Is the deep basic medicine catalogue "ginseng fruit" or "soul returning pill"?

Shandong is light Feng Shui turns around Come to my house today! Originally, the list of base drugs was not favored, but there was a 360 degree reversal, a magic counterattack On October 11, the general office of the State Council issued the opinions on further ensuring the supply and price stability of drugs in short supply (GBF [2019] No 47, hereinafter referred to as the opinions) The opinions put forward the relevant requirements of "1 + X" for the allocation and use of basic drugs, that is, gradually realizing the allocation of basic drugs in government run primary medical and health institutions, secondary public hospitals and tertiary public hospitals In principle, the proportion of quantity shall not be less than 90%, 80% and 60% respectively We will promote medical institutions at all levels to form a "1 + X" (1 is the national catalogue of basic drugs, X is non basic drugs, which shall be determined by each region according to the actual situation) medication model, and optimize and standardize the medication structure In a moment, the list of basic drugs seems to have become a white snow from xialiba For medical people, entering the list of basic drugs is equivalent to stepping into a palace full of gold But the question is, how much money do you have to wait for the base drug? Just waiting for the feast and revelry after entering the basic medicine? Is the basic medicine catalog an immortal "ginseng fruit" or a "soul returning pill" that can strengthen brain and kidney? First of all, we have to face the problem of compensation mechanism of primary medical institutions According to the statistics of the statistical information center of the national health and Health Commission, by the end of September 2019, there were 954000 primary medical and health institutions, including 35000 community health service centers (stations), 36000 township hospitals, 621000 village clinics and 238000 clinics In addition to the official data, according to incomplete statistics, there are 440000 pharmacies, 1.4 million grassroots doctors, 700 million urban community residents, 600 million rural and township residents This series of data is the theoretical market basis of primary medical care in China On the one hand, the national policy strongly supports the hierarchical diagnosis and treatment, and all kinds of enterprises recruit soldiers and prepare to show their strength at the grass-roots level; on the other hand, the grass-roots medical talents are out of touch, the equipment is old, the level of diagnosis and treatment is low, and the public's medical habits are hard to change According to the statistical bulletin on the development of China's health and family planning in 2016, in 2016, the number of outpatients in township health centers and community health service centers (stations) accounted for 22.7% of the total number of outpatients, which decreased by 0.2 percentage points over the previous year In the same year, 175.28 million people were admitted to the hospital, accounting for 77.1%; 41.65 million people were admitted to primary medical and health institutions, accounting for only 18.3% -- the tower top of the pyramid became larger and larger, the resources and patients of the top three hospitals became more and more concentrated, and the siphon effect became more and more serious In addition, after the implementation of zero margin sales in some basic medical institutions, the compensation mechanism has been unable to keep up with the promotion of the basic drug system As a result, the enthusiasm of grass-roots doctors for grass-roots medical treatment in some places has been reduced from "passionate like fire" to "merciless freezing point" How to realize the orderly sinking of high quality medical and health resources? How to solve the problem of drug circulation at the grass-roots level under the premise that the drug consumption at the grass-roots level is likely to increase substantially? From the top to the bottom, in all aspects, in fact, a lot of ideas have been put forward For example, the government increased investment, zero price difference sales of drugs, increased drug service fees, opened up multi-point practice of doctors, including the establishment of medical consortia and medical groups, and accelerated the pace of remote settlement of medical insurance, all contributed to the development of public hospital reform However, the reform of public hospitals, which is full of expectations of the public, has not been pushed forward as fast as expected according to relevant aspects ——On June 20, 2012, Shenzhen officially launched the reform of public hospitals ——On January 5, 2013, Shanghai launched the reform of public hospitals ——On January 1, 2017, Shenzhen officially implemented the price reform of reducing inspection fees and increasing diagnosis and treatment fees At this time, it has been 8 years since the opinions on reforming the price formation mechanism of drugs and medical services issued by relevant parties It can be seen that since the beginning of medical reform in 2009, the reform of corporate governance structure, a core of public hospital reform, has been slow, mainly because there is no clear definition of its concept and no clear explanation of its content Some local health and family planning departments set up an internal organization to manage public hospitals, which is nominally the reform of corporate governance structure, but it is likely to change soup without changing medicine But it is accompanied by a series of urgent needs of urban population growth ——The proportion of urban population in China continues to grow rapidly In 2004, the proportion of urban population was only 41.7% By 2013, the proportion had increased to 53.7%, while the goal of the national urbanization rate is to reach 70% by 2030 ——"The rapid development of urbanization means that the marginal needs of the city will continue to expand, all kinds of" new areas "will continue to emerge, and the floating population will continue to increase, which leads to a huge gap in community medical services Once there is a problem with the body, people still flock to large hospitals." It is said that the medical reform has entered the deep water area But no one thought that the work of public hospital reform alone had been in the "deep water area" for seven or eight years It's hard to say if you feel the stone It's estimated that it's almost flooded This is exactly: medical reform Fengyun Road, blood and tears accompany the journey! "The essence of the reform of the corporate governance structure of public hospitals is the decentralization of government power to hospitals, and hospitals really have independent decision-making power in terms of people and property But just relying on the decentralization of the government does not mean that all problems have been solved The government, hospitals and doctors need to adapt to the new power structure and learn from practice " In short, if the speed of this reform, especially the compensation mechanism of