◆ After the collection of coronary stents from about 13,000 yuan to about 700 yuan, there has been a sound of "no supply", is the supply really insufficient?
◆ Why is the artificial joint known as the most difficult collection of high-value medical consumables? How to overcome the difficulties?
◆ The price of high-value medical consumables "diving", can the selected varieties be guaranteed quality and supply?
Original title :"The Art of War" for the Collection and Collection of High-Value Medical Consumables"
Wen | Song Rui and Zhang Yuqi, reporters of the "Lookout" news weekly
The unreasonable price moisture of china's high-value medical consumables has been gradually squeezed out since 2020 - the Joint Procurement Office of High-value Medical Consumables of the National Organization set up in Tianjin (hereinafter referred to as the Joint Procurement Office) has taken advantage of centralized procurement to make enterprises and patients win-win through "volume-for-price" and fought two "hard battles" on the two high-value medical consumables of coronary stents and artificial joints.
In November 2020, the first national organization of high-value medical consumables collection and production announced the results: the average price of coronary stents "dived" from about 13,000 yuan to about 700 yuan, a drop of 93%.
In September 2021, the results of the second batch of high-value medical consumables organized by the state were announced: the average price of artificial hip joints dropped from 35,000 yuan to about 7,000 yuan, and the average price of artificial knee joints fell from 32,000 yuan to about 5,000 yuan, with an average price reduction of 82%.
How can the price of high-value medical consumables achieve "diving"? Can the "Art of War" of Collecting and Collecting Ensure the Quality and Supply of Selected Varieties? On the occasion of the anniversary of the collection of high-value medical consumables, the reporter of this magazine will decrypt it for you one by one.
▲ On November 5, 2020, the National Organization Coronary Stent Centralized Procurement Declaration Information Disclosure Conference was held in Tianjin for the joint procurement of high-value medical consumables organized by the State Organization
Major surgery doesn't have to be delayed
"It's not pleasant to get sick, but after the operation, I feel like I've earned it." Shi Lei, who grew up in Tianjin, the hometown of cross-talk, joked with his own surgical payment slip.
On the morning of November 24, 2021, 50-year-old Shi Lei completed his second percutaneous coronary interventional surgery (PCI) at Tianjin First Central Hospital. This time, his heart was fitted with two coronary stents.
At the end of March 2021, Shi Lei suddenly suffered a heart attack and caused a coma, and after cardiac imaging, his aorta was completely blocked, and surgery was carried out immediately. After examination, Shi Lei's other blood vessel was blocked by 75%, and the doctor suggested that a second operation be performed after half a year.
"I have long watched the news and learned that from January 1, 2021, coronary stents have officially implemented a new price, and the original stents of 10,000 or 20,000 yuan are now only more than 700 yuan." Shi Lei said.
According to Shi Lei, his first surgery cost less than 20,000 yuan. "I looked at the bill of payments, and with the fact that I had health insurance and commercial insurance, I could barely spend any money. The cost of the second surgery is even more worrying, and I feel good about everything now. ”
The reporter noticed that on the ECG monitor next to Shi Lei's bed, the waveform line output in real time recorded his smooth and powerful heartbeat. Shi Lei pulled up the cuff and showed the reporter the surgical wound on his right wrist. "This wound is the size of a soybean, and the wound of the first operation healed so well that you can't see it without looking closely."
Lu Chengzhi, chief physician of the Cardiology Department of Tianjin First Central Hospital, said: "When the price of coronary stents was not reduced in the past, I once met patients who gave up because they could not afford surgery, and patients who wanted to escape the cost after installing coronary stents. After the coronary stent was collected and landed, such a situation rarely happened, and the people saved a lot of treatment costs. ”
In early November 2021, Xing Hua from Jilin had three coronary stents implanted in his heart due to a heart attack. "I know the old problems on my heart, before the doctor also recommended me to do coronary stent surgery, but a coronary stent to more than 20,000 yuan, there is a hospital for me to prepare 180,000 yuan medical expenses, this is too expensive, I think left and right or can not afford it, I have been dragging on not to do." Xing Hua, 49, sighed.
"This sudden myocardial infarction was admitted to the hospital, I did not expect a coronary stent only a few hundred yuan, I did not think about the direct operation, the operation fee plus hospitalization fee is only 30,000 yuan, a day after the operation to recover, feel very good." Xing Hua sighed: "The original price of major surgery has dropped, and the average people can afford it. Heart problems can kill people at any time, which is good, and patients with economic tension do not have to delay again and again. ”
Gao Xue, head of the centralized procurement team of the Joint Procurement Office, introduced that among the 10 products selected in the coronary stent, the highest quotation is 798 yuan and the lowest quotation is 469 yuan, including 7 products from 6 domestic enterprises and 3 products from 2 import enterprises.
According to the data provided by the Joint Procurement Office, from January to November 2021, medical institutions used a total of 1.3114 million selected products, an increase of 33.46% compared with the number of coronary stents used in the same period before the collection of drugs in 2020 (982,600), and the total amount of use in the first 11 months of 2021 has exceeded the national annual agreement procurement volume (1.07 million).
