The most difficult collection in history: dental implants stuck in the "mouth"

At the National Two Sessions in 2022, the proposal to "collect dental implants nationwide and include them in medical insurance" was once again proposed by a member of the National Committee of the Chinese People's Political Consultative Conference; the same proposal was also proposed last year
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Unsurprisingly, netizens left a warm message: "Reducing the price of dental implants" has always been one of the requests that have received the most letters from the masses since the establishment of the National Medical Insurance Bureau
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The total price (including the cost of teeth and surgery) is "8,000 yuan - 20,000 yuan" for a dental implant, which is often compared to "a tooth is equivalent to a BMW"
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This service is a special-needs medical service.
The hospital can set its own price according to the specific operating cost, and the people need to pay for it out of their own pockets
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Dental implants have medical attributes, but they have a luxury price, which naturally makes people feel "not worth it"
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In recent years, the National Medical Insurance Bureau has encouraged local medical insurance bureaus to try to collect medicines and consumables
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Last year, the Sichuan Medical Insurance Bureau took the initiative to apply for a pilot program of "collective collection of dental implants", which was highly popular among the masses.
In November of the same year, the information collection of dental implants was publicly collected
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In February 2022, the relevant person in charge of the National Medical Insurance Bureau said: "In the first half of this year, we will strive to launch a coalition reform of the local centralized procurement of dental implants
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" A series of actions by the medical insurance department made people feel that "the price of dental implants has been greatly reduced".
Possibly become a reality
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After seeing the news, a netizen immediately called the hospital to postpone the dental implant surgery he had made an appointment with: "I chose a Swiss brand of implants, which cost 20,000 yuan for the surgery.
I have also paid attention to it, maybe I only need to spend two or three thousand in the second half of the year
.
" But this netizen's imagination will hardly appear
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Contrary to expectations, relevant sources revealed that the Sichuan Medical Insurance Bureau encountered problems that had not occurred in the previous centralized procurement when it launched the pilot of "collective collection of dental implants"
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"This is probably the most difficult collection in history
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" The above-mentioned expert revealed
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First of all, private hospitals account for about 80% of dental implant projects.
Because dental implants are not covered by medical insurance, they are at their own expense, and private hospitals are not active in reporting volumes—there is no volume, which means that there is little point in haggling prices
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Secondly, the dental implant project is different from the previous centralized procurement of high-value consumables: the price of high-value consumables such as heart stents includes the doctor’s rebate fee, while the dental implant project accounts for the doctor’s operation fee, not the price of the implant.
——Even if the price of implants drops by 50%, the total price of dental implant projects can only drop by 2,000-3,000 yuan.
After including the operation fee, a tooth is still close to 10,000 yuan or more
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Unlike high blood pressure, infection, tumor and other "serious medical treatments" that are directly related to life and death, dental implants are not necessary options for the treatment of missing teeth, and there are other cheap alternatives (such as dentures, porcelain bridges, etc.
)
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This kind of "consumption-type" medical care is not within the jurisdiction of the medical insurance department that aims to "guarantee the basics"
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The original intention of the Medical Insurance Bureau is to seek more benefits for the people, but the implementation of centralized procurement of consumer medical care is actually not that simple
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The "icing on the cake" type of dental implant treatment is mainly driven by the value-added needs of patients, but it is difficult to count the number of patients in China who are willing to "pay more for better services", and there is no centralized procurement without "quantity".
Different from direct "administrative means to intervene in prices", it is difficult for enterprises to have enough enthusiasm to declare
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Dental implants are not currently covered by medical insurance.
How to guide relevant medical institutions to actively participate in the centralized procurement alliance is a difficult problem
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If dental implants are included in medical insurance, even if each person is restricted to reimburse only one dental implant, according to the existing gap, the medical insurance fund will spend at least several billion more; , It is even less cost-effective and unreasonable for the medical insurance fund to prevent people from becoming impoverished due to illness
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The deeper contradiction behind the landing of dental implant centralized procurement is that after the establishment of the National Medical Insurance Bureau in 2018, the national centralized procurement of pharmaceutical consumables was carried out, and the news that "high-value consumables have been reduced by up to 90%" is not uncommon.

