Medical reform for many years, drug prices are still high, is too many interests, or the current price formation mechanism and related tendering system design flaws? Or is there a problem with the extent and mechanism of 15% limit increase? The reporter conducted an investigation for this purpose.
Extensive gap between ex-factory price and retail price
A recent media survey found that the ex-factory price of drugs and the price tagged by the hospital or even the retail price gap are striking.
The case was widely reported by the media is 2 ml, 0.3 grams of clindamycin phosphate injection, in Shandong, the factory price of the drug is about 0.6 yuan per unit, in Beijing, the bid price is 11 yuan, the hospital retail price is 12.65 yuan. From the ex-factory price to the retail price, the price has more than doubled.
The situation of similarly high drug prices is not a case. The relevant departments have formulated a number of measures to curb drug prices.
At present, the mechanism and process for the formation of drug prices in China are as follows: According to the self-reported production costs of pharmaceutical companies, after being accounted for by the Price Division of the National Development and Reform Commission or the local price departments, each type of drug produces a "maximum retail price", which is the so-called "ceiling price." All provinces have centralized tendering and organized expert assessments, resulting in a “bid price†and the bid price is the hospital purchase price. According to China’s current policy, public hospitals with at least two yuan must implement a drug addition policy, that is, hospitals purchase up to 15% of the price of each drug on the purchase basis and sell it to patients, and must not negotiate with the supplier to lower the purchase price. Produce a "hospital retail price."
These seemingly normative mechanisms have many obstacles in reality.
Take Shanfuming Pharmaceutical Co., Ltd.'s production of 2 ml of 20 mg Nefopam hydrochloride injection as an example. The cost per factory is 0.32 yuan, the bid price is 18.49 yuan, the retail price of the hospital is 21.26 yuan, and the ex-factory price is The retail price difference is 66 times.
Many patients questioned why the ex-factory price and the retail price are even so different from the final bid price of the hospital. Why are there drugs that are cheap and drugs that are expensive?
The survey found that at present all levels of government's money to public hospitals only account for about 10% of the hospital's operating expenses, and the remaining 90% rely on the hospital to raise funds. This is the root cause of "the use of drugs to support medicine."
Some heads of hospitals and doctors expressed their difficulties. The 15% markup space prescribed by the government is the red line. The price of medical services is too low. The hospital can only “comply†with the purchase price for its own development and doctor’s welfare. A person in charge of the pharmacy department of a top-level hospital stated in private that the hospital was not the chief culprit of high drug prices. "We must also eat, drink, and develop. We can only choose drugs that are as high as possible."
Professor Sun Dongdong, director of the Center for Health Law Research at Peking University, has long been engaged in research on issues such as health policy and reform of the health care system. He said that the root cause of the high drug price is not the manufacturer or the hospital. According to their statistics, from the book side, a drug from the factory to the hands of the patient, the average profit of the manufacturer is 10%; the average hospital is 13%. The rest are left in the middle.
Sun Dongdong believes that excessive intermediate circulation is an important cause of high drug prices. There are multi-level agents from manufacturers to hospitals, such as first-level wholesalers, second-level wholesalers, and pharmaceutical companies at all levels. Each time the intermediate link "change hands" must be invoiced, the government must tax it. In addition, medicines need to be stored, transported, and distributed in circulation, which inevitably increases cost. At the same time, the highest retail price determined by the government price department is also a problem.
At present, the national ex-factory price of pharmaceutical factories, manufacturers are generally not high-priced, very little profit. The retail price of most hospital medicines complies with the 15% fare increase policy, and there is no violation. People questioned that drugs in pharmacies are cheaper than hospitals because pharmacies do not use tenders and can order directly from multiple channels. Therefore, the cost is low and it can be leveled out.
Bidding system has congenital defects
According to statistics, in order to curb the inflated pharmaceutical prices, China began to fully implement centralized bidding for drugs in 2001. At the same time, the National Development and Reform Commission sets the maximum retail price for each drug; it also stipulates that the retail price calculated by the hospital according to the approved bidding price plus 15% must not exceed the maximum retail price.
However, these two steps have been transformed and distorted in the process of actual progress, and even violated the original intention.
The survey found that the 15% drug addition policy of this limited price objective objectively “inflated†the high drug prices.