"We have brought together the procurement demand of medical institutions across the country, and the clear procurement volume can significantly reduce the cost of enterprises in the circulation link and sales link, so as to make room for enterprises to reduce prices." In order to maintain or expand the original market share, production enterprises will spontaneously reduce prices and achieve the effect of 'exchanging prices for quantity'. Gao Xue said.
"The centralized procurement of high-value medical consumables has effectively reduced the burden of medical treatment for patients and allowed the masses to enjoy the reform dividend." Li Guotian, secretary of the party group and director of the Tianjin Municipal Medical Security Bureau, said.
It is not only patients who benefit - the price of high-value medical consumables has been reduced, the pressure on the medical insurance fund pool has been reduced, and the doctors with scalpels have also increased a lot of "sunshine income".
"After the collection and extrusion of gray costs in the circulation link, manufacturers, distribution enterprises and medical institutions will return to a normal and equal purchase and sale relationship, and some provinces with lower surgical fees will raise the charging standards, and at the same time apply mechanisms such as medical insurance payment balance retention and payment method reform to enhance the 'sunshine income' of medical staff in relevant departments under the condition of stable workload." Zhang Tiejun, director of the Joint Procurement Office and deputy director of the Tianjin Municipal Medical Security Bureau, said.
How to avoid collecting "pressing the gourd to float up the scoop"
The measures to benefit the people with a significant reduction in the price of coronary stents have quickly been recognized by the people, and the "national team" has continued to accurately attack artificial joints, and it is expected that patients across the country will continue to use the selected products after the price reduction after March 2022.
It is understood that from coronary stents to artificial joints, the "national team's" collection of "art of war" is not simply copied. The principle of "one product, one policy" came into being.
"Orthopedic consumables are the category with the highest market value of high-value medical consumables, and due to the complex technical classification and combination, such consumables have long been difficult to centralized procurement." Zhang Minghui of the Business Section of the Joint Procurement Office said.
In order to gnaw down this hard bone, after conducting a lot of research on the clinical use of production enterprises, medical institutions, international market prices, etc., the joint procurement office designed a targeted procurement plan according to the characteristics of artificial joints, and tailored suitable collection rules.
It is understood that artificial joints are artificially manufactured joint prostheses used to replace the original hip and knee joints of the human body that need to be replaced due to osteonecrosis, comminuted fractures, osteoarticular diseases, bone tumors and other terminal diseases of the hip and knee joints.
"The artificial total hip joint is generally composed of 4 parts, and the artificial knee joint is generally composed of 3 parts. Hip knee prostheses are made of different materials depending on the part. Zhang Minghui said that compared with the collection of coronary stents in individual units, the difficulty of artificial joint collection has been doubled.
In accordance with the principle of "recruitment and procurement integration", after analyzing the massive procurement and use data, the joint procurement office will combine multiple major components required for clinical complete surgery for product system implementation procurement, to avoid some necessary components due to the shortage of unsolicited bids, or some components because they have not been included in the collection of crazy price increases, to ensure the integrity and safety of clinical treatment.
Ding Yilei, director of the Department of Pharmaceutical Price and Bidding and Procurement of the National Medical Security Bureau, introduced that the system-based quotation can avoid the situation of "pressing the gourd to float the scoop" and reduce the overall cost burden of patients.
At the National Organization Artificial Joint Centralized Procurement Declaration Information Open Conference held in September 2021, 44 of the 48 companies participating in the election were selected, with a winning rate of 92%. Domestic and foreign-funded enterprises have products to be selected, including well-known enterprises commonly used in medical institutions and emerging enterprises, taking into account market stability and vitality.
In Ding Yilei's view, the results of this election are basically in line with expectations. "The intended procurement volume of the selected products accounts for more than 80% of the total intended procurement volume of medical institutions, indicating that this collection has achieved a high degree of matching with the actual clinical needs while reducing the inflated price."
After counting the demand for artificial joints in 5804 medical institutions across the country, the Joint Procurement Office found that the intended purchase volume of artificial joints in the first year totaled 540,000 sets, accounting for 90% of the total demand. "Through the comparative analysis of the relevant cost situation in the early stage, this collection not only reduces the inflated price of artificial joints, but also gives the company a certain profit and development space, and achieves a multi-faceted balance." Ding Yilei said.
According to the estimation of the National Medical Insurance Bureau, according to the purchase price in 2020, the purchase amount of artificial hip and knee joints in public medical institutions is about 20 billion yuan, which is expected to save 16 billion yuan, and more than 500,000 joint replacement patients will benefit significantly every year.
How to preserve the quality of the selected varieties
As the first high-value medical consumable variety to be procured by the state in the "test water", coronary stents have appeared in the implementation of new prices, such as "incomplete coronary stent models" and "no money for surgery before, now there is money without stents".
