The latest setting of the national consumables centralized procurement policy, orthopedic joints are mixed

On June 4, the National Medical Insurance Administration and other eight ministries and commissions issued the "Guiding Opinions on Procurement and Use of High-Value Medical Consumables in National Organizations".
The document covers six aspects including overall requirements, coverage, procurement rules, and safeguards.
Put forward relevant opinions for the national organization of the centralized procurement and use of high-value medical consumables
.

  Since Anhui and Jiangsu took the lead in consumable procurement in 2019, the procurement of consumables has always been the focus of the market
.
Under the guidance of the National Medical Insurance Bureau, local-level centralized procurement pilots are in full swing
.
With the gradual maturity of the pilot centralized procurement system in various regions and the release of the national uniform code for consumables, the centralized procurement policy for high-value consumables has gradually become clear
.

  Jiang Changsong, director of the Price Recruitment and Procurement Office of the Institute of Medical Insurance, said that the issuance of this document indicates that mass procurement has become the mainstream mode of procurement of medical consumables, and mass procurement of medical consumables has entered a new stage of comprehensive promotion
.

  The centralized procurement policy framework has been established, and the alliance will become the main force

  The document clarifies that the overall idea of ​​centralized procurement of high-value consumables is "national organization, alliance procurement, platform operation".
The state formulates basic policies and requirements, organizes various regions to form alliances, and uses public medical institutions as the executive body to carry out national organization of high-value medical services.
Consumables are purchased in a centralized manner
.

  The document emphasizes that "organize various regions to form alliances.
" Since 2021, local centralized procurement in a single province has gradually decreased, provincial-level alliances have become more frequent, and members are constantly expanding
.
According to statistics, a certain scale of purchasing alliance has been formed in China
.
Including "Guangdong 16 Provinces Union", "Beijing-Tianjin-Hebei 3+N Union", "Inner Mongolia 14 Provinces Union", "Henan 12 Provinces Union", "Shaanxi 10 Provinces Union", "Six Provinces and Two Districts Union", "Sichuan 7 "Provincial alliance" and so on, larger volume means higher bargaining power, and the future alliance may become the mainstream
.

  In terms of procurement varieties, the document pointed out that some high-value medical consumables with large clinical usage, high procurement amount, mature clinical use, sufficient market competition, and high level of homogeneity should be included in the procurement scope
.

  Cardiovascular, orthopedics, ophthalmology and other fields have the characteristics of high purchase amount, mature clinical use, and sufficient market competition, and may be included in the purchase scope in the future
.

  In the procurement rules, the document pointed out that the agreed procurement volume is determined according to the procurement volume base and the agreed procurement ratio, and the selected prices and selected companies are generated through quality and price competition
.

  Jiang Changsong, director of the Price Recruitment Office of the Institute of Medical Insurance, pointed out that the rules of grouping, bidding, and selection should be used to learn from the local unreviewed drug and medical consumables collective procurement experience.
For example, Shanghai uses the market share of large and small groups; Jiangsu and Henan introduce the concept of "representatives" And the “resurrection match” approach; Anhui, Zhejiang, and Guizhou, clinical experts fully participate in the formulation of centralized procurement rules and comprehensive scoring of selected products; Guangdong and Chongqing selection rules both look at the decline and the price; Tianjin adopts volume linkage and two-way selection The way to carry out centralized procurement
.

  In terms of safeguard measures, the document points out four guarantees: to ensure quality, to ensure supply, to ensure priority use, and to ensure payment
.
After the national procurement of coronary stents, the price dropped to about 700 yuan, and the quality problem was questioned
.
Zhang Tiejun, director of the Joint Procurement Office and deputy director of the Tianjin Medical Security Bureau, said that the drug regulatory department will conduct full-cycle quality supervision on the production, circulation and use of coronary stents.
Each coronary stent has an identification code, from production to use.
It can be traced and supervised throughout the whole process
.

  This is the most detailed and comprehensive policy document for the centralized procurement of high-value consumables following the "Reform Plan for Governing High-Value Medical Consumables" and "Opinions on National Organizations for Centralized Procurement and Use of Supporting Measures for Coronary Stents"
.
The release of this document means that the basic framework of centralized procurement policy has been established and will gradually become normal in the future
.

   "One product, one policy" procurement ideas, explore the national procurement of orthopedic joints

  In the document, it is mentioned that according to the characteristics of the clinical use of high-value medical consumables, the degree of standardization, the number of participating companies and other factors, policies can be implemented in accordance with their aptitude, and procurement can be carried out by means of bidding, competitive negotiation, and inquiry
.

  With the clear structure of the top-level design framework for the procurement of high-value consumables in China, the procurement concept of "one product, one policy" for high-value medical consumables has gradually formed
.

