Zhong Dongbo is going to be the director of the bidding Department of the medical insurance bureau, and the state will organize procurement with volume or speed up

"The leverage of health insurance purchase is very large." Shortly after the establishment of the National Health Insurance Bureau, Zhong Dongbo, member of the Party committee and deputy director of the Beijing health and Family Planning Commission, said in a public address In the public list of the state health insurance bureau, the deputy director general of the Department of medicine price and bidding procurement of the state health insurance bureau, who has been in the Beijing health and Family Planning Commission for four years, is to be appointed Zhong Dongbo thought at that time that, unlike passive payment, the state health insurance bureau can play a regulatory role in guiding medical institutions to provide services It is worth noting that Zhong Dongbo praised the "Sanming model" on many occasions Even in the early years, "Sanming medical reform model will be promoted nationwide." In 2015, he wrote an article "unveiling the painting of the theory that Sanming medical reform can't be replicated", refuting the statement that "Sanming medical reform can't be replicated and can't be sustainable" In his essay as a non official of "Dr Zhong Dongbo", he mentioned that Sanming medical reform touched on the core issue of medical reform - the incentive and restraint mechanism of the president and doctors, which he also called the "two person theory" of public hospital reform Zhong Dongbo believes that in many medical reform policies and measures, including drug bidding and purchase policies, the incentive and restraint mechanism of reform president and doctor is undoubtedly in the center Zhong Dongbo, a typical scholar official, participated in the drafting of the central document of China's new medical reform in 2009 He served as deputy director of the General Affairs Office (WTO Affairs Office) of the Department of policies and regulations of the Ministry of health, deputy director and director of the Department of hospital operation supervision of the Department of medical service supervision of the Ministry of health, and deputy director of the Beijing Municipal Health Bureau In addition to Li Tao, deputy director of the state health insurance bureau, he is the second senior official of the state health insurance bureau who has been working in the health system for a long time and is familiar with the operation of medical institutions This year, as soon as the National Health Insurance Bureau was established, the domestic trillion yuan A-share pharmaceutical sector experienced a luoshengmen shock It has not been officially determined whether the focus is the pilot work of national drug centralized procurement, or the Sino US trade war or the structural adjustment of China's pharmaceutical market Before the first director of the Department of medicine price and bidding procurement, the industry had already been scrambling for the direction of national pilot work The pilot price of "volume purchase" in 11 cities or the volume centralized purchase of national pilot drugs linked with the whole country are regarded as the upgrading of "Shanghai mode" Prior to this, Shanghai has implemented three batches of belt purchase In August, Shanghai announced the results of the third batch of centralized bidding procurement The results showed that only two of the 21 winning varieties were awarded by Sanders, and the other 19 varieties were all awarded by domestic generic drugs The rules of the third batch of centralized bidding and purchase in Shanghai make the original foreign pharmaceutical companies compete with domestic generic pharmaceutical companies in the same platform Although it looks like a large-scale winning bid for generic drugs, it is not once and for all for generic drugs According to a research report from Zhongtai securities, most of the winning products purchased in three batches with volume originally had a low market share in Shanghai, hoping to acquire the market quickly with the help of monopoly effect The research report also pointed out that some drugs purchased in volume were replaced by similar drugs without price reduction at the hospital level, resulting in the "extrusion" of the varieties purchased in volume, which often resulted in the phenomenon of "inter product substitution" leading to the purchase volume not reaching the expectation A drug purchasing expert who didn't want to be named told the health point that "inter product substitution" is a big obstacle to the completion of the purchase volume After this situation, Shanghai intervened through administrative means to complete the purchase volume This national pilot, how to ensure that the hospital sufficient procurement? According to the minutes of a meeting held on September 11 at the symposium between the State Medical Insurance Bureau and drug manufacturers, the medical insurance department will be responsible for the medical institutions that do not purchase and use the national pilot purchased drugs according to the regulations, such as the total amount of medical insurance, the local reward and subsidy funds for the reform of public hospitals, the grade evaluation of medical institutions, the designated qualification of medical insurance, the evaluation and review of key specialties, and the medical institutions The person in charge shall be punished in the objective responsibility assessment However, the above drug purchasing experts, who do not want to be named, believe that the hospital will implement the national policy due to administrative pressure, but it is still difficult to fully realize the "carrying capacity" There are two ways for hospitals to benefit from drug bidding and purchase One is to continue to purchase high priced drugs through "inter product substitution" and secondary price negotiation, and then to get benefits from arrears of payment The more expensive the drugs are, the greater the benefits will be, that is, the profits will be the center The other is, under the policies of total medical insurance budget, balance and retention, and single disease payment, the lower the drug price, the greater the benefits will be, that is, the costs will be the center As the center The above-mentioned drug procurement experts who do not want to be named think that in the centralized drug procurement in China, if the hospital changes from profit centered to cost centered, then the drug "volume" procurement is easier to achieve But which way the hospital chooses to get the maximum benefit depends on the drug situation and the hospital itself "Hospitals will face pressure if they clearly have drugs that are cheap and pass the conformity assessment and hospitals purchase drugs that fail the conformity assessment at a higher price." Chang Feng, deputy director of the medical security policy research center of China Pharmaceutical University, thinks The above documents also show that according to 60% - 70% of the total annual drug consumption of all public medical institutions in the pilot area, the total procurement volume is estimated, and the medical institutions in the pilot city sign a volume purchase and sale contract with the production enterprises accordingly For the remaining amount, all medical institutions can still purchase other winning and online varieties of provincial drug centralized procurement Chen Hao, a