How much can the price of a pacemaker be reduced by the 22 provincial Super Purchasing Group?

The centralized procurement took two steps forward, and the Super Procurement Group of 22 provinces swung the centralized procurement broadsword to the pacemaker in the high-value medical consumables
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On October 18, the Shaanxi Provincial Medical Insurance Bureau issued the "Implementation Plan for Centralized Pacemaker Procurement in the Provinces (Regions and Corps) of the Inter-Provincial Union" (hereinafter referred to as the "Plan")
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The "Plan" decided to carry out centralized procurement of pacemakers in Shaanxi, Gansu, Ningxia, Xinjiang, Xinjiang Construction Corps, Hunan, Guangxi, Hainan and other places
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Prior to this, on September 8, Beijing-Tianjin-Hebei and Heiji, Liao, Meng, Jin, Shandong, Henan, Sichuan, Guizhou and Tibet formed a 3+N alliance
.
As a result, a 22-province super purchasing group for pacemakers was formed
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Pacemakers are recognized by the medical community as the most effective treatment for chronic cardiac arrhythmia.
They are mainly divided into single-chamber, double-chamber, three-chamber and three-chamber defibrillation
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The price of the lower-end single-chamber pacemaker is 20,000 to 30,000 yuan, the price of the higher-end three-chamber pacemaker is about 100,000 yuan, and the price of the three-chamber defibrillation pacemaker is 150,000 to 250,000 yuan
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The dual-chamber pacemaker is the main application type in the domestic market, and the price is about 50,000 yuan
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According to the "2020 China Cardiovascular Health and Disease Report", dual-chamber pacemakers account for nearly 70% of all types of pacemakers
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Promote the return of prices to reasonable levels and reduce the burden on patients.
This is the overall requirement for the centralized procurement of pacemakers in the 7-province alliance of Shaanxi, and the scope of centralized procurement is the dual-chamber pacemaker with a higher application type in the Chinese market
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What impact will the Super Purchasing Group that landed in January have on the market? These people who have extravagant expectations even for a normal heartbeat-insufficient penetration rate and unsatisfied clinical needs.
China's aging process is accelerating, which has promoted the continuous increase in the incidence of heart-related diseases
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According to the "China Cardiovascular Disease Report 2018", the number of heart failure patients in China has reached 5 million, and the incidence of heart failure in the 35-74 year old population in China is about 9 per thousand, and it is increasing year by year.

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Generally, a healthy adult's heart beats more than 60 times per minute, but patients with arrhythmia are far below this number, and a normal heartbeat becomes their luxury
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And implanting a pacemaker is currently the only exact and effective treatment for bradycardia
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If the heart is not beating, it means death.
For patients with slow heart rate, a pacemaker can help the heart beat
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Han Shiqin, deputy director of the Department of Cardiology, Xinghua People's Hospital, told the health community
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However, it is worth noting that China's pacemaker penetration rate is seriously insufficient, and the needs of many clinical patients cannot be met
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According to statistics from Zhongcheng Medical Devices, in 2018, the number of pacemakers implanted in Mainland China was about 80,000, and the number of implanted pacemakers per million population was 60, which is significantly different from the 236 in Hong Kong, while the United States and Japan are even more It is to reach 1,000 units
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Patients are concentrated in the top three hospitals, patient acceptance, pacemaker costs, and other issues.
Medical insurance payment has become a barrier to the development of the pacemaker market
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Pacemaker implantation in the heart is a minimally invasive surgery.
Because it involves the heart and main blood vessels, there is a greater risk during the operation
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It is a fourth-level surgery .
Han Shiqin said
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According to the "Measures for the Management of Surgery Levels in Medical Institutions (Trial)", the fourth-level surgery is the most difficult surgery, the procedure is complex, and the risk is high
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The subjective wishes of patients are also more inclined to go to the top three hospitals for pacemaker surgery
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In reality, since cardiac pacemaker surgery is an implantation operation, it has a long service life and involves replacement during the period, which is closely related to life and health
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On the other hand, the price of China's mainstream dual-chamber pacemaker is around 50,000 yuan, which is mainly imported, which also causes a heavy economic burden
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A single-chamber pacemaker lead is implanted into the right atrium or right ventricle, and only the atrium or ventricle is paced alone
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Dual-chamber cardiac pacemakers are implanted with wires in the right atrium and right ventricle, which can maintain sequential atrioventricular pacing
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Three-chamber cardiac pacemaker refers to cardiac resynchronization therapy, or dual-ventricular synchronized pacing.
