Official: Centralized procurement of large-scale medical equipment, involving CT, MRI, etc.

Medical Network News, August 26.
Recently, at a press conference held by the Secretariat of the State Council’s Medical Reform Leading Group and the National Health Commission on the promotion of Sanming’s medical reform experience, Huang Ruxin, Party Secretary and Director of the Fujian Provincial Health Commission, introduced that Fujian’s experience in Sanming’s medical reform In summary and promotion, the "three medical" linkages were deepened.
The provincial centralized procurement of large-scale equipment such as CT and MRI successfully solved the problem, and the average price was reduced by more than 50%
.
Not long ago, in the bid announcement of the centralized procurement project of some large-scale B medical equipment in Fujian Province (the first batch of 2021), Suzhou Langrun's 1.
5T and above MRI won the bid price even reached 2.
93 million yuan, which is higher than the price of centralized procurement in Anhui Province last year.
Even lower!

According to the previous notice issued by the Anhui Provincial Medical Insurance Bureau, the Provincial Health Commission and other four departments, the "Implementation Plan for the Centralized Procurement of Class B Large-scale Medical Equipment in the Province" (hereinafter referred to as the "Implementation Plan") notice, insist on purchasing in quantity and changing by quantity.
Price has become the relevant principle of this centralized procurement
.
As soon as the news of large-scale medical equipment purchases by the Anhui Medical Insurance Bureau first came out, it immediately attracted industry attention.
The capital market was also moved by the wind.
Mindray Medical’s share price fell in response, with a drop of more than 8% that day, and a cumulative drop of more than 10% in the following 4 trading days.
, The market value has evaporated over 50 billion yuan
.
The market view generally believes that Mindray Medical’s recent decline in its share price has been affected by the news of the centralized procurement of large-scale medical equipment
.
Many small and medium-sized large medical equipment manufacturers are also very anxious.
Will Anhui's large-scale medical equipment centralized procurement pilots evolve into a normalized trend?
　　1.
5T and 3.
0T MRI prices ushered in the biggest drop in
2015, the State Council’s medical reform leading group decided to launch a comprehensive provincial-level medical reform pilot, involving two batches of 11 pilot provinces, including Jiangsu, Anhui, Fujian, Qinghai, Zhejiang, Chongqing, and Sichuan , Shaanxi, Hunan, Ningxia and Shanghai, decided to take the lead in promoting the high-quality development of public hospitals in 11 comprehensive medical reform pilot provinces , and Anhui is one of them.

.
From 2014 to 2016, the provincial procurement of large-scale medical equipment was still a routine process.
The Anhui Provincial Medical Reform Office and the Provincial Health and Family Planning Commission have issued documents to promote large-scale medical equipment of Class B and medical equipment with a unit price of more than 2 million yuan to participate in the provincial concentration.
Purchase
.
According to reports, the first batch of centralized procurement of equipment in Anhui Province was opened on September 16, 2015.
By May of the following year, the Provincial Pharmaceutical Acquisition Center had organized a total of 15 batches of Class B large-scale medical equipment with a unit price of more than 2 million yuan.
Centralized procurement of equipment
.
According to statistics, the centralized procurement involved 47 medical institutions in the province, 64 sets of large-scale B medical equipment, and 3 sets of other medical equipment with a unit price of more than 2 million yuan, and the total purchase amount exceeded 370 million yuan
.
Compared with the market price, there are 28 double-row, 16-row, large-aperture, and 64-row CT equipment, with a price reduction of 44.
2%; 14 sets of 1.
5T and 3.
0T nuclear magnetic resonance equipment, with an average price reduction of 29.
9%; linear accelerator equipment 14 sets, with an average price reduction of 39.
6%; 8 digital subtraction angiography equipment, with an average price reduction of 43.
2%; 3 sets of other medical equipment with a unit price of more than 2 million yuan, including sea fuselage, molybdenum target machine, and extracorporeal lithotripsy The average price cut is 9%
.
The first batch of CT bidding equipment includes 2 rows of CT, large aperture CT, 64 rows of CT and ultra-high-end CT.
The user units include 11 medical institutions of different levels such as provincial hospitals, Siemens, GE, Philips, Neusoft, Toshiba, etc.
Well-known companies participate in public bidding
.
B medical equipment very wide coverage, comprising more than 64 rows and CT, a surgical robot, 1.
5T MRI system and above
.
These equipment are the mainstream configuration of the top three hospitals, and the purchase price is generally between 10 million yuan and 30 million yuan
.
On May 28 this year, the Affiliated Hospital of North Sichuan Medical College purchased large-scale medical equipment such as color Doppler ultrasound, X-ray machines, and gene sequencing for a total price of 78.
42 million yuan
.
In May of the same year, Dongyang City People’s Hospital and Beihai City People’s Hospital purchased Siemens’ PET-CT, both at a price of more than 25 million yuan.

