On the direction of medical reform from the implementation of centralized purchase in public hospitals

Source: the guiding opinions on the implementation of centralized drug purchase in public hospitals (2014-11-15) has been circulating for a while All kinds of immortals have carried out omni-directional and multi angle analysis, so I don't need to instigate anything here But these days, I have been thinking quietly, and I always feel like I have something to say About two years ago, for reasons that everyone knew, I chose to escape from the sea of bidding At that time, the bidding for Anhui county-level public hospitals was just completed, and Chongqing pharmaceutical exchange was born At that time, I was thinking, where is the future road of drug bidding? Should we always win the bid at the lowest price year after year? Should we always take the money to buy cabbage to sell white powder? So I chose to say goodbye to the bothered bidding and turned to engage in the government work of medical insurance prices, thinking that I would be out of trouble from now on This year, when version 6.12 of the implementation draft of centralized procurement of public hospitals was released, I analyzed it At that time, one of the opinions was: "we should give full play to the organization and coordination role of health and family planning administrative departments at all levels, mobilize the active role of medical personnel in the formulation, evaluation and negotiation of drug purchase plans, and focus on meeting the basic drug demand" At first, I think: This article is obviously aimed at the past bidding work, paying too much attention to the role of the provincial drug procurement center, ignoring the role of the organization and coordination of the health administrative departments at all levels and the role of the hospital procurement, resulting in the frequent phenomenon that some drugs are "not accepted in one move, only in one move" However, the choice of words and sentences in government documents actually has profound connotation and extensive extension The implicit words between lines are not clear until now In the implementation opinions of the new version of drug procurement, it has been more clearly mentioned: "to enhance the participation of hospitals in drug procurement Encourage local governments to explore innovation in combination with practice " "In the pilot city of public hospitals, it is allowed to purchase on the provincial platform with the city as the unit If the transaction price of the pilot city is lower than the provincial bid winning price, the whole province will purchase at the transaction price of the pilot city." These words of enhancing the participation of hospital procurement and the pilot city's self procurement are not the second bargaining of changing vest? Then, since the pilot city's second bargaining is allowed, can its transaction price be higher than the provincial bid winning price? If you don't think it's easy to say? Let's see the pilot city's bidding pioneer—— Anshan and Sanming, low prices have already made foreign companies flee Next, if the transaction price of the pilot city is lower than the provincial bidding price, then other regions of the province should be leveled Next, what if there are two pilot cities in the province? Today, there are Xiamen and Sanming in Fujian, Zhuhai and Shenzhen in Guangdong, Wuhu and Maanshan in Anhui, Shaoxing and Ningbo in Zhejiang Since then, this side of the singing and that side of the performance, the performance of the second bargaining around the city is so colorful and colorful Suddenly one day, the national development and Reform Commission said that it didn't care about the price In the future, drug price management will almost certainly be transferred to the responsibility of bidding and social security The two prices of winning price and paying price will compete with each other Who is lower than who? When I see here, I can't help sweating and weeping The bidding is so like a shadow It's thousands of turns and hundreds of times You have hidden thousands of mountains and rivers After years, he came here You reach out to refuse him, but he has taken you into his arms (sorry to copy Zhu Ziqing's writing here) Drug government around the core of price, followed by the second bargaining is finally back to the origin With the development and Reform Commission's drug price liberalization, the cancellation of drug markup in public hospitals, the reform of medical insurance payment system and the advent of the era of medical e-commerce, the market mechanism of price discovery may be gradually established in the clamor of second price negotiation, and drug bidding will be reborn on the basis of de administration, and the leading power of procurement will eventually be returned to the market The provincial bid winning price eventually becomes the price limit of the Internet (similar to the current maximum retail price of the national development and Reform Commission), and the bidding has only evolved into a basic access platform, a data collection and Analysis Center, a service center, and a regulatory center At that time, we will be in a hurry in a remote city, in a corner of the city's health, health care and even hospital departments Some people say that the new deal can not save the failure of the health care reform, but I do not think so After all, health care reform is striding forward, and the "medicine" economic bubble supported by the "expensive drugs" may eventually collapse, and the defeat is just a losing battle for pharmaceutical companies.