The hospital loses the authority of payment settlement, and the medical insurance bureau makes efforts to purchase with quantity

The hospital lost the authority of payment settlement, and the medical insurance bureau made efforts to purchase with volume On November 15, the notice of the leading group of the State Council on deepening the reform of the medical and health system on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City issued by the national health and Health Commission made it clear that in 2020, according to the unified deployment of the state, the scope of centralized procurement and use of drugs by the state organizations will be expanded Comprehensive medical reform pilot provinces should take the lead in promoting medical insurance agencies to directly settle payments with drug production or circulation enterprises, and other provinces should also actively explore The medical insurance department will directly settle the payment with pharmaceutical companies and businesses Cheng Botao, secretary-general of Hubei pharmaceutical industry association, told sabilan that the hospital was seriously in arrears with the drug payment of the drug enterprises In the past, the hospital could increase 15% of the purchase price and make profits from drug sales Now that the bonus has been cancelled, the hospital has no profit from the drugs, and the hospital also has the cost of purchasing logistics and the salary of management personnel The hospital without the drug income will further delay the payment of drugs and obtain the income in disguised form (the drug money is transferred to hospital construction, equipment purchase and other expenses) For a long time, hospital payment is the slowest link in the whole payment process of medical insurance, which leads to limited space for enterprises to reduce prices due to cost considerations At present, the direction of medical reform is to reduce drug prices for the benefit of people's livelihood Therefore, direct payment of medical insurance is to promote reform in a wider range According to the analysis of the author, the attitude of "the medical insurance agency directly settles the payment with the pharmaceutical production or circulation enterprises" in the documents of the health care Commission actually dispels the concern that the pharmaceutical enterprises are afraid of the long period of payment recovery For timely settlement and payment collection, it is also the focus of the national volume procurement program, as well as the provincial implementation of the volume procurement expansion In short, it is to reassure pharmaceutical companies: don't worry about price reduction, sales volume is guaranteed, and the payment is settled on time The document of the health care Commission requires the pilot provinces of medical reform to take the lead in promoting the payment for medical insurance settlement, which shows that the layout of the reform of medical insurance payment mode is becoming more and more obvious Guo Xinfeng, partner of Nanjing Leyao Venture Capital Management Co., Ltd., told saibelan that it is necessary for the medical insurance bureau to open up the payment link and reduce the amount of money occupied by the hospital The hospital should not have involved in the drug payment, and the medical insurance bureau is the buyer and payer As the payer of the medical insurance, the reform of the payment link by the medical insurance bureau is in the works He analyzed to reduce one collection payment link, improve the payment efficiency, and gather the payment links through commercial companies to lay a foundation for forming a unified market and integrating bidding and procurement, as well as prepare for the local version of 4 + 7 volume procurement However, the hospital lost the right to settle the payment, and the medical insurance bureau bypassed the fragmented single hospital (the collection link, the hospital defaulted on the drug payment for the longest time, ranging from 30 days, 45 days to 3 months, 12 months), and concentrated the payment link through commercial companies, laying the foundation for the formation of a unified market and the integration of recruitment and acquisition In fact, the notice of the leading group of the State Council on deepening the reform of the medical and health system on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City issued by the national health and Health Commission indicates that before the end of September 2020, the pilot provinces of comprehensive medical reform should take the lead in exploring and adopting the methods of independent or cross regional alliance, etc., according to the volume of procurement, the integration of recruitment and acquisition, the priority of quality, and the assurance of quality Requirements for quantity and payment guarantee According to the plan, the national organization, in combination with the provinces, will explore the implementation of volume procurement separately, which will be the highlight of next year's medical reform, and also the node from the 4 + 7 pilot to the nationwide coverage of volume procurement After that, it will be more perfect and intensive, and its impact on the pharmaceutical industry will be more and more determined Guo Xinfeng disclosed that at present, the National Health Insurance Bureau and the provincial health insurance bureau have a relatively clear division of labor in organizing the volume purchase: the national health insurance bureau organizes the negotiation of over evaluated drugs, while the volume purchase of non evaluated drugs is led by the provincial health insurance bureau Driven by the policy, the local medical insurance bureau will lead its own procurement with volume, and will also adopt the way of volume for price and low-cost bid winning The pharmaceutical enterprises will definitely reduce their prices significantly to ensure the successful selection, and ultimately the price of generic drugs without evaluation will be significantly reduced - the mode is the same as that of 4 + 7 and expansion In fact, on November 12, the public resource trading center of Hunan Province released the notice on the special centralized procurement of Antibacterials in public medical institutions in 2019, which announced the procurement volume of 52 antibacterials, and selected drugs by comparing prices This is good for powerful pharmaceutical companies, and the polarization will be more obvious Zhou Jiuping, a well-known pharmacist, told cypress blue He judged that after the medical insurance agencies master the drug centralized purchase and payment for goods, the use of medical insurance funds will be more efficient, the capital return of the winning enterprises will be better guaranteed, the industry concentration will be rapidly increased, and the opposite is that a large number of homogeneous drugs will be eliminated - this is actually the effect of volume purchase The volume purchase will continue to expand, and the living space of homogenized products is becoming more and more limited I can't use me too At least we need mebetter, preferably innovate Zhou Jiuping said that this is consistent with the current direction of supply side reform and industrial upgrading of the whole country In the past, the homogeneity of pharmaceutical enterprises was too serious, the overcapacity was low and repeated, and the reform of pharmaceutical industry was also in the process of industrial upgrading in line with the general direction of national supply side reform In fact, this trend is not difficult to judge Guo Xinfeng said that in the process of 4 + 7 centralized purchase in the place where the volume of purchase and bidding are integrated, the fierce price game will be launched in order to compete for the market For example, Guangzhou GPO, the lowest price of esomeprazole for injection is 39 yuan From the perspective of national version with volume purchase negotiation, price war is inevitable Those generic companies with low production capacity, high cost and the same quality of drugs but no price advantage will be eliminated.