researcher at the Research Center for drug policy and management, Tongji Medical College, Huazhong University of science and technology, believes that the original bidding procurement mode in 11 cities will not change much, but the national pilot will certainly bring about price linkage across the country "Although all regions do not have the right to collect the bid price of the national pilot, they will still ask for the price to be applied," said Chen Hao, who believes that the pilot is more a method exploration and price benchmarking "If there is a lower bid price in Beijing and Tianjin, Hebei may follow up, and the economic level of Jiangsu and Shanghai will not differ much, so it may follow up It is even possible (in other regions) to imitate this pattern " A head of sales at a domestic pharmaceutical company said At the Shanghai Forum on September 11, officials also told the enterprises present that they should be fully prepared for the price unification of the whole country when purchasing the winning products in large quantities Expert: the pharmaceutical market will still recover in the future However, on the second day of the Shanghai Symposium, the share prices of more than 100 companies fell, and the concept of generic drugs fell for at least five days Some people call it, this is the second half of the vaccine case, another let the pharmaceutical market shake three shake event This shake, coupled with trade frictions between China and the United States, has led to media reports that the A-share market has evaporated hundreds of billions of yuan On the contrary, the centralized bidding procurement of the National Health Insurance Bureau involves all drugs that have passed the consistency evaluation, but only 33 drugs, which is not much compared with the general provincial bidding procurement of thousands of drugs Some industry figures estimate that 70% of the market in 11 cities accounts for 20% - 25% of the national market Generally speaking, the scope of this centralized bidding is only 33 national 20% - 25% markets that have passed the consistency evaluation But why does it cause a stronger rebound than the market and public opinion? "Not because of the purchase of these 33 drugs, but because of the expected response to the possible expansion of cities and varieties in the future, which is based on an overly pessimistic interpretation In addition, there are many factors such as trade friction between China and the United States " Chang Feng said In other words, this pessimistic interpretation comes more from the pressure of drug prices and the market The person in charge of sales of the above domestic pharmaceutical enterprises expressed her concern to healthpoint: after spending nearly ten million yuan to pass the consistency evaluation, if the price of the products is reduced and won the bid, then whether the hospital can complete the promised purchase volume on time, and whether the price will be reduced and won the bid but won't get 60% - 70% of the market; if other enterprises win the bid at a low price, then the market already occupied may be handed over to others Foreign funded original research pharmaceutical companies also have concerns A senior expert from the Industry Association told the health point that foreign pharmaceutical enterprises are worried about the "one size fits all" of the hospital In the remaining 30% - 40% of the drug use, they also purchase the winning varieties and give up the unsuccessful varieties completely Meanwhile, foreign pharmaceutical enterprises also hope to allow provinces to independently determine the purchase proportion and payment standard of the winning varieties in combination with the economic conditions of various regions A person close to the decision-making level of the health insurance bureau said to the health point that most of the drugs intensively purchased in the national pilot are the original research drugs that occupy a dominant position in the market If the generic drugs win the bid, the market will expand If they fail to win the bid, there are still some markets to fight for However, the reality is more complicated Different drugs and different enterprises face different situations According to the Research Report of China Merchants Securities, the enterprises that have passed the consistency evaluation exclusively will monopolize the market without reducing the price of the original research drug, and the price reduction range will be slightly smaller, which will benefit the enterprises; while when two enterprises have passed the consistency evaluation, the enterprises that have already occupied a certain market share and have built their own sales team may encounter the threat of significant price reduction from each other; when three enterprises have passed the consistency evaluation In the evaluation, the price of drugs will be the highest It is worth noting that Changfeng believes that once some generic drugs are replaced on a large scale and form drug habits, it is proved that the curative effect is good and the adverse reactions are controllable, the original drugs may be replaced on a large scale This is also the situation that foreign original research pharmaceutical enterprises are worried about As a result, the voice of drug market reshuffle in the industry one after another In this regard, Changfeng believes that if generic drugs can pass the consistency evaluation, they will have a very large market share and profits that can be expected On the contrary, it is a good thing that drugs with poor quality and fail to pass the consistency evaluation were sold with gold in the past to realize profits, and now they are expelled from the market through "purchasing with quantity" According to the sales director of the above-mentioned pharmaceutical enterprises, after spending a lot of energy to pass the consistency evaluation, the pharmaceutical enterprises still purchase according to the principle of winning the bid at the lowest price, and the winning bidder enjoys most of the market, which is a kind of frustration for the future enterprises to do the consistency evaluation Chen Qiyu, chairman of Fosun Pharmaceutical, recently said in public that enterprises hope to shuffle the market, but if the shuffle is too fast, it will hit the industry too hard He wants the drug supplier sequence to be established In addition, the sales director of the above-mentioned pharmaceutical enterprises also expressed similar expectations She hoped that the market could be shared by the enterprises passing the consistency evaluation, rather than a bid winning monopoly She believed that this would also encourage the enterprises to apply for the consistency evaluation Changfeng believes that "purchasing with quantity" will reduce the market share of pharmaceutical companies due to non quality factors He said that if the pharmaceutical enterprises operate normally and the market confirms the results of purchasing, the market expectation will pick up For some enterprises, in addition to facing the "lowest price" of national linkage, the future development of their sales team may also need to be reconsidered Chang Feng said that if the incidence of disease risk does not change significantly compared with the original, then generic drugs will replace the original research drugs in a large area, which will have a huge impact on both the drug companies that build their own sales teams and the companies that undertake marketing.