Prof. Gu Wei, an expert who has long been dedicated to medical reform research and the School of Government Management of Peking University, pointed out that the original intention of the 15% drug addition policy was to ensure that the hospital had reasonable profits and normal operations, and also hoped that the final price of drugs could be controlled within a reasonable range. However, the actual situation has caused the hospital to favor high-priced drugs, and some good medicines for the treatment of common diseases are difficult to enter the procurement catalog.
The "zero spread" implemented in some areas has evolved into more stringent price increases. Sun Dongdong said that the grass-roots survey found that the effect of the zero difference is that the hospital loses the sales revenue of medicines, and the finances cannot make up for it. Instead, it dampens the enthusiasm of doctors.
As a result, this policy and the congenital defects in the design of the bidding system for drugs lead to high drug prices.
A number of experts told this reporter that participating hospital bidders, drug companies bidding parties and the middle party (bidding office or tendering company) reached the same interest: that is, the bid price is high to benefit all parties, regardless of the company’s sales profit It will be more after the hospital has increased the price, and the commission received by the middle side will be more.
Professor Sun Dongdong said that participating parties form a de facto interest community. Under such a kind of interest, the final result can only be a concerted effort to push up the bid price. .
This system also caused many “legitimate†changes in the circulation of pharmaceuticals from manufacturers to hospitals, and it was possible to legally “rinse†the ex-factory price to the final, “outrageous†bid price, and objectively derived the circulation of drugs. Multiple intermediate interests.
The consensus of experts is that the crux of the excessive intermediate interest links is the institutional defect of the bidding system.
Some experts also stated that hospitals still have rebates and rebates. In actual operation, the company “passes back†to the hospitals and doctors through smart forms such as “doing charityâ€, and it also becomes an important source of hospital profits.
Cancellation of 15% fare increase policy
How to curb the "high drug price" as a matter of urgency.
Many experts said that in addition to reforming the system of drug bidding system, they should actively adjust the 15% drug price increase policy.
Prof. Gu Wei said that the policy of increasing the price of drugs in public hospitals by 15% should be eliminated as soon as possible, and their drug inquiry and procurement autonomy should be given. Only in this way can the drug prices be initially suppressed.
Sun Dongdong believes that curbing the high value of drug prices is fundamentally starting from the institutional mechanism for in-depth transformation or even redesign. At the same time, government pricing mechanisms should be reformed to limit the maximum retail price.
Zhuang Yiqiang, deputy secretary-general of the Chinese Hospital Association, called on all parties to resolve the top-level design of the system and not to use doctors as scapegoats for all medical problems.
The above-mentioned experts unanimously appealed that we must fundamentally solve the problem of inflated drug prices, and we must reform and improve the medical insurance payment mechanism as soon as possible, and implement a compound payment method based on disease-based payment and total prepayment. The patients will be packaged and handed over to the hospital to implement the capping of the total number of visits and the mode of retention of hospital balances. In this way, medicines become a cost investment rather than a profit, and drug prices can come down.
background
Excessive drug prices have plagued the public for many years, and drug bidding systems and price formation mechanisms have encountered severe challenges.
In recent days, the media have reported that the ex-factory price of drugs has fallen by a factor of several times the final winning price of the hospital and even the retail price, which has once again caused concern from all walks of life.
On December 1st, the National Development and Reform Commission issued a new regulation on the management of drug prices, namely, the "Drug-parity-come parity rule." It clearly stipulates that the price of the same active pharmaceutical ingredient must be the same to prevent the company from changing the name and changing the packaging format.
Prior to November 30, the State Council executive meeting reviewed and in principle passed the "Regulations on the Implementation of the Tendering and Bidding Law of the People's Republic of China (Draft)", further clarifying the provisions preventing bidders from collaborating with successful bidders on rights trading.
Stones of Other Hills
Germany: Complete separation of "medicine" and "medicine"
In Germany, "medical" and "medicine" are completely separated. The doctor prescribes the medicine and the patient goes to the pharmacy to take the medicine. The cost of medicines prescribed by doctors for patients, hospitalization fees for patients, etc. are paid by the insurance company after they have been checked. This fundamentally prevents doctors from obtaining "rebate" opportunities from prescribing patients, and pharmaceutical companies are unable to induce doctors.
France: Implementing a forced price cut
In France, the government directly sets the prices of medicines that can be reimbursed by social insurance. For drugs that do not require social insurance reimbursement, the price of the drug is determined by the drug manufacturer. 95% of the prescription drugs circulating on the French market can be reimbursed. Once a drug enters the Drug Reimbursement Catalogue, it can be reimbursed in full. Therefore, drug price control is very strict.
