It is bound to become a trend that the zero plus of national medical consumption enters the countdown and volume purchase

Written by Wu yeting Written by Tan zhuoju Liu ran, editor in chief According to documents issued half a month ago by Shanghai Medical Insurance Bureau and health care Commission, medical devices in public hospitals in Shanghai will be sold at the actual purchase price from today (December 20), without any price increase Jiangsu Province also recently issued a document, starting from 0:00 on December 31, cancelling the consumables bonus In Shanxi Province, zero mark up of consumables will be implemented from January 1, 2020 The State Council has a timetable for abolishing the public hospital consumables bonus across the country According to the reform plan for high value medical consumables issued by the State Council on July 31, 2019, by the end of 2019, all public medical institutions should realize "zero margin" sales of medical consumables There is only more than one week left in 2019 According to incomplete statistics, up to now, nearly 20 provinces and cities across the country are canceling the consumables bonus Canceling the addition of consumables is only one of the top-level design steps of national medical reform The policy of zero addition of consumables, like the cancellation of drug addition, only removes the "moisture" that you can see on the surface, and more "moisture" behind it comes from all aspects of drug circulation To squeeze out these water, the next step is bound to be volume procurement Zhan Jifu believes that, like the volume procurement of drugs, the field of consumables is also a deep-water area with complex interests, which needs the determination and courage of reform As early as October 2013, Sanming began to implement the joint price limit purchase of drugs (consumables) in the city's public hospitals According to people familiar with the matter, who do not want to be named, the national health insurance bureau is "promoting the purchase of high-value consumables in volume" Before that, the joint procurement test of consumables has also been carried out all over the country On June 30, 2018, Beijing, Tianjin and Hebei implemented the joint procurement of medical consumables, which was implemented simultaneously in more than 800 public medical institutions above the second level in three places The purchase catalogue includes six kinds of medical consumables, such as cardiac stent, pacemaker, anti adhesion material, hemostasis material, artificial joint, stapler, etc the price after negotiation is 15% lower than the original price, and the cost of consumables can be saved by 550 million yuan a year How to make up for the lost revenue of hospitals and doctors in the process of canceling the addition of consumables and the upcoming procurement of consumables? The answer is: raise the price of medical services However, according to their own situation, the main supporting measures of zero markup of consumables are "smart", such as reducing the cost of other projects Shi Ji (pseudonym), a supplier of reagents for Shanghai public hospitals, analyzed in detail the layer by layer pricing mechanism of consumables Specifically, a certain high-value consumables will be pasted with different prices in the circulation process: there is a cost price in the factory; the first or multi-level agents and suppliers will generate different prices in the transfer process; when they are sold to the hospital, they are also a price; what is displayed on the sunshine platform is the winning price of the hospital; after the addition based on the winning price, they are the final patients' expenses The price paid According to Shi Ji, in Shanghai, the actual purchase price and bid price of hospitals are different From the perspective of high value consumables, the purchase price is 85% to 95% of the bidding price, and the percentage is usually in the range of 5% - 15% In this process, the hospital has a profit margin of 5000 yuan, part of which will be distributed to departments and doctors as bonus After the cancellation of the bonus, the profit of the hospital will be reduced to 3000 yuan In addition, the rebate given by the consumables supplier to some "big experts" accounts for about 25% of the purchase price of the hospital Of the 17000 yuan, more than 4000 yuan is for "big experts" After cancelling the 10% mark up of consumables, the patients still have to pay 20000 yuan for 6000 yuan of consumables Some have questioned this "The total elimination of the medical consumables bonus is vigorous, but for patients, even the imported medical consumables with very high price can only reduce the expenditure of hundreds to thousands of yuan at most, which has no practical significance." One expert believes that the elimination of the addition of consumables seems to squeeze out only a little water, but it will change the way hospitals introduce consumables In the past, because of the bonus, hospitals always tend to choose consumables with high price After the cancellation of the bonus, the hospitals have no reason to continue to choose consumables with high price on the surface "Reduce the cost of reagents by 10 million a year." A week before Shanghai was about to implement the zero addition policy for consumables, Shi Ji, the reagent supplier, heard such a request from the chief of the equipment department in the office of the equipment department of a top three hospital Originally, the hospital roughly calculated that after the implementation of the zero plus policy for consumables, the hospital would form an income gap of about 30 million yuan In order to make up for the 30 million, we should naturally find a way in other expenses The products purchased by a hospital are mainly divided into drugs, consumables (low value consumables and high value consumables), reagents and equipment Drugs have achieved zero addition and volume purchase, there is no space to continue to reduce costs, the rest is reagents and equipment