In addition to the implantation of wires in the right atrium and right ventricle, the wires are implanted through the coronary sinus to the lateral or posterior vein of the left ventricle.
Epicardial pacing of the left ventricle restores the synchronization of the left and right ventricles
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The more cavities, the more accurately the heartbeat can be simulated, and the higher the R&D and production barrier
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Foreign brands in the pacemaker market in China have an absolute monopoly
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Up to now, domestic pacemakers are only concentrated in the single-chamber and double-chamber ranges, and the three-chamber is still monopolized by foreign capital
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According to data from the Guosen Securities Economic Research Institute, the first echelon of foreign brands, Medtronic, Abbott, and Poco accounted for 43.
0%, 23.
7%, and 17.
8% respectively, and the Big Three accounted for 84.
5%
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Coupled with the second-tier Bidori and Sorin Group, the market share of imported pacemakers has reached 95.
7%
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Among them, the only approved domestic implantable cardiac pacemakers are Chuangling Heart Rhythm, Lepu Medical (Qin Ming Medical), and Lifetech, with a market share of only about 5%
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In addition, from the perspective of medical insurance payment, the financial burden of patients is also heavier
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Relevant staff of the Medical Insurance Office of Jiangxi Provincial People’s Hospital told the health community that the maximum reimbursement for cardiac pacemakers in Nanchang’s employee medical insurance is 15,000 yuan, and the patient pays for the part exceeding the maximum limit; the maximum reimbursement for the rural medical insurance is 10,000 yuan, and the part exceeding the maximum limit is paid by the patient.
The patient pays
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It can be seen that for a dual-chamber pacemaker of about 50,000 yuan/set, the patient will have to pay 30,000 to 40,000 yuan at his own expense, plus the cost of diagnosis and treatment, hospitalization, and medicine will be even higher
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For rural patients, the financial burden of self-finance is relatively heavy, and for patients with financial constraints, it may affect their lives and health
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The market is growing fast and the price is weak.
In recent years, the pace of pacemaker implantation in China has been increasing year by year
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According to statistics from the National Health Commission's online registration system, pacemaker implantation in 2019 increased by 9.
3% compared to 2018
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However, with the rapid growth of the pacemaker market, prices remain high
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In 2018, China's pacemaker imports amounted to US$161 million.
Based on the calculation of the terminal price being 3 to 4 times higher than the ex-factory price, the domestic pacemaker market is between 3.
4 billion and 4.
4 billion yuan
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According to the latest statistics of the General Administration of Customs in September 2021, the average import price of each pacemaker is about 13,633 yuan
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However, the actual price paid by patients is more than three times the import price, and there is more intermediate water, which brings a heavier economic burden to patients, and calls for price reductions are gradually increasing
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As a result, the centralized procurement of pacemakers has also been carried out in many provinces: in 2020, Anhui, Qinghai, and Shandong carried out the purchase of pacemakers, but the relative decline was limited
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Specifically, the average decrease of Anhui single-chamber and dual-chamber pacemakers was 46.
75%; the average decrease of Qinghai dual-chamber pacemakers was 13%; the average decrease of Fujian dual-chamber pacemakers was 36.
92%; the average decrease of Shandong centralized procurement It is 51.
86%
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Obviously, the price reduction is still a big difference compared to the coronary stents and artificial joints in high-value medical consumables: the price reduction of coronary stents is more than 90%, and the price reduction of artificial joints is more than 80%
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The centralized procurement of pacemakers in Jiangsu will benefit patients.
In Wuxi in early September 2021, the rain was continuous
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Continuous rain and rain caused the road to be wet and slippery.
66-year-old Li Xiufang accidentally fell down while doing farm work.