The French government banned the price increase of medicines with less than two-and-a-half years of listing. After the deadline, drugs can only float within the percentage stipulated by the government. It is also possible to control drug prices through price cuts and forced price cuts.
Japan: Price Control Prescription Drugs
The Japan Pharmaceutical Affairs Law stipulates that any medical drug that is applicable to medical insurance cannot set prices freely. Instead, the government establishes the announced retail price. Since Japan implements universal health insurance, the number of medicines not included in the medical insurance catalog is very small. Therefore, in fact, Japan imposes price control on almost all prescription drugs.
At present, there are approximately 14,000 to 15,000 kinds of drugs that are priced by the government in Japan, which can basically meet the needs of most patients. However, for some medical drugs that are not used to treat diseases, such as wrinkle-removing drugs, the government does not interfere with its pricing. (According to open data editing)
Dialogue with Professor Gu Wei
Cancellation of 15% increase can be immediate
Q: What do you think is the real reason for the high drug prices?
A: The government has established a ridiculous game rule that stipulates that public hospitals can only sell up to 15% of the price.
In Beijing, Yanjing Beer's wholesale price is priced at $1. The most common restaurant, beer's normal selling price is also $3, and the rate of increase is at least 300%.
Imagine if the government stipulated that restaurants could only increase the price of beer by 15%. What would be the result? Restaurants either don’t sell Yanjing at all, and they only sell imported beers, which have high purchase prices and high bonuses. They either purchase bottles from wholesalers at RMB 3 or RMB and sell them at RMB 3.45 per bottle. At the same time, they require wholesalers to provide 2 bottles per restaurant. Yuan "rebate". If the government bans "rebates," let wholesalers do something "charity" to restaurants, such as donating wok, air conditioners, and range hoods.
The catering industry does not have such a ridiculous "system" and therefore there is no problem of high beer prices. As for the fact that some restaurant beer is really not cheap, that is another problem. However, there are such "system" problems in hospitals. Therefore, the strange phenomenon that never occurs in the sale of beer is endless in the sale of drugs.
Q: What are the problems with drug bidding?
A: There are many problems in the centralized bidding and procurement system for medicines. There is no space for them to elaborate here. One point must be clarified that centralized tendering of medicines does not exert force on suppressing the high drug prices in public hospitals. It is not its own problem but it is the price increase control. In other words, the above-mentioned absurd rules of the game have also destroyed the centralized bidding system for drugs.
The bidding process must involve experts. Regardless of how it is screened, most experts come from public hospitals. Since the government stipulates that public hospitals can only increase the price of drugs by 15%, normal people in public hospitals will not be enamored of lowering the bid price of drugs. Therefore, whether or not the expert selection process is reasonable is not relevant here. Even if it is reasonable, the bid evaluation experts have no incentive to "bargain."
Q: Is there an immediate policy to curb drug prices?
Answer: Yes! If the government stipulates that the province’s bidding price is the retail price of public hospitals, then all medicines will fall by 13% from the current retail level overnight (that is, they will not add 15% to the winning bid price). However, what is more important is that at the same time, it must give public hospitals the right to make inquiries and procurement of drugs, and they must independently increase their prices under the bid price.
This policy is different from the "zero drug odds" policy. The drug zero-rate policy does not allow people to increase prices, so public hospitals cannot live and can only rely on financial support. The financial support system is even worse. The Chinese people had seen this system more than 30 years ago and the hospital would have no incentive. Once such a policy is implemented throughout the country, it is even more difficult for ordinary people to see a doctor.
Dialogue with Professor Sun Dongdong
Reform the bidding system from the source of the system
Q: What are the problems with the current bidding system?
A: This system design itself is flawed and does not solve the fundamental problem. Someone once asked me if construction bidding can be successful and why bidding for medicine fails. This is because the interests of all parties involved in construction bidding are antagonistic. That is, investors want to spend less, and construction companies want to make more money. Therefore, they need to find a balance point and naturally want to bargain.
In the drug bidding and tendering system, the interests of all parties are the same, that is, hospitals, pharmaceutical companies, drug dealers and intermediary parties (bidding offices and tendering companies) have the same interests, form a common interest community, and jointly work together to push up the bid price.