primary medical institutions, cannot be significantly accelerated, the enthusiasm of hospitals and doctors will not be improved, and the basic drug market will still be full of variables That is to say, there will still be room for the model of medicine based medicine, and it is still uncertain whether the basic drug policy can be implemented 100% at the grass-roots level Will grass-roots units resist and wait and see, and then use base drugs unwillingly? These are the problems that must be considered when entering the base drug If the basic medicine is used, do you think about how it works? In March 2013, the new version of the national essential drug catalog was officially published In the same year, emphasis was placed on "looking back and strict supplement" By the end of March 2014, 9 provinces and cities had added more than 200 varieties to the national new version of the basic drug catalogue There are three characteristics of local medicine supplement, which are "golden cicada's shelling", "Jianghu's self-improvement" and "unique" Gold cicada is out of its shell, that is, the supplement catalogue of basic drugs in different regions is generally changed into another term, instead of using the term "basic drug catalogue", it is replaced by "basic drug catalogue", "commonly used drug catalogue", "Supplementary Drug Catalogue", "purchasing catalogue" and "daily purchasing catalogue" Since the beginning of the Jianghu, that is to say, after the country formulated the list of base drugs and required that it should not be supplemented in principle, all regions still need to add hundreds of supplementary lists of product specifications in combination with their own characteristics At the same time, in the aspect of guiding the use of drugs in hospitals, it is required that all levels of hospitals should forcefully allocate the use proportion of basic drugs, and use administrative instructions to require hospitals at all levels to expand the sales proportion of basic drugs, so as to achieve the goal of controlling large prescriptions and excessive use of drugs The overlapping rate of supplementary varieties in each province is low Why, you know! At that time, the key words of the supplement catalogue of basic drugs were exclusive, large varieties and proprietary Chinese medicines It was the best solution to solve the past problems and meet the local drug demand, and a balanced product reflecting the administrative efforts to solve problems and the pursuit of market interests As a policy product is also the basic drug of structural products, at that time, it confirmed a popular saying on the Internet outlet: standing on the outlet, pigs will fly! In order to seize the basic drugs, agents, commercial companies have thrown a lot of money, the agent conditions of the basic drugs are also rising Huge amount of margin and first delivery of goods are the most core parts of the condition and negotiation of basic drug agent On this basis, we can ignore market capacity, market structure and sales strategy But what about the facts? First of all, enterprises should understand their own positioning First, based on their own understanding, which market segment they are positioning in, what is the gap or problem between your resources and positioning objectives? Second, what are the solutions to these problems? In the process of solving the problem, can the factor of base drug give you a positive impetus to achieve your goal? Most importantly, how much do you know about the basic drug varieties themselves? How to judge the market prospect of base drugs? Is it just a halo with a base drug? Is there a whole set of product promotion strategies for base drugs? What kind of support and service do market agents and commercial companies have? Do basic drugs have corresponding competitive resources in the field of treatment? If there is nothing, that is to simply occupy a pit and want to enter the base drug catalog, then why?! The most important thing is that a new round of purchasing with capacity comes along This kind of price cutting and killing device will basically be used exclusively for over evaluated varieties and base drugs Are enterprises well prepared to deal with it? Most importantly, the chain of custody will be extended to doctors' prescriptions Although he has the identity of basic medicine, if the strategy is not well thought out and he still wants to draw in the spring and Autumn period with the method of eating and drinking, it is estimated that it will be a dead end In 2017, the health and Family Planning Commission of Guangdong Province issued a notice on further clarifying the requirements of the basic drug system of our province, which boldly subverted the "basic drug system" which has been vigorously implemented for many years since the medical reform This document was issued in 2014 under the background of the national health and Family Planning Commission's "opinions on Further Strengthening the management of drug allocation and use in primary medical and health institutions", especially in the context of relevant policies successively issued by provinces to support primary medical institutions to purchase non-basic drugs, and in the context of the integration of urban and rural medical insurance in Guangdong Province Such a fact is very clear, for many years, the scope of commonly used drugs at the grass-roots level has already exceeded the national basic drug catalog In the 21st century, China's economic and social development level has ranked in the upper middle-income countries (the world bank's grouping standard is that the per capita GDP is between 4126 and 12735 US dollars, and China's per capita GDP in 2015 has reached about 7900 US dollars), which will inevitably produce diversified medical demand The aging population has also contributed to the growth of medical demand On March 13, 2018, the State Council's major reform plan was put forward According to the plan, the national health and Health Commission will be established, the national health and Family Planning Commission will not be retained, and the National Medical Security Bureau will be established; the State Administration of market supervision and administration will be established, and the State Drug Administration will be established separately, and the State Food and drug administration will not be retained However, in this context, on October 25, 2018, the new version of the national drug base catalogue (685) was officially published This means that China will still maintain the "dual directory" situation of the basic drug catalog and the basic medical insurance catalog The national health insurance bureau is required to "take over" the payment connection work of the basic drug catalog The introduction of the new version of the basic drug catalog has aroused a lot of admiration, regret, calmness, surprise, carnival, loss and sadness in the industry Compared with the 2009 and 2012 versions of the catalogue of base drugs, the supporting measures of base drug 1 + X, which was published in 2018 version, did not come late until 2019 The measures emphasize in particular