One month thereafter, she was often accompanied by paroxysmal chest tightness, heart palpitations, and dark fainting
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The family was worried, and was sent to Xinghua People’s Hospital for treatment.
He was diagnosed with arrhythmia, third-degree atrioventricular block, and grade 3 hypertension (very high risk).
It is a type of adaptation for cardiac pacemaker implantation surgery.
Disease
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In the end, a month later, Li Xiufang successfully and safely completed the operation
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I feel very good now, my body is recovering well, and my heartbeat is obvious
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Li Xiufang said to the health sector
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Jiangsu Province, where Li Xiufang is located, has carried out two collections of pacemakers
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In July 2019, the average price of dual-chamber cardiac pacemakers in Jiangsu Province was reduced by 15.
86%, and the highest reduction was 38.
13%; in June 2021, the fifth round of procurement negotiations for the medical consumables alliance of public medical institutions in Jiangsu Province was carried out, pacing The average drop of the device was 60%, the highest drop was 69%, and the price dropped from RMB 50,000 to 60,000 to around RMB 20,000
.
Han Shiqin is the chief surgeon in charge of Li Xiufang’s operation.
He told the health community that Li Xiufang installed a temporary pacemaker and imported dual-chamber pacemaker.
A total of about 30,000 yuan will be spent, and 50% to 60% will be reimbursed according to the proportion of the new rural cooperative medical system.
Li Xiufang will eventually pay about 18,000 yuan personally
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Thanks to the centralized procurement of pacemakers in Jiangsu, compared with the past, the cost of Li Xiufang has been reduced by about 5,000 yuan
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She said
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The country’s policies are great for ordinary people, and they have saved us a lot of money.
I am especially grateful to the country
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Li Xiufang said
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Can the Super Purchasing Group keep the lowest price? Previously, the centralized procurement of pacemakers was dominated by the provinces alone.
This time, the Beijing-Tianjin-Hebei 3+N Alliance and the 22-province Super Purchasing Group of the Shaanxi Eight-province Alliance are expected to achieve the The effect of volume-for-price and volume-price linkage gives the product more room for price reduction and the lowest price
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Compared with coronary stents and artificial joints, the amount of cardiac pacemakers is still not comparable.
A substantial price reduction is unlikely, so it may not bring changes to the market
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Medical reform expert Xu Yucai emphasized in an interview with the health community
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First of all, any policy of centralized procurement of medical supplies is expected and supported by medical staff, which helps to clarify that the main body of medical services is medical technology, not articles
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Collective procurement should be treated with a scientific and multi-faceted attitude
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Authoritative doctors in the industry told the health community that unlike domestic manufacturers in the coronary stent market, the R&D and production capacity has been up, and pacemakers have not yet risen on a large scale.
Scientific research innovation is unfavorable
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The doctor believes that large import manufacturers should be unwilling to sacrifice quality in the face of centralized procurement; the other side of the coin is that imported brands will reduce their investment in the Chinese market.
In terms of scientific research and innovation and promotion of technology, it is right China will definitely weaken
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What he worries most is that domestic manufacturers have not gained a firm foothold for the time being, and because the difference between investment and expected benefits is not optimistic, various aspects of reducing R&D and product innovation power will affect the progress of domestic technology and products
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No matter how much pacemaker prices are reduced, the proportion of medical insurance reimbursement should be increased, especially the proportion of medical insurance that can be affordable for rural patients
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Tang Changdong, a special author in the health sector, said that due to the reform effect of the first batch of centralized procurement of stents, the centralized procurement market for pacemakers can cope with and have psychological expectations
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However, the difference between pacemakers and stents is that if imported products are eliminated through centralized procurement, there is a possibility that patients will be burdened due to the quality differences of domestic brands
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Tang Changdong believes that in the face of the uniqueness of life, the health industry cannot determine the selectivity of a product based on a purely economic viewpoint and value attributes
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The right to life belongs to the patient.
The consistency of the goals and interests of the patient and the medical institution is to save lives.
There should not be too many interfering factors.
Only respect for science, respect for life, and respect for laws
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The above-mentioned doctor said
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(Li Xiufang is a pseudonym in the text)