How to solve the primary problem of medical reform? The maximum price is the key!

Medicine Network February 20th, the unreasonable use of drugs and drug prices is the primary problem of medical reform, the implementation of drug hospital zero-price sales and unified tender procurement of drugs has not solved this problem very well.
the goal of treating the unreasonable use of drugs by cutting off the interest relationship between hospitals and medicines.
Although on the face of it, the proportion of drugs decreased, but the absolute dosing of drugs did not decline, and some increased, because the fundamental reason for the unreasonable use of drugs is that there is an interest relationship between doctors and drug dealers, hospital prescription rights in the hands of doctors, drug dealers by giving doctors rebates, prompting doctors to use more drugs, rebate rate of about 15-20%.
Drug zero-price sales also led to hospitals through increasing the amount of consumables and other ways to make up for losses, supplies accounted for about 10% from the past to about 20%, and now in the implementation of zero-price sales of supplies, hospitals to make up for the loss of many ways, is the next step to develop a large-scale equipment inspection zero-benefit policy? The goal of unified tender procurement of medicines with the intention of reducing drug prices has not been fully achieved, as most drugs tendered through provincial platforms can also be re-offered, with a return rate of usually 15-20 per cent.
problems in the procurement of belt volume are worth studying.
We note that the rebate rate and secondary bargaining rate of drug dealers to doctors are about 15-20%, this 30-40% profit margin, should be the main contradiction of the drug problem.
to squeeze out this abnormal profit margin, or to return it to the hospital, is a key part of our treatment of the drug problem.
measures to deal with the drug problem cannot violate the laws of the socialist market economy, otherwise it will inevitably end in failure.
medical institutions are in the socialist market economy environment, in the sale of drugs, to clear the government's macro-control function and market resource allocation function, the relevant government departments can not replace the hospital, can not interfere with the market order.
government's most effective, convenient and administrative resource-saving approach to drug macro-control is to implement the maximum price sales management of drugs.
hospital purchase price is the hospital's own business, should be by the hospital and drug dealers in accordance with the law of market operation negotiations or tenders.
how to determine a reasonable first maximum price is the key, China has many years of provincial tender platform data, so it is easy to determine the maximum price.
The State Administration of Health Insurance may conduct a large-data analysis of the tender prices of drugs on provincial platforms nationwide, select the lowest price or reasonable price of a drug as the national maximum price for the first time, and carry out dynamic management, or it may determine the maximum price on a provincial basis.
Hospitals can purchase drugs on their own, or they can form a hospital alliance or through non-governmental third-party agencies to conduct unified tender procurement to determine the purchase price of drugs, the lower the purchase price, the higher the profit, the hospital has a strong negotiating power, will try to lower the purchase price.
Government departments mainly do a good job of monitoring: First, to grasp the purchase price of hospital drugs, by the Health Insurance Bureau responsible for the second is to grasp the market drug supply, by the health care and health departments responsible for the third is to master the operation of enterprises and drug quality, by the Ministry of Industry and Information and Drug Supervision responsible for the fourth is the doctor to take drug rebates, by the health department responsible.
General need to monitor 1-2 years, if a drug in the hospital already has a relatively stable procurement price, the market supply situation is good, the normal operation of enterprises, there are doctors to take rebates, you can consider lowering the maximum price, on the other way, we must consider the floating maximum price.
test example: a drug A, by the medical insurance bureau investigation and analysis, a province tender platform price of 10 yuan / branch for the lowest price in the country, through comprehensive analysis of the price is also more reasonable, if the drug does not exist a secondary offer and doctors to get rebates, the health insurance bureau should determine 11.5 yuan / branch (10 plus 10×15%) is the country's first maximum price, if there is a secondary offer and doctors get rebates, you can determine 10 yuan / branch for the country's first maximum price.
Next, led by the Health Insurance Bureau to monitor drugs, for example, after a year of monitoring, drug A most hospital procurement price of 8 yuan / branch, the market supply is adequate, the operation of enterprises is good, although there are individual enterprises have a loss, because of the enterprise's low level of science and technology, poor management capacity, at the same time, found that some hospitals still have doctors to take kickbacks.
meet the conditions for lowering the maximum price, for example, the maximum price can be adjusted to 9.2 yuan / branch (8 plus 8×15%).
so dynamic management, after several rounds of adjustment, the price of drug A will certainly return to rationality.