The preliminary strategy of the above-mentioned top three hospitals is to reduce the cost of reagents, equipment and other logistics expenses, including the cost of hospital decoration, by 10 million yuan each In fact, not all hospitals can find ways to make up for the income gap created by zero plus Departments that used to rely on consumables plus as the main source of revenue will be more affected by policies In terms of the overall progress of medical reform, after the completion of the reform of drugs and consumables, reagents are likely to be the next goal Orthopedics, endocardiology and ophthalmology are known as high value consumables gathering departments, but what many people don't know is that in a hospital, the laboratory may be the most profitable department The laboratory's in vitro diagnostic reagents, profit margin and sales volume rank first in all departments of the hospital, according to a consumables vendor Shi Ji also confirmed this point, and the discount rate of reagents is much higher than that of high value consumables (from 85% to 95%) Generally speaking, 40% discount for imported products and 20% to 30% discount for domestic products If the selling price of a reagent is 100 yuan, according to different products, the purchase cost of the hospital is between 25 yuan and 40 yuan Zhang Wu, a doctor in the laboratory of a top three hospital in Shanghai, also admitted In his opinion, the price of reagents is too high, while the price of doctor's labor service is too low From the perspective of stool test, the price of routine stool test is only 3 yuan Doctors need to manually judge 13 indicators, including color, hardness, microscopic observation of protozoa, eggs, red blood cells, macrophages, etc If we want to test the two indicators of occult blood and fecal transferrin, we need to use the "occult blood duplex test reagent", which costs 40 yuan, more than 13 times the price of routine test The cost of this kind of reagent is only 5-6 yuan, and there is a lot of space for compression Many doctors worry that the zero mark up of consumables will affect their income This is also true in hospitals The cost of consumables plus and the price difference between consumables entering and leaving the hospital are the main sources for hospitals to give bonus to departments and doctors - the income of operation and inspection items stipulated by medical insurance is too low to cover the cost of hospital personnel At this stage, the reasonable income reduced by canceling the medical consumables bonus is mainly adjusted by adjusting the price of medical services, appropriate financial subsidies, linking with the payment of medical insurance, etc Taking Shandong as an example, since December 10, Shandong Province has adjusted the prices of 524 medical services while canceling the addition of consumables "This adjustment is mainly to adjust the markup translation of the cancelled medical consumables to the price of medical services." Guo Jishui, deputy director of the provincial health insurance bureau, said publicly Among them, there are 57 items to reduce the price, mainly including blood routine, liver function, kidney function and other inspection items that are mainly concluded by the analysis of instruments and equipment, as well as large-scale equipment inspection items such as dual source spiral CT In addition, the prices of 467 projects were all increased, including the projects of superior disciplines in Shandong such as emergency treatment, pain, otolaryngology, gynecology and obstetrics, neurosurgery, and the projects of treatment, traditional Chinese medicine, which mainly reflected the technical labor value of medical personnel and compared with the low prices in other provinces, or the projects with high technical content such as intervention, general anesthesia, surgery, endoscopy, etc and the use of separately charged consumables was relatively concentrated Project Before that, the joint reform of medical consumption officially implemented in June 2019 in Beijing has played a combined fist of "one reduction, one promotion, one cancellation, one purchase and one improvement", cancelled the addition of medical consumables, carried out the national pilot drug centralized procurement, implemented the joint procurement of medical consumables in Beijing, Tianjin and Hebei, and regulated the price adjustment of medical service projects In terms of medical services, Beijing adjusted the prices of 6621 items at one time The adjusted items have decreased or increased, and the price reduction is mainly the inspection items of large-scale medical instruments and equipment; the price increase is the items reflecting the labor value of medical personnel, such as traditional Chinese medicine, rehabilitation, surgery, etc Shanghai also made a price adjustment for medical services before canceling the consumables bonus On August 26, Shanghai Medical Insurance Bureau released the notice on the price of some new medical services in this city, which mainly focused on cardio cerebrovascular department In the article "Beijing Medical Consumption reform: the price of medical services is rising, but the burden of patients is lightening" by eight Jianwen, it is pointed out that Beijing cancels the addition of medical consumables, squeezes out the water in the circulation link, and frees up 2 billion yuan space for medical institutions in the aspect of medical service price rising Taking Beijing Tongren Hospital Affiliated to Capital Medical University as an example, the price of intraocular lens consumables decreased from more than 5000 yuan in 2009 to more than 4700 yuan this year Sanming, a model of medical reform in Fujian Province, has adjusted 4318 medical service prices six times The proportion of public hospitals' medical service income (excluding drugs, consumables, inspection and laboratory test income) in medical income has increased to 42%, the highest reached 68.6%, and the hospital income structure has been greatly optimized.