Recently, some areas have tried to trust the hospital's pharmacy to cut off the link between medicines and achieve drug price reduction. The actual result is just the opposite. All hospitals that host hospital pharmacies are pharmaceutical companies. If enterprises want to make profits, they must rely on selling drugs. So there was one more price increase.
Question: How to truly solve the problem of high drug prices?
A: The final solution is to start reforms from the system. Eliminating the use of drugs to raise medical care, raising the level of diagnosis and treatment and the cost of medical treatment, so that hospitals and doctors can really rely on the ability and level of medical services to support themselves. Grass-roots hospitals, especially in rural areas, have little therapeutic activity and rely mainly on selling drugs. Why is it easy to produce counterfeit drugs in rural areas? It is because there is no other way out, and only excessive costs can be reduced. Therefore, it is difficult for basic-level hospitals to support themselves through medical services and must be incorporated into state protection. At present, basic-level hospitals adopt two lines of revenue and expenditure, and only sell basic medicines, which are limited to fewer varieties and have a slower effect. This has led to the shortage of township hospitals and overcrowding in hospitals at or above the county level. The solution is that hospitals at the township level should also be allowed to sell medicines other than the list of essential medicines, and medical insurance should keep up.
The serious shortage of government investment in hospitals also contributed to the high drug prices. Last year, we conducted a sample survey of public hospitals across the country on the reform of public hospitals. At present, the government investment of public hospitals in the country accounts for an average of 8% of the hospital's revenue, and that of the top three hospitals is less than 3%. Quite a number of county-level hospitals, the government not only does not give money, but also has to pay millions of hospitals each year. The people's demand for medical environment improvement and medical equipment is getting higher and higher. But where does the money come from? The government basically does not give it. Hospitals have to solve their own problems by relying on loans, delaying remittances from drug companies. This, to a large extent, forced drug makers to increase drug prices.
In short, the core problem of high drug prices is caused by the lack of government management. The government should make efforts to rectify medical order and medical order, purchase services, build platforms, and supervise the quality and circulation of medicines. In addition, we must resolve the system deficiencies in the tender procurement system; compress the intermediate links, introduce competition mechanisms, allow middlemen to compete, and who will serve them well. Only in this way can the drug prices really come down.
Extensive gap between ex-factory price and retail price
A recent media survey found that the ex-factory price of drugs and the price tagged by the hospital or even the retail price gap are striking.
The case was widely reported by the media is 2 ml, 0.3 grams of clindamycin phosphate injection, in Shandong, the factory price of the drug is about 0.6 yuan per unit, in Beijing, the bid price is 11 yuan, the hospital retail price is 12.65 yuan. From the ex-factory price to the retail price, the price has more than doubled.
The situation of similarly high drug prices is not a case. The relevant departments have formulated a number of measures to curb drug prices.
At present, the mechanism and process for the formation of drug prices in China are as follows: According to the self-reported production costs of pharmaceutical companies, after being accounted for by the Price Division of the National Development and Reform Commission or the local price departments, each type of drug produces a "maximum retail price", which is the so-called "ceiling price." All provinces have centralized tendering and organized expert assessments, resulting in a “bid price†and the bid price is the hospital purchase price. According to China’s current policy, public hospitals with at least two yuan must implement a drug addition policy, that is, hospitals purchase up to 15% of the price of each drug on the purchase basis and sell it to patients, and must not negotiate with the supplier to lower the purchase price. Produce a "hospital retail price."
These seemingly normative mechanisms have many obstacles in reality.
Take Shanfuming Pharmaceutical Co., Ltd.'s production of 2 ml of 20 mg Nefopam hydrochloride injection as an example. The cost per factory is 0.32 yuan, the bid price is 18.49 yuan, the retail price of the hospital is 21.26 yuan, and the ex-factory price is The retail price difference is 66 times.
Many patients questioned why the ex-factory price and the retail price are even so different from the final bid price of the hospital. Why are there drugs that are cheap and drugs that are expensive?
The survey found that at present all levels of government's money to public hospitals only account for about 10% of the hospital's operating expenses, and the remaining 90% rely on the hospital to raise funds. This is the root cause of "the use of drugs to support medicine."
