our government allows medical institutions to take the sales of drugs to obtain the difference in price income of the "medicine to support the doctor" policy, so that the sale of drugs and medical institutions, medical staff, between the direct economic interests, the higher the price of drugs the better.
Once again, the lack of cost constraints on the consumption of medicines has made it possible to realize the inflated prices of medicines. With the deepening of the reform of China's health insurance system, the individual part of the increase, but because individuals lack the necessary knowledge and means to judge whether the price of drugs is reasonable, and insurance companies and other professional organizations have not yet intervened in the process of reviewing the price of drugs for health insurance, it is also difficult to produce effective constraints on the excessive price of medicines in the final consumption link.
Finally, the lack of a grass-roots community health service system has resulted in an overloaded outpatient clinic for medical institutions, especially large urban comprehensive medical institutions, thus creating a monopoly on the sale of their medicines. The provision of diagnosis and treatment of common and chronic diseases, preventive health care and referral services for community patients by general practitioners is one of the keys to breaking the monopoly of large medical institutions.
The current centralized bidding of drugs can only have some impact on the 40% of drug prices between wholesale and medical institutions, but cannot affect the 30% of drug prices between medical institutions and patients. Because the centralized bidding for medicines has not changed the monopoly of medical institutions in the retail of medicines (on the contrary, it has been strengthened), has not changed the compensation mechanism of "supporting doctors with medicines", has not introduced a new mechanism for restraining medical expenses and has not established a community health service system, therefore, the part of the price of medicines that has already been lowered can hardly be reflected in the final part of the sale of medicines. This not only makes centralized bidding and purchasing lower the price of medicines, but also makes it more difficult for the centralized bidding and purchasing to reduce the price of medicines. This not only makes the centralized bidding and purchasing to reduce the effect of drug prices greatly reduced, at the same time, the centralized bidding and purchasing of drugs in the existence of a large number of irregularities, illegal phenomena also make this policy is increasingly towards its opposite.
Canceling the centralized bidding and purchasing system for medicines will only bring the reform back to the starting point, and further improving the system and accelerating the reform of medical institutions and the medical insurance system is the best policy
In the background of China's traditional medicine and health system, a solid "alliance of interests" has already been formed between drug manufacturers and medical institutions.
In the context of China's traditional medicine and health system, a strong "alliance of interests" has been formed between drug manufacturers and medical institutions: high rebates and high prices have become the **** same choice for manufacturers and medical institutions, and there is no mechanism to protect the interests of patients in the formation of drug prices.
It is worth noting that the centralized bidding and purchasing system has produced pressure to make this "alliance of interests" has produced a "crack". Under the pressure of strong public opinion and the pharmaceutical regulatory authorities, medical institutions have made a choice: to use their dominant position in the bidding and purchasing to suppress the purchase price of medicines, and to maximize the retention of the benefits gained from this. Drug manufacturers are in a completely passive position, in addition to still have to bear a variety of public relations costs and rebates, but also to pay the various costs of the bidding, while only accepting the low prices offered by the medical institutions, drug manufacturers profit margins are shrinking day by day.
Therefore, relying only on the centralized bidding and purchasing system for medicines, it is impossible to fundamentally break the "alliance of interests" between drug manufacturers and medical institutions. We should take full advantage of this opportunity to further improve the current system of centralized bidding for drugs on the basis of accelerating the reform of the relevant systems, including weakening the monopoly of medical institutions in the sales terminal of medicines and the compensation mechanism of "medicines for doctors," strengthening the cost of consumer review mechanism, and introducing policies that can substantially promote the community health service system, and so on. The government has also introduced policies that can substantially promote the community health service system, and so on.
If the centralized bidding and purchasing system for medicines continues to be pushed forward without any supporting reforms, the limited price reduction effect of this system will gradually disappear. Because once the majority of drug manufacturers realize that there is no way out, they will try to reach a new balance of interests with the medical institutions in the centralized bidding system arrangements. In fact, this trend has begun to appear: some places appeared in the bidding price of drugs several times higher than the wholesale price of the phenomenon. Some media disclosure, wholesalers 1.5 yuan can supply a kind of injection, and hospitals in the bidding price is as high as 13.46 yuan; the same kind of gerberellin injection, market wholesalers for 47.58 yuan, and the bidding price of up to 127 yuan. Once this phenomenon spreads, it means that the centralized bidding and purchasing system for drugs has no value.
Buyer-led centralized bidding system for drugs does not meet China's national conditions, the direction of development is a third-party electronic trading system
From the practice of Europe and the United States, the centralized purchasing of medicines there are two main modes: a buyer-led purchasing model; a third-party-neutral purchasing model. According to the current provisions of China's centralized bidding and purchasing of medicines, medical institutions are the main actors in bidding and purchasing. Medical institutions have the right to choose their own bidding agency, therefore, China's centralized drug procurement is a buyer-led procurement model. In fact, the bidding agency led by the health authority makes the buyer-led model more complicated and inefficient.