.
In July last year, the price of GE 1.
5T MRI procurement for medical equipment purchased by Dengzhou Maternity and Child Health Hospital was 11.
53 million yuan.
In May of this year, Zhoukou Central Hospital’s 3.
0T MRI procurement project won the bid price of 23.
5 million.
.
.
This year 8 At the beginning of this month, the Office of the Anhui Provincial Medical Insurance Bureau issued an article "Our province has achieved initial results in the centralized procurement of large-scale medical equipment
.
" According to the article, as of the end of June, the total amount of equipment procurement in 2020 will reach 444 million yuan, which is a savings of nearly 180 million yuan compared with the hospital’s budgeted purchase price, and a capital saving rate of 28.
8%
.
At the same time, the winning bid price of the equipment continued to drop.
For example, the unit price of the second package of 1.
5T MRI, Suzhou Langrun won the bid of 2.
97 million yuan, and the national centralized procurement of 1.
5T MRI fell below 3 million yuan for the first time; the second package of 3.
0T MRI was won by GE's 750w.
The unit price dropped from 8.
96 million yuan in 2018 to 5.
87 million yuan, and the 3.
0T magnetic resonance of the national centralized procurement fell below 6 million yuan for the first time
.
According to the results of winning bids in recent years, the purpose of the centralized procurement of large-scale medical equipment in Anhui Province is to reduce prices, and we have seen that the average price reduction is about 30%.
Anhui Medical Insurance Bureau issued a document saying that "achieving initial results" is true
.
And medicines , supplies incorporate different Jicai, high prices, large-scale high-tech medical equipment into the provincial with the amount of purchase is the first time, "1.
5T MRI for the first time fell below three million yuan", "3.
0T MRI for the first time fell below 600 Compared with the normal market price, this strength is indeed so great that it even makes some small and medium-sized large medical equipment manufacturers “fearful”
.
Large-scale medical equipment registration, materials, and research and development costs are high, and the 1.
5T magnetic resonance of more than 2.
9 million basically has no profit margins
.
This time, the Anhui Provincial Medical Insurance Bureau mentioned the principle of "purchasing with quantity", turning centralized procurement into "purchasing with quantity", and clearly pointed out: "Use the scale effect, exchange price with quantity, and encourage the purchase of domestic equipment
.
According to this One path and the performance of other local policies, Anhui’s large-scale medical equipment centralized procurement pilot has a growing trend, and the price of 1.
5T and 3.
0T magnetic resonance may usher in a greater decline in the future
.

　　The research and development cost of large-scale medical equipment
is so expensive.
The principle of MRI must be very complicated, right? Magnet technology is difficult and costly.
For a 1.
5T NMR instrument, the cost of optical superconductor accounts for 30% to 40% of the total cost, and the cost of a 3.
0T instrument superconducting magnet accounts for 50% to 60% of the total cost.

.
In addition to the magnet system, the technical difficulties of the spectrum analyzer, radio frequency system, and computer image reconstruction system are very high.
They are all high-tech cutting-edge products.
In addition, the MRI technology has been used by Siemens, General Electric, Philips before.
With the monopoly of the Big Three, the price is naturally expensive
.
Our country’s first nuclear magnetic resonance instruments were also imported from these three companies, but once the equipment had problems, the high maintenance costs and parts procurement costs made many hospitals unbearable, which made many medical workers inspiring to break Technology monopoly
.
The efforts paid off.
United Imaging Medical, Langrun Medical, Neusoft Medical, Anke, Electric Kangda and other companies finally came up with equipment that has the same performance as the imported 1.
5T nuclear magnetic resonance instrument, which gradually replaced the imported 1.
5T.
Market monopoly in China
.
However, the domestic 3.
0T is still difficult to break through the market monopoly, and the market share is mainly in the hands of the "big three"
.
The MRI machine is mainly composed of several major components: magnet, spectrum analyzer, coil, and application software
.
The most difficult ones are magnets, spectrum analyzers, and application software
.
Except for coils, they are all cutting-edge products with high-tech content
.

