40 hospitals were named by the Health Insurance Bureau because "the amount of reporting is not collected"!

On December 14, Tibet issued the "Circular on Issues Related to the Reporting and Procurement of National CollectiveLy Collected Drugs", which notified some medical institutions that reported the volume but the procurement volume was zero during the third batch of collective procurement cycles organized by some countries, involving 40 hospitals.

To be honest, this situation appears in today's "normalization and institutionalization" of collection and collection, which is really surprising. To this day, there is such a bold medical institution?!

Therefore, I can't help but be angry with the relevant departments! The Tibet circular pointed out that since the state organized the centralized procurement of drugs, there has been a serious decoupling of the reported volume and procurement of individual medical institutions in the Tibet Autonomous Region, and there is even a problem of zero completion of the agreed procurement volume, which has seriously affected the quality and credibility of the centralized procurement of drugs in Tibet and the whole country. At the same time, the local and municipal medical security bureaus are required to attach great importance to the above problems and take timely and effective measures to rectify them. In the future, the Tibet Medical Insurance Bureau will include the reported volume and performance of various localities in the comprehensive evaluation, and link it with relevant indicators such as the allocation of funds. Where the situation is serious, joint discipline inspection and supervision departments and other departments will employ disciplinary measures such as interviews and accountability.

So, the national procurement has a reported amount, but the purchase volume is zero, how much "privacy" is behind it?

First, some medical institutions do not have a good understanding of quantity procurement

For many years, the government has tried many ways to solve the problem of the masses seeing a doctor, which is difficult to see and expensive. Focusing on the "problem of expensive medicines", in terms of reducing drug prices, such as the maximum retail price of controlled drugs, the purchase and sale markup rate of controlled medical institutions, the implementation of differential mark-up rates, the prohibition of discounts, the control of the amount and average cost of single prescriptions, the proportion of controlled drugs, the strong implementation of centralized government bidding and procurement, the implementation of centralized bidding and procurement of drugs by provincial governments, zero price difference, the prohibition of "secondary bargaining", the commitment of a single source of goods, the strict crackdown on rebates and other commercial bribery behaviors, the implementation of two lines of revenue and expenditure, etc., in fact, one by one, they have failed. In the indomitable reflection of repeated defeats, the Super Health Insurance Bureau realized that the root cause of the failure to achieve "victory" in centralized bidding and procurement was that there was no "amount". Therefore, "procurement with quantity" is on the agenda.

On November 14, 2018, the fifth meeting of the Central Committee for Comprehensively Deepening Reform deliberated and adopted the Pilot Program for Centralized Procurement of Drugs organized by the State, which clarified the overall ideas of the state organization, alliance procurement, and platform operation.

On November 15, 2018, with the consent of the Central Committee for Comprehensively Deepening Reform, the state organized a pilot project for centralized drug procurement, with the scope of Beijing, Tianjin, Shanghai, Chongqing and Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu and Xi'an (hereinafter referred to as 4+7 cities).

On December 10, 2019, the National Medical Insurance Bureau issued the "Opinions on Doing a Good Job in the Current Drug Price Management", which clearly deepened the reform of the centralized drug procurement system, and adhered to the direction of "volume procurement, volume price linkage, and integration of recruitment and procurement", so as to promote the return of drug prices to a reasonable level.

The so-called procurement with quantity, that is, in the bidding announcement, the required procurement volume will be announced, and in the bidding process, in addition to considering the price, it is also necessary to consider whether you can afford the corresponding production energy.

And where does this "quantity" come from? According to the procurement policy with quantity, all medical institutions involved in the collection are required to forecast and agree on the annual procurement volume according to 70% of the average procurement volume in the previous 1-3 years. The reason is that according to the agreed annual procurement volume of 70% of the average procurement volume in previous years, on the one hand, there is a certain space for clinical business changes, on the other hand, it is hoped that the agreed amount must be completed, giving the enterprise a more reliable amount of "commitment", but also showing the government's "nine words".

However, for the government's institutional arrangement, some medical institutions do not recognize the position, so they are arbitrary when reporting the amount, careless when signing the contract, and indifferent when implementing.