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While effectively solving the burden of the people, it also raised the public's expectations for the "price reduction" of centralized procurement
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Therefore, many of the above-mentioned netizens who want to "wait half a year for dental implant surgery" will most likely have to wait for a long time after half a year
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What's more, you may never wait for the "two or three thousand" dental implants that meet your expectations
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Is it the responsibility and obligation of the national medical insurance to reduce the price of "consumer medical care" with high social demand? Do people have to meet the demand for price reduction of medical items? This is an important issue that needs to be faced after the normalization of centralized procurement
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-01- Private hospitals account for the majority: the price is determined by the market, and there is no room for price reduction in service fees "There is a lot of pressure on the centralized collection of dental implants
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" What he said about the centralized procurement of dental implants in Sichuan refers to: On November 17, 2021, the Sichuan Provincial Pharmaceutical Equipment Centralized Procurement and Pharmaceutical Price Supervision Platform issued a notice for the procurement of high-value oral medical consumables.
Including implants, repair abutments,
etc.
The scope of recruitment is eight provinces and two districts.
According to Sichuan’s previous alliance records, the eight provinces and two districts should include Heilongjiang, Shanxi, Inner Mongolia Autonomous Region, Liaoning, Jilin, Sichuan, Tibet Autonomous Region, Hainan, Qinghai, and Guizhou
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At present, the key to the implementation of the centralized procurement of dental implants is that the current consumption of dental implants is concentrated in private medical institutions, "private medical institutions and public medical institutions 8:2"
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Different from the previously successful centralized procurement of medical consumables such as coronary stents, dental implants are very dependent on the public medical system.
It belongs to medical beauty and has a strong consumption attribute
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What’s more interesting is that one implant in a public hospital costs between 12,000 and 25,000 yuan, while one implant in a private hospital is cheaper, and one implant costs between 8,000 and 20,000 yuan
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A stomatologist from a tertiary hospital in Chengdu said that the price of public hospitals is higher than that of private hospitals because of the high operating costs of public hospitals.
in cost
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Compared with public hospitals, private hospitals are not only cheaper, but also provide better services
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"Generally, qualified public hospital dentists are either owners of private medical institutions or shareholders.
" These doctors may transfer all patients who can pay to private hospitals.
Go
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And a freelance stomatologist in a private hospital earns twice as much as a single operation in a private hospital than in a public hospital
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In this way, if the private medical institution, which accounts for the bulk of the dental implant market, is not interested in promoting dental implants If there is no motivation for the collection, the quantity of dental implant collection will not be able to increase, and it will not be reflected in the exchange of quantity for price, and it will be difficult to push away
the implant collection.
In addition, the implant collection is not only "for implants".
", the price of dental implants (implants) itself only accounts for 3-50% of an operation.
In addition to the implants themselves, the medical consumables needed in a dental implant operation also include machines, crowns, screws, screws, etc.
"Six In
addition, the cost of surgery is also the bulk of the cost of dental implant treatment, which is the doctor's skill.
Many dental implant patients told Shenlanguan that the surgical level of dentists with different qualifications is very different, and the charges are also very different.
The brand and specifications are the same, and the difference between doctors can also make the same surgery price difference of about 2-3,000 yuan
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Medical consumables can be reduced in price as a whole, but labor costs are difficult to calculate and plan in the same way
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At present, the ratio of dental implant surgical consumables to service costs is roughly It is one-to-one.
Consumables can be replaced by domestic products to lower the price.
However, the training cycle of dentists and the turnover rate of dental implant surgery are fixed, and there is no way to improve efficiency, which also determines that there are not many surgical services.
There is room for price reduction
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Moreover, from a macro perspective, it is unrealistic to expect a reduction in the price of medical services.
In recent years, the National Health and Health Commission has promoted the reform of medical service fees
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The main theme is to increase the cost of medical services.
The starting point of the medical insurance bureau leading the centralized procurement to destroy the moisture of pharmaceutical consumables has the same goal, but in the operation path, it is difficult to avoid contradictions between the two aspects.

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Relevant persons revealed to Shenlanguan that whether it is imported or domestic implant manufacturers, they still support the centralized procurement of dental implants, because as long as the price can be exchanged for the quantity, the final profit of the merchant is guaranteed
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However, due to the two key factors that the main dental implant operations are concentrated in private medical institutions and the difficulty of reducing the labor cost of doctors, it is difficult to guarantee the "quantity" of the price
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"I hope everyone doesn't expect too much," said a relevant person.
At present, the public's fantasy about the centralized procurement of dental implants is to drop from tens of thousands of yuan to a few thousand, but the final result may not reach such a price reduction
.
-02-.
Supply side: It is difficult for a clever woman to cook without rice.
On the other side, even if the patient wants a low price and the doctor is willing to use it, there must be enough supply
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In addition to the brand premium, the price of dental implants is more or less corresponding to different materials in different price ranges
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The properties corresponding to different materials are reflected in the service life on the one hand.
Basically, the higher the price, the longer the use time; , the more expensive
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At present, the practice of many private dental clinics is to further reduce the price of low-end products to acquire customers, and then increase the penetration rate of high-end products (public hospitals will not do this, because they will not take the initiative to "acquire customers") , but high-end products have little incentive to cut prices, because the cost is there
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If the price of high-end products is forcibly reduced to a certain level through "quantity-for-price", and then all patients use high-end products, does the amount of "low-end products" need to be added to high-end products? This is another complex mathematical problem for the volume of medical institutions and the quotations of enterprises
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Moreover, the localization of high-end dental implant consumables (mainly implants) is not optimistic.