In this regard, the Joint Procurement Office immediately investigated and gave the overall situation of the whole country: from January to November 2021, the selected enterprises have supplied 2.6007 million selected stents, reaching more than 2.42 times the annual agreed purchase volume and 1.98 times the actual use of hospitals.
This means that from the national point of view, the supply of coronary stents is higher than the actual amount of use, and the inventory of coronary stents of various specifications is sufficient, and there is no overall situation that coronary stents are "not supplied".
"The inflated price of coronary stents before collection supports the delivery company to provide a 'nanny-style' service of on-call, replenishment and gift at any time." After the price of coronary stent collection and procurement landed, logistics costs were greatly reduced, and it was necessary to 'digest' through modern technologies such as improving efficiency and increasing accuracy, and production enterprises, distribution companies and medical institutions continuously improved supply efficiency in the run-in. Gao Xue said.
At the same time, the Joint Procurement Office, together with relevant departments, will guide medical institutions to strengthen procurement and inventory management capacity building, and improve the efficiency of information transmission and procurement operations. It is reported that the Joint Procurement Office has specially developed the online coronary stent capacity and inventory filling function, which is convenient for timely understanding the inventory of the selected products and predicting the shortage.
According to Tianjin First Central Hospital, the hospital has strengthened the refined management of high-value medical consumables in the hospital, such as stockpiling, use, inventory, and replenishment. "Our cardiology department completed more than 1,200 PCI procedures in all of 2020. After the new price landed, more than 1600 units have been completed since 2021. The relevant person in charge of the cardiology department of the hospital said, "In August 2021, the hospital applied for an increment from the system and received incremental supplements in a timely manner, which can meet the supply as a whole." ”
Recently, in the work of filling in the procurement requirements of artificial joint collection and collection medical institutions, Xia Qun, director of the Department of Orthopedics of Tianjin First Central Hospital, asked his colleagues in the Department of Cardiology for advice on the experience of declaring product dosage for the first time.
In order to avoid the situation that the main reporting product did not win the bid and affect the subsequent use of the hospital, he originally decided to put the eggs in different baskets - to report the amount of different joint models. Knowing that the artificial joint collection is on top of the experience of coronary stent collection and collection, and there is a margin allocation link, Xia Qun is more at ease.
"With this link, the hospital does not have to be too nervous when reporting the amount in the early stage, and according to the subsequent use, it can also select some products that are convenient for our doctors to use from the winning enterprises and products when the 'margin allocation'." Doctors hope to use more familiar products, just like driving a familiar car, how much 'throttle' under the foot is in mind, and the patient will be more at ease. Xia Qun said.
Different from coronary stent surgery, artificial joint replacement has a strong demand for accompanying services such as surgery, logistics and distribution, warehouse management, and supporting tools. In addition to basic services such as product distribution and disinfection, it is also necessary to guide the use of products at the surgical site to ensure the accuracy of the application of each component.
Zhang Tiejun said that in order to ensure that clinical use is not affected, artificial joint collection requires enterprises to clarify the price of accompanying services, and include the price of accompanying services in the calculation of bidding prices. This not only improves the transparency of the product price composition, but also ensures that the selected products can provide a complete companion service. "If the disinfection link is clearly borne by the medical department, the cost of disinfection is not amortized into the price of the product." Zhang Tiejun said.
After the price of artificial joint collection dives, the "difficulty coefficient" of production, distribution and medical institutions is doubled, and many people are worried that enterprises will squeeze the accompanying services and then affect the subsequent supply and use.
In order to ensure supply, the Joint Procurement Office stipulates that when an enterprise declares a product, it can freely choose to supply the whole country or only supply part of the city, so as to ensure that the enterprise chooses the supply area according to its own ability and historical sales scope, and can ensure sufficient and timely supply after the selection.
In response to the problem of "price reduction, no quality reduction" that patients are most concerned about, Gao Xue said that enterprises must ensure the quality of supply products, and any adjustment of raw materials and production processes must be reported to the State Food and Drug Administration for approval and strict inspection. As far as coronary stents are concerned, the drug regulatory department conducts full-cycle quality supervision on the production, circulation and use of coronary stents, "each coronary stent has an identification code, from production to use can be traced and supervised throughout the process." Gao Xue said.
In order to do a good job in the implementation of artificial joints, the Joint Procurement Office will establish a registration system and develop a registration system for medical consumables (artificial joints) for medical insurance in China. Chen Yuxiang, the responsible comrade for the information work of the Joint Procurement Office, said: "The system will establish patient files and summarize the use data by collecting patient information, practitioner information, product use information and surgery related information, so as to facilitate product quality supervision and accountability." ”
"What the people are concerned about is the direction of our efforts. In the future, we will carry out centralized procurement of more high-value medical consumables with large clinical consumption, higher procurement amount, more mature clinical use, and production by many enterprises, so as to exchange prices for quantity and benefit the people. Zhang Tiejun said.
Published in Lookout, No. 1, 2022
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