Second, there are obvious problems in the amount of reporting,

The health care sector lacks guidance and regulation

According to the 40 medical institutions in Tibet (in fact, not 40 medical institutions, but 40 quality regulations agreed to purchase drugs), the General Hospital of the Tibet Military Region has 1 quality regulation, 6 county-level hospitals involve 19 quality regulations, 1 community health service center has 1 quality regulation, and 8 township health centers have 19 quality regulations. The problem is very obvious from the quality specifications and purchase quantity of drugs submitted for procurement. For example, olanzapine oral disintegration tablets, this drug is suitable for acute phase and maintenance treatment of schizophrenia and other psychosis with severe positive symptoms (e.g., delusions, hallucinations, thought disorders, hostility and suspicion) and/or negative symptoms (e.g., emotional apathy, emotional and social withdrawal, speech poverty), and can also alleviate the secondary affective symptoms common to schizophrenia and related diseases. Therefore, its clinical use has a very strong pertinence and a very "narrow" indication. However, judging from the fact that the reported amount has not been collected, there are obvious abnormalities. For example, the agreed purchase volume of Bianba County People's Hospital in Changdu City is 50,000 tablets of 5 mg and 5,000 tablets of 10 mg, while online searches have learned that the total population of Bianba County is only 32,000 people. Renbu County Muxiang Health Center 5 mg agreed to purchase 50,000 tablets, 10 mg 10,000 tablets. Purchases of other medicines were also reported as abnormal.

As a local medical insurance department, the purchase volume reported by medical institutions should also be guided and monitored, and abnormal abnormalities should be reminded and pointed out in a timely manner, especially when signing the agreement, this pass should be done well, otherwise it will bring trouble to the next step of implementation. At the same time, for medical institutions that report the amount but have not purchased, they must also be reminded in time that they cannot ignore the question, and only know that the punishment is reported, which is obviously a dereliction of duty. This point is also required in the Tibet circular, which pointed out that the centralized procurement of drugs organized by the state is an important embodiment of the deepening and development of China's medical reform, and is an important measure for medical insurance to achieve the goals of promoting reform, seeing practical results, and benefiting people's livelihood. The local municipal medical security bureaus shall supervise and guide relevant medical institutions to do a good job in reporting and purchasing in all aspects of the work in accordance with relevant duties, and complete the centralized procurement of pharmaceutical equipment with high quality.

Third, there is a congenital "deficiency" in procurement with quantity

From the Tibet circular, it can be reflected that the reported amount of drug procurement by medical institutions is "untrue", and this phenomenon in the collection is not only a problem in Tibet, but also exists in many parts of the country. Of course, the main reason for the untruthful report is that medical institutions do not attach importance to it, do not understand the "amount" in the purchase of the amount, lack of contract spirit, always think that the signing of the enterprise is a paper agreement (it is understood that the purchase contract with the amount or the online signing, not even a paper), can be implemented or not executed, in fact, it is not so, this agreement is to implement the purchase amount, and the advance report is the core of the purchase with the amount, according to the amount of the reported amount of the agreement to sign the purchase amount and perform the contract is the key to the volume of procurement. If you can't truthfully report the quantity and implement the procurement according to the agreement, it will actually hit the face of the "quantity" procurement, touch the "bottom line" of the quantity procurement, and it is absolutely unforgivable in the procurement system with the quantity.

But in fact, there is indeed a congenital "deficiency" in quantity procurement, that is, it is impossible to accurately predict the dosage of drugs used in medical services, because for a medical institution, it is never possible to predict what disease the patient will get, how many people will get sick, and how many people will go to your hospital for treatment after getting sick.

Therefore, there is a lot of uncertainty in the purchase of quantity. The actual purchase volume of a certain drug after the official notification is significantly higher than the agreed purchase volume is also one of the performances of the procurement volume that is difficult to accurately predict the purchase volume. What can be done is to do as much as possible with the amount of procurement, the use of all aspects of the actual do a good job, because according to the medical insurance 14th Five-Year Plan, by 2025, China's drug collection will reach at least 500 kinds, health materials at least reach more than five categories, which means that more than 80% of the drugs of general medical institutions will be achieved through the purchase of quantity, at that time, medical institutions if they do not do this well, I am afraid that they will close their doors.

Source: Medical Community Think Tank

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