Some heads of hospitals and doctors expressed their difficulties. The 15% markup space prescribed by the government is the red line. The price of medical services is too low. The hospital can only “comply†with the purchase price for its own development and doctor’s welfare. A person in charge of the pharmacy department of a top-level hospital stated in private that the hospital was not the chief culprit of high drug prices. "We must also eat, drink, and develop. We can only choose drugs that are as high as possible."
Professor Sun Dongdong, director of the Center for Health Law Research at Peking University, has long been engaged in research on issues such as health policy and reform of the health care system. He said that the root cause of the high drug price is not the manufacturer or the hospital. According to their statistics, from the book side, a drug from the factory to the hands of the patient, the average profit of the manufacturer is 10%; the average hospital is 13%. The rest are left in the middle.
Sun Dongdong believes that excessive intermediate circulation is an important cause of high drug prices. There are multi-level agents from manufacturers to hospitals, such as first-level wholesalers, second-level wholesalers, and pharmaceutical companies at all levels. Each time the intermediate link "change hands" must be invoiced, the government must tax it. In addition, medicines need to be stored, transported, and distributed in circulation, which inevitably increases cost. At the same time, the highest retail price determined by the government price department is also a problem.
At present, the national ex-factory price of pharmaceutical factories, manufacturers are generally not high-priced, very little profit. The retail price of most hospital medicines complies with the 15% fare increase policy, and there is no violation. People questioned that drugs in pharmacies are cheaper than hospitals because pharmacies do not use tenders and can order directly from multiple channels. Therefore, the cost is low and it can be leveled out.
Bidding system has congenital defects
According to statistics, in order to curb the inflated pharmaceutical prices, China began to fully implement centralized bidding for drugs in 2001. At the same time, the National Development and Reform Commission sets the maximum retail price for each drug; it also stipulates that the retail price calculated by the hospital according to the approved bidding price plus 15% must not exceed the maximum retail price.
However, these two steps have been transformed and distorted in the process of actual progress, and even violated the original intention.
The survey found that the 15% drug addition policy of this limited price objective objectively “inflated†the high drug prices.
Prof. Gu Wei, an expert who has long been dedicated to medical reform research and the School of Government Management of Peking University, pointed out that the original intention of the 15% drug addition policy was to ensure that the hospital had reasonable profits and normal operations, and also hoped that the final price of drugs could be controlled within a reasonable range. However, the actual situation has caused the hospital to favor high-priced drugs, and some good medicines for the treatment of common diseases are difficult to enter the procurement catalog.
The "zero spread" implemented in some areas has evolved into more stringent price increases. Sun Dongdong said that the grass-roots survey found that the effect of the zero difference is that the hospital loses the sales revenue of medicines, and the finances cannot make up for it. Instead, it dampens the enthusiasm of doctors.
As a result, this policy and the congenital defects in the design of the bidding system for drugs lead to high drug prices.
A number of experts told this reporter that participating hospital bidders, drug companies bidding parties and the middle party (bidding office or tendering company) reached the same interest: that is, the bid price is high to benefit all parties, regardless of the company’s sales profit It will be more after the hospital has increased the price, and the commission received by the middle side will be more.
Professor Sun Dongdong said that participating parties form a de facto interest community. Under such a kind of interest, the final result can only be a concerted effort to push up the bid price. .
This system also caused many “legitimate†changes in the circulation of pharmaceuticals from manufacturers to hospitals, and it was possible to legally “rinse†the ex-factory price to the final, “outrageous†bid price, and objectively derived the circulation of drugs. Multiple intermediate interests.
The consensus of experts is that the crux of the excessive intermediate interest links is the institutional defect of the bidding system.
Some experts also stated that hospitals still have rebates and rebates. In actual operation, the company “passes back†to the hospitals and doctors through smart forms such as “doing charityâ€, and it also becomes an important source of hospital profits.
Cancellation of 15% fare increase policy
How to curb the "high drug price" as a matter of urgency.
Many experts said that in addition to reforming the system of drug bidding system, they should actively adjust the 15% drug price increase policy.
Prof. Gu Wei said that the policy of increasing the price of drugs in public hospitals by 15% should be eliminated as soon as possible, and their drug inquiry and procurement autonomy should be given. Only in this way can the drug prices be initially suppressed.
Sun Dongdong believes that curbing the high value of drug prices is fundamentally starting from the institutional mechanism for in-depth transformation or even redesign. At the same time, government pricing mechanisms should be reformed to limit the maximum retail price.
