Effectively controlling the disorderly growth of medical expenses and effectively improving the quality and level of medical services should become the essence of the core and goal of medical reform.
Pharmaceutical ice and fire, while pharmaceutical companies for the first to open the second bargaining in some areas of the drug purchase prices fell by more than 20%, but surprised to find that medical institutions in the medical reform policy design did not involve the second bargaining part of the enterprise profit, and is being implemented in the structural adjustment of medical costs in the design of serious omissions and deviations, As a result, medical institutions not only directly take away the second bargaining part of pharmaceutical enterprises far more than the hospital\'s drug markup, but also get double benefits from the significant adjustment of the state and medical costs, and the interests are seriously damaged by the state, the public and the majority of pharmaceutical enterprises.
The hospital makes more than double the markup
The range of drug mark-ups varies from 10-15% in various places, and the margin of profit in the second bargaining has long exceeded the above range. Provincial and municipal secondary bargaining is in full gear, but the current plan to structural adjustment of medical institutions, such as diagnosis and treatment costs, personnel salaries, etc., but still according to the policy design at the beginning of the cancellation of drug addition on the hospital drug income reduction by the state financial subsidies and increase of medical costs such as treatment fees, nursing fees, surgery fees to balance and compensate, completely forgetting the existence of secondary bargaining.
At the same time, the cost control target of 30% drugs +20% consumables in the pilot reform guidance of public hospitals has only increased compared with the previous national average of about 40-45% drugs, and the proportion of inspection fees has reached 30-35% a few years ago, and it will still surge. For people and the country, the burden of spending has not eased and is more likely to continue to accelerate. Coupled with the sharp rise in consultation fees and surgery fees, the good intention of controlling the growth of medical costs is really not so easy to achieve, and it is more likely to drift away from it.
The state has made part of the financial support for the cancellation of drug addition regions and hospitals, while various medical costs have been significantly adjusted, and some pilot hospitals can basically achieve balance of payments after demonstration, then it is really necessary to sharply slash the profits of pharmaceutical enterprises in the second bargaining, so that enterprises lose their living space, is it really necessary, and where has the profit part of the second bargaining enterprises gone? If the structural deficit in the income of medical institutions is not digested and made up by improving their own professional management and operating capabilities, but to be borne by the pharmaceutical industry, holding the second bargaining enterprise to make huge profits, why will they reach out to the country and the people, one hand to subsidize, the other hand to raise prices, how can medical costs come down? If medical costs continue to soar, far beyond the era of medicine to support medicine, medical reform has evolved into a vigorous drug reform leading to a serious contraction of the pharmaceutical industry, medical institutions not only do not have to bear any responsibility and losses, on the contrary, both internal and external play karate multiple profits. Is the policy design of medical institutions and pharmaceutical companies so different from each other seriously unbalanced? Why and for whom is healthcare reform being changed? Is the design of medical reform coherent and systematic? Do medical reform experts really understand the management of medical institutions and pharmaceutical industry?
Such a policy design only benefits the beneficiaries and even the main body of the medical reform to ensure that the object is only a single side of the medical institution, is there a serious deviation between the policy design of the medical reform and the target subject and the evaluation subject? At the expense of national interests, public interests and the interests of the pharmaceutical industry to ensure that medical institutions are not affected by any, but doubled in benefits, such a medical reform positioning will only continue to spoil medical institutions, let it go, rather than patient-oriented, market-oriented competition, enterprise operation, naturally can not mention the effective control and reduction of medical costs, improve the standardized service quality of medical institutions. Continue to increase the risk and severity of commercial bribery and corruption in medical institutions.
Second bargaining for enterprises
Whether it is a second bargaining on the basis of provincial standards or a direct transfer of profits to medical institutions, the second bargaining has made many pharmaceutical companies feel overwhelmed. In addition to the implementation of the cancellation of public hospital mark-up in individual provinces, other provinces are only carried out in some pilot hospitals. The second bargaining is carried out in prefecture-level cities and provincial and municipal hospitals. The deviation of epitaxy between them is great. The hospital that has not canceled the drug addition enjoys the income of the addition, while ordering the enterprise to make a substantial profit, and the medicine is more turbulent, which is really difficult to understand.
Hospitals implement a zero-margin rate, the loss of drug markup is partially subsidized by the state finance, and the rest has been compensated from the substantial increase in medical costs. The second bargaining actually continues to reduce the proportion of drug amount or directly subsidizes medical institutions so that they continue to enjoy the policy of overusing drugs to support medicine has drawn attention. The 20% margin of profit not only makes hospitals earn far more than the drug markup. At the same time, in the name of abolishing the medical surcharge, it benefits from both the national finance and the adjustment of medical expenses. The second bargaining should not be carried out, and the reasonable range should be controlled in how many causes widespread controversy in the industry.
If you calculate this account from the perspective of the enterprise, the second bargaining margin is generally set at 20%, which means that the net profit of the enterprise\'s products directly decreases by 20%, which has exceeded the average profit margin of the pharmaceutical industry. Not only are the basic and low-cost drugs failing to survive, but the new drugs are also in danger. Quite a lot of products remove the huge research and development investment, marketing investment, fixed assets investment, personnel salaries, taxes, financing loans and other financial costs of various names, expensive expenses, gross profit may not be higher than this, how can it bear? If the secondary bargaining continues to be implemented, the benefits will undoubtedly only be products with truly inflated prices, and all other products that are not inflated will be cleared out, leading to industrial crises and unscientific and unfair phenomena.
Previously, I helped some regions to design a centralized procurement and distribution plan with both the functions of secondary bargaining and pharmacy trusteeship. The loss of hospital income caused by the cancellation of the addition shall be borne by the state finance, and the rest shall be compensated by the drug enterprise trusteeship costs (the cost limit is 5-10%), which can ensure that medical institutions are not affected by anything compared with the past. If medical institutions increase medical fees significantly, the state financial subsidies and trusteeship fees compensation should be reduced or cancelled accordingly. We will ensure that government investment is not wasted, that state financial expenditure and the burden on enterprises are kept within a reasonable range, and that the pricing of different products is scientifically adjusted, which will not be simple and one-size-fits-all. Policy design is more professional, comprehensive and systematic, scientific sharing, the country, the public, medical institutions and pharmaceutical enterprises can be harmonious and prosperous.
Similarly, if only structural adjustment is made without root cause governance, the proportion of drugs seems to decrease, the growth of individual costs and total costs is not controlled, and an effective standardized regulatory system of prescription first review and then pricing is not established and a system of patient rights and interests protection is not established. Will only continue to drive up health care costs across the board. Chinese medical reform has unique national characteristics, if simply copy Russia, will make people lose satisfactory medical service quality and advanced diagnosis and treatment technology and medicine; If we simply copy the West and use overseas medical costs as a template, it will only continue to increase the cost of medical treatment for people. How to effectively control the disorderly growth of medical costs, while effectively improving the quality and level of medical services, should become the essence of the core and goal of medical reform, both indispensable.
Information Source: Xinkang Jie