　　1.
Magnet
MRI is a bottomless hole
.
According to the information provided by industry insiders, a 1.
5T MRI machine, its superconducting magnet accounts for 30%-40% of the total system cost, and the superconducting magnet of a 3.
0T MRI machine accounts for 50% of the total system cost.
～60%
.
To a certain extent, the higher the resolution of the instrument, the stronger the magnetic field is needed, and the higher the field strength, the clearer the picture will be obtained.

.
Although the principle of superconducting magnets is simple, due to the particularity of its design and the complexity of the process, it requires strong and comprehensive engineering capabilities.
The technical threshold is very high.
We have not overcome many difficulties at present, which has resulted in a stable domestic market.
The supply of superconducting magnet products has long been monopolized by foreign companies
.
For example, General Electric (GE) in the United States, Siemens and Philips in Germany
.

　　2 , spectrum analyzer
magnetic resonance imaging in the spectrum analyzer technology extremely difficult, because the human body is very complex, high-resolution instruments can be observed very fine structure, which leads to a very large number of signal generation
.
The sensitivity, speed, accuracy, etc.
of the spectrum analyzer have become the key to the accuracy and credibility of the inspection results
.

　　3.
Coils
Coils are like the antennas in our electronic devices such as televisions and mobile phones.
Their task is to transmit and receive electromagnetic waves.
In the vernacular, they are a pile of regularly arranged metal wires, so the technical content is not too high
.

　　4.
Application software It
takes a lot of time to write a set of excellent supporting software, and its workload is no less than writing a simple operating system
.
And the number of software sales of nuclear magnetic resonance instrument is too small, after all, the number of nuclear magnetic resonance instruments in the world does not add up to the number of computers in a county
.
A large amount of human and financial investment, but few products, the unit price will be relatively high
.
NMR machines are produced and modeled by different manufacturers, and the price of the machine is ominous
.
Generally, the imported machine is about 4-6 million, and the domestically produced machine is about 3.
5 million
.
The average price of a superconducting 1.
5T machine is 10 million yuan, and a 3.
0T requires 15 to 20 million yuan.

.
The cost of these machines is also related to the materials and coils used by the machines.
The above is just a brief introduction to the composition of the nuclear magnetic resonance instrument.
There are still many parts required.
The high R&D costs and operating costs make the equipment prices naturally expensive
.