Zhuang Yiqiang, deputy secretary-general of the Chinese Hospital Association, called on all parties to resolve the top-level design of the system and not to use doctors as scapegoats for all medical problems.
The above-mentioned experts unanimously appealed that we must fundamentally solve the problem of inflated drug prices, and we must reform and improve the medical insurance payment mechanism as soon as possible, and implement a compound payment method based on disease-based payment and total prepayment. The patients will be packaged and handed over to the hospital to implement the capping of the total number of visits and the mode of retention of hospital balances. In this way, medicines become a cost investment rather than a profit, and drug prices can come down.
background
Excessive drug prices have plagued the public for many years, and drug bidding systems and price formation mechanisms have encountered severe challenges.
In recent days, the media have reported that the ex-factory price of drugs has fallen by a factor of several times the final winning price of the hospital and even the retail price, which has once again caused concern from all walks of life.
On December 1st, the National Development and Reform Commission issued a new regulation on the management of drug prices, namely, the "Drug-parity-come parity rule." It clearly stipulates that the price of the same active pharmaceutical ingredient must be the same to prevent the company from changing the name and changing the packaging format.
Prior to November 30, the State Council executive meeting reviewed and in principle passed the "Regulations on the Implementation of the Tendering and Bidding Law of the People's Republic of China (Draft)", further clarifying the provisions preventing bidders from collaborating with successful bidders on rights trading.
Stones of Other Hills
Germany: Complete separation of "medicine" and "medicine"
In Germany, "medical" and "medicine" are completely separated. The doctor prescribes the medicine and the patient goes to the pharmacy to take the medicine. The cost of medicines prescribed by doctors for patients, hospitalization fees for patients, etc. are paid by the insurance company after they have been checked. This fundamentally prevents doctors from obtaining "rebate" opportunities from prescribing patients, and pharmaceutical companies are unable to induce doctors.
France: Implementing a forced price cut
In France, the government directly sets the prices of medicines that can be reimbursed by social insurance. For drugs that do not require social insurance reimbursement, the price of the drug is determined by the drug manufacturer. 95% of the prescription drugs circulating on the French market can be reimbursed. Once a drug enters the Drug Reimbursement Catalogue, it can be reimbursed in full. Therefore, drug price control is very strict.
The French government banned the price increase of medicines with less than two-and-a-half years of listing. After the deadline, drugs can only float within the percentage stipulated by the government. It is also possible to control drug prices through price cuts and forced price cuts.
Japan: Price Control Prescription Drugs
The Japan Pharmaceutical Affairs Law stipulates that any medical drug that is applicable to medical insurance cannot set prices freely. Instead, the government establishes the announced retail price. Since Japan implements universal health insurance, the number of medicines not included in the medical insurance catalog is very small. Therefore, in fact, Japan imposes price control on almost all prescription drugs.
At present, there are approximately 14,000 to 15,000 kinds of drugs that are priced by the government in Japan, which can basically meet the needs of most patients. However, for some medical drugs that are not used to treat diseases, such as wrinkle-removing drugs, the government does not interfere with its pricing. (According to open data editing)
Dialogue with Professor Gu Wei
Cancellation of 15% increase can be immediate
Q: What do you think is the real reason for the high drug prices?
A: The government has established a ridiculous game rule that stipulates that public hospitals can only sell up to 15% of the price.
In Beijing, Yanjing Beer's wholesale price is priced at $1. The most common restaurant, beer's normal selling price is also $3, and the rate of increase is at least 300%.
Imagine if the government stipulated that restaurants could only increase the price of beer by 15%. What would be the result? Restaurants either don’t sell Yanjing at all, and they only sell imported beers, which have high purchase prices and high bonuses. They either purchase bottles from wholesalers at RMB 3 or RMB and sell them at RMB 3.45 per bottle. At the same time, they require wholesalers to provide 2 bottles per restaurant. Yuan "rebate". If the government bans "rebates," let wholesalers do something "charity" to restaurants, such as donating wok, air conditioners, and range hoods.
The catering industry does not have such a ridiculous "system" and therefore there is no problem of high beer prices. As for the fact that some restaurant beer is really not cheap, that is another problem. However, there are such "system" problems in hospitals. Therefore, the strange phenomenon that never occurs in the sale of beer is endless in the sale of drugs.
Q: What are the problems with drug bidding?