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According to a report from Pacific Securities, the current technology of domestic implants is mainly in surface treatment technology and processing precision, which determines the overall service life and performance of the product; in addition, the implant system has matching Planting tools and high-end products are all creating this "product ecology", while the domestic implant system has not yet reached this stage; finally, coupled with the long-term run on high-end Korean brands, domestic implants can only be sold at "low prices" Find space in the market
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And because of the late start of technology, there are very few domestic dental implant consumables that can be clinically used at present, but dental implants, like tumor drugs, are a product that depends on clinical data, and the more high-end materials require clinical evidence Also the more
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Due to the lack of clinical data, domestic materials in turn affect the commercialization and technical iteration of the product itself
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△Domestic implant companies have been approved Image source: Pacific Securities China's innovative drugs have completed the Great Leap Forward of the rise of domestic production through supervision and capital, but dental implants, especially high-end implant materials, are far from this stage
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Several domestic dental-related listed companies are not all manufacturers of related products.
For example, Zhenghai Bio mainly promotes oral prosthetic membranes, and implants are its agency business; National porcelain materials are more inclined to upstream materials, and their products mainly focus on dentures and dental crowns; Aojing Medical also mainly produces oral orthopaedic repair materials; Dabo Medical's dental materials are handled by its subsidiary, Baitotai.
Although there are implants, both the company's business share and industry market share can basically be ignored
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Therefore, the lack of supply also makes the centralized procurement of dental implants naturally lack of price negotiation conditions
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-03- Is the centralized procurement of consumer medical products a KPI for the medical insurance sector? Compared with the centralized procurement of high-value consumables, biological drugs, and proprietary Chinese medicines, the centralized procurement of consumer medical products is even more difficult
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The issue of volume, as well as the willingness of medical institutions and pharmaceutical companies are tough to crack
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After the normalization of centralized procurement, the nationwide volume procurement of conventional serious treatment products has become commonplace, and now no one even discusses the most sensitive secondary market.

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Coronary stents, whose difficulty in centralized procurement has risen to a higher level, have already landed.
At present, the centralized procurement of biological drugs and proprietary Chinese medicines is also being carried out one after another.
It is no accident that they will also be implemented this year (2022)
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Therefore, next, the Medical Insurance Bureau is also exploring the "price constraint mechanism" of some new products, so the centralized procurement of orthopedic consumables, lenses and dental implants can also be seen in the past two years
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So in the future, will the market see "new jobs" from the Medical Insurance Bureau, such as higher-end medical services, assisted reproduction, surgical robots, painless gastroscopy.
.
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Maybe it will also fall on the pillow desk of the relevant personnel of the Medical Insurance Bureau
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However, centralized procurement is only a means of "compressing" the intermediate circulation links.
In a sense, centralized procurement has assumed part of the functions of "China's PBM (Patient Welfare Organization)", which is a mechanism to promote "medical separation".
, a sharp sword to cut off the "gray income" of doctors.
Therefore, in the future medical services, whichever product has an excessive proportion of this part, the centralized procurement will naturally shift to this part
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Based on this trend, when the circulation system gradually matures, the focus of the domestic pharmaceutical industry will shift more to the R&D and manufacturing ends
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But it needs to be pointed out that in the process of routing, the medical insurance department needs to weigh the "education and promotion cost" necessary for drug circulation.
After all, China's medication guidelines are largely driven by pharmaceutical companies, at least the current centralized procurement ignores this part expenditure
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Of course, in addition to compressing intermediate links and reducing prices, the policy of centralized procurement actually has another mechanism of action, which is to support "latecomers"
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Many generic drug companies have not had a high market share before, and even many of them are varieties that have just been listed before the negotiation.
They have completed the leap from zero to ten through the road of centralized procurement
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This is not only for local companies, but also for foreign pharmaceutical companies that start from scratch in the Chinese market (for example, in this Guangdong centralized procurement, Novo Nordisk participated in the application of growth hormone as a latecomer)
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Going back to the centralized procurement of dental implants, if the top-level design can design a rule specifically to increase the use of domestic implants in the final landing clause, then it can be regarded as an administrative means to promote local dental implant companies to overtake on the curve.

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