  In November 2020, the state organized the first round of procurement of "Hualuo" coronary stents
.
In the national procurement of coronary stents, only coronary drug-eluting stent systems made of chromium alloy and drug-loaded rapamycin and its derivatives are included in the scope of centralized procurement
.

  Following the coronary stent, the orthopedic joint will be tested immediately
.
Unlike coronary stents, orthopedic products are measured in tens of thousands, which makes it difficult to conduct a unified quality evaluation
.
Under this circumstance, the purchase of medical consumables takes a one-product-one-policy approach
.

  As can be seen from the "Draft for Solicitation of Comments" published so far, this procurement idea is also reflected in the grouping rules
.
The hip joint prostheses are divided into three groups: ceramic-ceramic, ceramic-polyethylene, and alloy-polyethylene
.
Knee joints are not grouped by material
.

  In the future, special consumables in some subdivisions of consumables will be more flexible in terms of quantity and price selection, which is expected to usher in new changes and open new markets
.

  The joint country picks up, the good and the bad coexist

  With the development of national procurement, manufacturers will inevitably lower prices in exchange for market share.
A sharp drop in the price of artificial joints is a foreseeable trend
.
In this context, the industry will face a reshuffle
.

  It can be seen from the "Draft for Comments" that has been published that the standards for centralized procurement and grouping are beneficial to manufacturers with the ability to develop and produce joint bioceramics
.

  As mentioned above, in terms of the grouping rules, the product grouping is adopted first and then the enterprise grouping
.
According to the difference of the friction interface (femoral head + acetabular lining), the hip joint prosthesis is divided into three groups: ceramic-ceramic, ceramic-polyethylene, and alloy-polyethylene
.
Knee joints are not grouped by material
.

  Under normal circumstances, the service life of an artificial joint is mainly determined by the wear of the friction interface.
If worn to a certain degree, the components will be damaged, and then the function will be affected, and surgical revision is required
.
The wear life of the prosthesis mainly depends on the material of the friction interface, the degree of wear resistance is ceramic to ceramic>ceramic to polyethylene>metal to polyethylene
.
Compared with metal prostheses, ceramics are more expensive in the market
.

  The development of orthopedics comes with the development of materials science
.
At present, the upstream of orthopedics is still in the early stage of development.
One or two domestic companies have overcome the difficulties of materials science and have the ability to develop and produce bioceramics for joints.
They have a certain advantage in the price competition of centralized procurement
.

  In addition, doctors have stronger motivation for the promotion of new products after the centralized procurement cuts prices
.
After the national acquisition of coronary stents, the amount of innovative products such as drug balloons and degradable stents has increased significantly
.

  Therefore, mass purchase will hit the "cabbage price" of orthopedic joints, and the compression of clinical costs will cause doctors to reduce their enthusiasm for orthopedic consumables.
Innovative products such as joint robots will usher in a period of development dividends
.
At present, many domestic and foreign companies are deploying in this field.
For example, Stryker organically integrates the MAKO joint robot with its own joint implant products to form a synergistic mechanism between the two and make its orthopedics business regain its splendor
.
There are also more than 10 domestically developed joint surgery robots, including Tianzhihang, Minimally Invasive Medical, and Chunli Medical
.
Who can take the lead in mass production of robots and combine their own products to achieve precision medicine, who can seize a larger share
.

  For manufacturers that have a layout in innovative fields such as ceramic materials and joint robots, joint centralized procurement will usher in good news
.
But for small manufacturers whose products are lagging behind and are driven by sales, it will be negative
.
With the progress of centralized procurement, the future will be forced to the line of life and death
.
There is a trend of "big fish eating small fish" in the entire industry.
Some listed companies or state-owned enterprises, and even central enterprises, may take over the market, and small manufacturers disappear as the big waves wash away the sand
.

  In addition, the profits of dealers will be greatly reduced.
Now dealers are in danger, 80-90% will be eliminated, and they may only be able to provide services in the future
.

  The normalization of centralized procurement of high-value consumables has been basically clear
.
In this context, the centralized procurement of consumables will be significantly upgraded in 2021.
Many super-large regional alliances have successively tested the water to carry out mass procurement.
The pace of centralized procurement will also be further accelerated, and more varieties will be swept into the wave of mass procurement
.

  At the national level, national procurement of orthopedic joints will also accelerate entry.
Under the tide of price cuts, it will be beneficial to the current subdivision of new orthopedic materials, which is not high in domestic production, to realize import substitution.
At the same time, with the in-depth implementation of joint procurement, In the future, there will be a rapid ramp-up period in sales of joint robots
.
In general, domestic leading companies with strong innovation capabilities are expected to benefit from the industry reshuffle, while small manufacturers lacking R&D capabilities and most distributors may face extinction
.
( Eshare Medical Equipment Exchange )