From the situation in the United States, the buyer-led centralized purchasing model of drugs can effectively save purchasing costs, improve purchasing efficiency, and standardize purchasing behavior. However, this buyer-led centralized purchasing model has created a lot of problems in our country because of the different industrial environments and healthcare systems in the two countries. The U.S. pharmaceutical industry is an oligopoly market structure, the market dominance of drug manufacturers is relatively strong, and at the same time, due to the division of medicine, medical institutions in the drug procurement market influence is relatively small. Therefore, the buyer-led centralized purchasing model can effectively improve the unfavorable position of medical institutions in the transaction, which is conducive to the development of the drug market.
China's pharmaceutical industry is characterized by a small scale, large number of enterprises, excess total production capacity, the market power of drug manufacturers is very small, coupled with the lack of separation of medicine, hospitals monopolize 80% of the drug market. The result of adopting a buyer-led centralized purchasing model is that the strong are stronger and the weak are weaker.
The direction of China's centralized bidding and procurement system for medicines is to develop a third-party electronic trading system that is independent of both buyers and sellers. This third-party electronic trading system can avoid, to a considerable extent, the problems caused by the buyer-led model that reinforces the monopoly position of medical institutions. Electronic means can gradually reduce the cost of enterprises to participate in the bidding; can be weakened to a certain extent the monopoly of medical institutions; the security and stability of data provided by electronic transaction records can also provide convenience for the supervision of drugs and so on. Of course, the relevant system changes do not keep up, the monopoly of medical institutions can not be completely broken. In this sense, whether it is the current centralized bidding and purchasing of drugs, or the future of the third-party electronic trading system, its effect in promoting a good circulation order and the formation of a reasonable price of medicines, ultimately depends on the separation of medicine and other related system changes.
Do not exaggerate the role of centralized bidding for medicines
Constitutional Law of Li
In recent years, some regions, in the policy positioning and public opinion guidance of centralized bidding for medicines, ignored the limited scope of the role of centralized bidding for procurement and gave it too many functions, resulting in the public's misperception of this system. Its main performance:
One is the misunderstanding that centralized bidding and purchasing can reduce the inflated prices of medicines. In many areas, the media reported price reductions of more than 20%, and individual areas even reached more than 40%. However, most patients generally believe that they do not feel the resulting price reductions. This is because the price reduction reported by the media is the arithmetic average price of the drugs sold, reflecting the price level of all the candidate varieties sold, which cannot be directly linked to the patients' drug expenses. The patient's drug costs are determined by the level of medication used by the healthcare organization and the habit of using medication.
The second is the misconception that the centralized bidding and procurement can correct the unethical practices in the purchase and sale of medicines from the source. In fact, the current centralized bidding procurement policy can play a role in correcting the wind, but can not correct the wind from the source. Centralized bidding and purchasing only realizes the disclosure of transaction information, and over the years, the unethical practices in the purchase and sale of medicines in China have mainly occurred in the use of medicines, which is not a purchasing problem. If you think that the existing centralized bidding and procurement is a sunshine project, it is only a ray of sunshine that pierces the dark curtain of drug trading, and it can not make the drug trading process sunshine. In the centralized bidding and purchasing of the initial stage of the expectations of the corrective action is too high, is unrealistic.
Third is the mistaken belief that centralized bidding and procurement can reduce the burden on patients. Causes of excessive burden on patients, there are price problems, quality problems, the use of the problem, but first of all, the use of the problem --- prescription rebates lead to clinical irrational use of drugs is to increase the burden of patients' drug costs is the main reason. Drug purchasing behavior, the impact are the price level of drugs, not the clinician's choice of drugs and rational application. Clinical irrational use of drugs aggravates the burden of patients is a medical system problem, involving many deep-rooted contradictions that have existed for a long time in China's medical industry. In the medical system reform to fully deepen the compensation mechanism of medical institutions can be improved before the centralized bidding and purchasing benefits will be largely offset by the clinical irrational use of drugs.
Centralized bidding procurement is a reform measure for the benefit of the country and the people, but while adhering to this system, we should also recognize that the scope of the role of centralized bidding procurement is limited, and can only regulate the procurement behavior, if you think that the circulation of drugs and even some of the deep-rooted problems in the health care system will be "a move on the right" will only reduce the social satisfaction of the centralized bidding procurement policy. If we believe that the centralized bidding and procurement policy will be "one-trick pony", it will only reduce the social satisfaction of the policy and increase the resistance to the reform. The relevant departments in the centralized bidding procurement policy positioning and public opinion guidance, should not do this kind of harmful and unhelpful things.