Outpatient co-ordination will compress the growth rate of the drug retail market and reduce the expectations of the Internet medical market.

After the launch of the outpatient co-ordination reform, the retail market for out-of-hospital drugs will face a significant decline, and Internet medical companies that rely on selling drugs for their living will face the challenge of a clear decline in market expectations in the future.
east Asia, the outflow from outside the hospital is limited in scale and takes a very long time, and the overall effect is not good.
this is mainly due to three points: the overall control of the cost of primary outpatient clinics and hospitals is more successful, the frequency of visits to medical institutions is higher, the interests of hospitals in medicine is difficult to eradicate in the short term.
First of all, in terms of outpatient costs, whether in Japan, Singapore or Hong Kong and Taiwan in China, outpatient costs are controlled at a relatively low level, not only in terms of the cost of consultation, including testing and medicines, but also at a relatively low price.
, the average Chinese mainland of outpatients in the hospital is growing faster, especially in third-tier hospitals.
2018, the average out-patient cost of a public three-tier hospital will be 322.1 yuan, far higher than the average cost of 200 yuan or less at the grass-roots level.
the introduction of outpatient co-ordination, effective control of outpatient average cost will be one of the key elements to ensure the implementation of the system.
, the frequency of medical visits to medical institutions is higher.
because of outpatient co-ordination, patients prefer to go to a medical facility rather than buy their own medicine at a pharmacy.
such as Japan, the number of annual visits per capita reached 13, Taiwan is more than 15.
Chinese mainland number of visits per capita in some of the most aging cities has exceeded 10.
, as health insurance accounts shrink and outpatient co-ordination is implemented, the trend will become more pronounced, and even some OTC drugs will be sold more in hospitals.
, this has increased the burden on medical institutions, on the other hand, it has also contributed to the overall increase in medical costs.
, the overall growth rate of health care costs remains manageable due to the maturation of total health care and control over service and drug prices.
, it is difficult for medical institutions to eradicate the benefits of medicines in the short term.
Because doctors' fees in East Asia are driven to a lower level, the benefits of medical services attached to medicines are clearer, and changing the economic dynamics of medical institutions will not succeed overnight, requiring continued subsidies and strict regulation.
in Japan and Taiwan, as long as hospitals can still profit from drugs, prescription outflows are a huge challenge.
Japan's three-pronged model, which has been driving prescription outflows since 1974 to 91 percent in 45 years, is premised on substantial subsidies for doctors.
, for example, in 2013, prescription outflows were 67%, 763 million prescriptions were issued a year, and prescriptions were paid 6,650 billion yen.
china's health insurance is clearly unable to afford such high subsidies.
taiwan's hospitals are reluctant to prescribe outflows, and even if drug service charges are over-halved, hospitals are still clinging to prescriptions.
Taiwan's hospital prescription outflow rate is less than 1%, if the grass-roots included, Taiwan's prescription outflow rate is 34%, but even so, most of the prescriptions still flow to the hospital or clinic side pharmacies.
because hospital side shops often have a clear interest relationship with the hospital, such a prescription outflow is of little practical significance.
, even in the United States, where fees are high, medical institutions are still drug-based, and this is not a simple increase in fees to achieve the goal.
as the trend for U.S. hospitals to buy clinics grows, hospitals are more likely to sell their drugs through outpatient clinics than through pharmacies.
because U.S. hospitals can make big profits by selling drugs out-patient.
hospital's outpatient business and commercial insurance are settled at 67% of the hospital's fees, which have become a new way for hospitals to make money by selling drugs through outpatients because of the high hospital fees.
a report released in early 2019 by Allianz Bernstein, a study of outpatient drug prices at 34 medical groups found that outpatient drug prices in hospitals were 3-7 times the average price.
, whether generic or brand-name, research hospitals have the highest prices.
, for example, Neulasta, an oncology drug at New York's E.G. Hospital, sells for $55,000, 12.5 times Medicare's average price, while other research hospitals sell for $20,000, 4.5 times Medicare's average.
therefore, as large hospitals and the grass-roots level continue to integrate, the future prescriptions will be more and more retained within the hospital group, rather than flowing out of the hospital, which is a global trend.
However, China's generic drug market is facing a drastic reshuffle, especially as drug collection continues in the hospital, the price of drugs that have been included in the collection has fallen sharply, forcing some drug companies that have not been included in the collection or are unwilling to reduce prices to focus on opening up the retail market outside the hospital.
, especially before medicare payments are fully pushed out, there is still a certain sales window for such drugs in the retail market.
but with the development of outpatient co-ordination and the gradual landing of medical insurance payments, patients' access to medicines will be concentrated in medical institutions.
of course, there will still be some out-of-pocket users in the drug retail market, but this size is extremely limited to support the loss of any one variety in exiting health insurance.
from Japan's OTC drug tax cuts have not been effective, health care and tax policy on the user's positive and negative incentives are not at all on an equal scale, let than entirely at the user's own expense.
The Japanese government wants to reduce the number of visits to hospitals for minor illnesses because of the high frequency of visits per capita in Japan, so in 2017 self-medication tax deductions have been introduced, allowing users to buy OTC drugs and peripheral health products for more than 12,000 yen a year to deduct a tax.
but the tax cuts are indirect than Medicare payments, the overall effect is not good, users continue to go to medical institutions, rather than drugstores to buy OTC drugs.
And, from the point of view of prescription drugs themselves, because they can not be directly targeted at individuals to promote publicity, and by the impact of early gold sales, doctors and users of brand loyalty does not exist, once into the drug retail sector, unless converted to OTC drugs, it is difficult to make it like OTC drugs with a strong brand effect of products, which is another factor in the prescription drug outflow has a greater challenge.
therefore, with the development of outpatient co-ordination, users will be more into the hospital and primary medical institutions, medical institutions do not have the basis for a large-scale outflow of prescriptions, or even OTC will reverse the flow to the hospital.
and the Internet medical coverage is based entirely on offline medical institutions, third-party platforms have difficulty obtaining scalable coverage.
This constrains the future scale of third-party Internet healthcare platforms in two ways, with patients accelerating access to medical facilities and prescription drugs and OTC products being more digested in hospitals as a result of outpatient co-ordination and shrinking health insurance accounts, contrary to the trend that platform companies want from patient outflows.
From the simple analysis above, as health insurance coverage expands, while out-of-the-way costs still account for a percentage of spending, this is primarily the out-of-the-way and out-of-the-way portion of health coverage, and it is difficult to create a fully out-of-the-way market outside of health insurance.
third-party Internet medical platforms, which sell OTC and surrounding health products, need to be more realistic in terms of market size expectations, and it is clearly unrealistic to expect large-scale outflows of prescriptions and user-owned digestion.
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