　　Where will the large-scale medical equipment go in the future?
In December 2020, the Anhui Provincial Medical Insurance Bureau clearly stated in the consultation document on the province’s large-scale B-type large-scale medical equipment procurement: public hospitals at the city and county level and above, the second and above large-scale medical equipment configuration, in principle when the actual implementation is implemented All choose domestically produced; the first configuration of public hospitals below the city and county level must choose domestically produced
.
According to data from the Anhui Provincial Medical Insurance Bureau, in 2020, public medical institutions across the province will sign up to purchase 70 sets of Class B medical equipment
.
Among them, 8 domestic brands won the bid, accounting for 17.
8%; domestic equipment (domestic brands and foreign brands produced in China) won the bid for 15 sets (8 domestic brands, and GE Tianjin won the bid for 1.
5T magnetic resonance package 1 7 sets) , The number of winning bids accounted for 33.
3%
.
The proportion of domestically-made equipment winning bids is on the rise compared with previous years, basically forming a situation where domestically-made equipment and imported equipment are fully competitive
.
Except for Anhui Province, all localities are encouraging and supporting domestically-made equipment to improve the level of domestically-made equipment in medical institutions
.
In April this year, Hainan Province announced the "Opinions of the Ministry of Commerce of the National Development and Reform Commission on Special Measures to Support the Construction of Hainan Free Trade Port to Relax Market Access", encouraging the first (set) of high-end medical equipment to be produced in Hainan
.
All domestic large-scale medical equipment that is listed in the first (set) promotion and application guidance catalog of major technical equipment or listed in the category A and B large-scale medical equipment configuration licensing catalogs will be given priority in government procurement as long as they are produced in Hainan
.
In June of the same year, a bidding document with a total budget of 270 million yuan in Yunnan Province showed that the bidding equipment does not accept imported products and all require domestic production
.
At the same time, the Guangdong Provincial Health Commission issued the "Guangdong Province 2018-2020 Class B Large-scale Medical Equipment Configuration Planning and Technical Evaluation Standards (Trial) Notice" to encourage public medical devicesThe user shall give priority to the configuration of domestically-made self-owned brand Class B large-scale medical equipment
.
In Zhejiang, there are 195 types of medical equipment included in the unified demonstration list of imported products purchased by the provincial government this year
.
This shows that, in addition to the 195 types of medical equipment, government procurement needs to give priority to domestic equipment
.
This shows that the purchase of domestic medical equipment has become a trend
.
On July 28, the Shenzhen Municipal Bureau of Finance issued the "2021 Municipal Public Medical and Health Institutions' 8 Categories of Medical Equipment Bulk Procurement Projects Before Competitive Negotiation Procurement Approval Publicity".
It is proposed to represent 22 municipal medical and health institutions through public solicitation of supply.
It implements bulk procurement through competitive negotiation.
The procurement items include eight types of medical equipment such as MRI and CT
.
It can be seen that the simultaneous operation of large-scale medical equipment procurement at the municipal and provincial levels will inevitably have a huge impact on companies that focus on the medical equipment sector
.
As a technology-driven medical device industry, investment in R&D and innovation will affect the company's future growth space
.
In 2019, CT-based imaging equipment revenue was 1.
252 billion yuan, accounting for 65% of Neusoft Medical’s revenue.
R&D investment accounted for a considerable proportion of total revenue.
If capitalized R&D investment is added, Neusoft Medical 2017, 2018 The R&D investment in the three years of 2019 was 152 million yuan, 170 million yuan and 181 million yuan, accounting for 10.
55%, 8.
85% and 9.
39% of revenue respectively
.
If capitalized R&D investment is added, Neusoft Medical’s R&D investment in 2017, 2018, and 2019 will reach 358 million, 401 million, and 408 million, respectively, accounting for 24.
75%, 20.
8%, and 21.
21% of revenue
.

　
Neusoft Medical's R&D investment in 2017, 2018, and 2019 is in the domestic medical device industry.
Neusoft Medical’s R&D investment and strength are second only to Mindray.
The R&D investment in 2017, 2018, and 2019 was 1.
132 billion, 1.
420 billion, and 1.
649 billion, respectively.
Yuan, accounting for 10.
13%, 10.
33% and 9.
96% of revenue respectively
.
Such R&D investment supports Neusoft Medical to gain a larger market share in the future, and GPS R&D investment is above 20% to 30%
.
As a long-established domestic medical equipment company, Wandong has shown weakness in recent years, which is related to the stagnation of its core business DR product line
.
According to Wandong Medical’s 2020 annual report, the total R&D investment cost was 86,411,300 yuan, a year-on-year decrease of 7.
79%.
The total R&D investment accounted for only 7.
64% of operating income.
Among them, the R&D investment in DR in 2020 was less than 6%
.
According to the data released by Medical Recruitment, the top 5 MRI domestic market shares in 2020 are Siemens, GE, Philips, United Imaging, and Wandong.
Among them, Wandong’s market share in 2020 is only 1.
98%, and it will be in the mid-to-high-end MRI field.
It is not a small challenge for Wandong to compete head-on with foreign manufacturers and outstanding domestic manufacturers
.
If Anhui’s centralized procurement pilots evolve into normalization and even include large-scale medical equipment in the scope of national procurement, the profit margins of winning bidders will be greatly reduced, which will affect the enthusiasm of domestic equipment research and development.
This will break the monopoly and make breakthroughs for domestic large-scale medical equipment.
The result of "stuck neck" and catching up with the high-end GPS can be imagined
.
In addition, as the successful bidders continue to concentrate on leading companies, more small and medium-sized domestic large-scale medical equipment companies will even be in danger of being eliminated in the future
.