A: There are many problems in the centralized bidding and procurement system for medicines. There is no space for them to elaborate here. One point must be clarified that centralized tendering of medicines does not exert force on suppressing the high drug prices in public hospitals. It is not its own problem but it is the price increase control. In other words, the above-mentioned absurd rules of the game have also destroyed the centralized bidding system for drugs.
The bidding process must involve experts. Regardless of how it is screened, most experts come from public hospitals. Since the government stipulates that public hospitals can only increase the price of drugs by 15%, normal people in public hospitals will not be enamored of lowering the bid price of drugs. Therefore, whether or not the expert selection process is reasonable is not relevant here. Even if it is reasonable, the bid evaluation experts have no incentive to "bargain."
Q: Is there an immediate policy to curb drug prices?
Answer: Yes! If the government stipulates that the province’s bidding price is the retail price of public hospitals, then all medicines will fall by 13% from the current retail level overnight (that is, they will not add 15% to the winning bid price). However, what is more important is that at the same time, it must give public hospitals the right to make inquiries and procurement of drugs, and they must independently increase their prices under the bid price.
This policy is different from the "zero drug odds" policy. The drug zero-rate policy does not allow people to increase prices, so public hospitals cannot live and can only rely on financial support. The financial support system is even worse. The Chinese people had seen this system more than 30 years ago and the hospital would have no incentive. Once such a policy is implemented throughout the country, it is even more difficult for ordinary people to see a doctor.
Dialogue with Professor Sun Dongdong
Reform the bidding system from the source of the system
Q: What are the problems with the current bidding system?
A: This system design itself is flawed and does not solve the fundamental problem. Someone once asked me if construction bidding can be successful and why bidding for medicine fails. This is because the interests of all parties involved in construction bidding are antagonistic. That is, investors want to spend less, and construction companies want to make more money. Therefore, they need to find a balance point and naturally want to bargain.
In the drug bidding and tendering system, the interests of all parties are the same, that is, hospitals, pharmaceutical companies, drug dealers and intermediary parties (bidding offices and tendering companies) have the same interests, form a common interest community, and jointly work together to push up the bid price.
Recently, some areas have tried to trust the hospital's pharmacy to cut off the link between medicines and achieve drug price reduction. The actual result is just the opposite. All hospitals that host hospital pharmacies are pharmaceutical companies. If enterprises want to make profits, they must rely on selling drugs. So there was one more price increase.
Question: How to truly solve the problem of high drug prices?
A: The final solution is to start reforms from the system. Eliminating the use of drugs to raise medical care, raising the level of diagnosis and treatment and the cost of medical treatment, so that hospitals and doctors can really rely on the ability and level of medical services to support themselves. Grass-roots hospitals, especially in rural areas, have little therapeutic activity and rely mainly on selling drugs. Why is it easy to produce counterfeit drugs in rural areas? It is because there is no other way out, and only excessive costs can be reduced. Therefore, it is difficult for basic-level hospitals to support themselves through medical services and must be incorporated into state protection. At present, basic-level hospitals adopt two lines of revenue and expenditure, and only sell basic medicines, which are limited to fewer varieties and have a slower effect. This has led to the shortage of township hospitals and overcrowding in hospitals at or above the county level. The solution is that hospitals at the township level should also be allowed to sell medicines other than the list of essential medicines, and medical insurance should keep up.
The serious shortage of government investment in hospitals also contributed to the high drug prices. Last year, we conducted a sample survey of public hospitals across the country on the reform of public hospitals. At present, the government investment of public hospitals in the country accounts for an average of 8% of the hospital's revenue, and that of the top three hospitals is less than 3%. Quite a number of county-level hospitals, the government not only does not give money, but also has to pay millions of hospitals each year. The people's demand for medical environment improvement and medical equipment is getting higher and higher. But where does the money come from? The government basically does not give it. Hospitals have to solve their own problems by relying on loans, delaying remittances from drug companies. This, to a large extent, forced drug makers to increase drug prices.
In short, the core problem of high drug prices is caused by the lack of government management. The government should make efforts to rectify medical order and medical order, purchase services, build platforms, and supervise the quality and circulation of medicines. In addition, we must resolve the system deficiencies in the tender procurement system; compress the intermediate links, introduce competition mechanisms, allow middlemen to compete, and who will serve them well. Only in this way can the drug prices really come down.
Ganzhou Green days Biochemical Technology Co., Ltd. , http://www.cn-gangdao.com