Source: Visual China
Author | Zhou Junzi
Edit | Jan Pudding
Produced by | Prism Tencent Xiaoman Studio
In January 2021, after more than a month of toothache, Li Xiaoli, a dispatcher at Hefei Fenghua Auto Parts Co., Ltd., finally decided to treat her teeth. After the doctor's diagnosis, she recommended that she implant her teeth, but the price of dental implants of tens of thousands of yuan surprised her with a monthly salary of 4,000: "Ordinary working class is difficult to bear." ”
Li Xiaoli's other status is that of a deputy to the National People's Congress and a part-time vice chairman of the Feidong County Federation of Trade Unions. With this personal experience, after researching the local dental implant market, she submitted the "Proposal on Regulating the Cost of Dental Implant Materials and Including the Cost of Treatment and Service Costs in Medical Insurance" at the "Two Sessions" in March.
"In a hospital below the county level, the oral treatment clinic receives an average of about 30 patients per day, and the average cost of a dental implant treatment ranges from about 6,000-20,000 yuan." If you plant full teeth, it is equivalent to buying a suite in the county." She wrote in the proposal.
"Dental implants are very controversial and criticized a lot, and dental implants are an important way to repair missing teeth, and the social demand is also very large." A year later, at the State Council's regular policy briefing on February 11, 2022, Chen Jinfu, deputy director of the National Medical Security Bureau, said that the procedures for implant dental collection were basically mature, and they were ready to strive to launch such a local collection alliance reform in the first half of this year.
This is also the first time that the National Medical Insurance Bureau has announced the timetable for the collection of dental implants after the executive meeting of the State Council on January 10 proposed to carry out the collection of orthopedic consumables, drug balloons, dental implants, etc. at the national and provincial levels.
Once it enters the collection, the market expects that the price of dental implants will be greatly reduced. The dilemma of consumers "not planting toothaches, planting heartaches" is expected to improve.
It should be known that as the first collection project in the field of high-value medical consumables, the price of coronary stents has dropped from an average price of about 13,000 yuan to about 700 yuan, a drop of 93%. In the second batch of high-value medical consumables included in the collection, the average price of artificial hip joints dropped from 35,000 yuan to about 7,000 yuan; the average price of artificial knee joints fell from 32,000 yuan to about 5,000 yuan, a decrease of 82%.
Is "Dental Implant Freedom" really going to happen?
Implant costs only 10%
Dental implants, a method of restoring missing teeth based on the lower structure within the implanted tissue to support and fix the upper dental restoration. There are two main steps: first, the implant is buried in the alveolar bone of the toothless site through a small operation to form an artificial tooth root, and the second stage of surgery is carried out after 3-6 months, and then the beautiful and natural porcelain teeth are connected to the artificial tooth root about 1 month after the operation.
Compared with the traditional two treatment methods of movable dentures and fixed dentures, implants are comfortable and aesthetically pleasing, closer to natural teeth, and do not damage normal teeth, and have a longer use cycle, so they were once regarded as the "third pair of teeth" in addition to deciduous teeth and permanent teeth. Of course, to match it, it also costs more.
Bai Tingting (pseudonym), a dentist in the department of stomatology at a well-known tertiary hospital in Beijing, introduced to the author that the current implant cost of a single tooth on the market ranges from several thousand yuan to nearly 30,000 yuan. From a nationwide perspective, even in the most remote border towns, the total cost of planting a tooth is seven or eight thousand yuan, "which is the cheapest price."
If the patient's situation is more complicated, it will cost 200,000-300,000 to make a bite of teeth in the most well-known hospital in the country, such as Peking University Dental. "A little car ran in." She teased.
In the impression of Li Yanqi, director of the Department of Stomatology at Zong Renqing Memorial Hospital, the most expensive dental implant surgery he had done cost 250,000 yuan. The subject is a patient with severe periodontal disease who needs to have all of their original teeth removed and re-implanted in their entire mouth. According to him, patients with tooth loss due to periodontal disease account for at least 50% or 60%.
The implant system consists of an implant, a implant abutment and a crown. Among them, the implant, as the most core material, determines the final price of a tooth.
According to a survey data of Pacific Securities, the cost of implants in the domestic market is about 8000-22000 yuan, of which the price of implants is 3500-12000 yuan, accounting for 50% of the entire surgical cost; the cost of surgery and anesthesia is 3000-5000 yuan, accounting for 25%; the cost of implant abutment is 1500 yuan, accounting for 10%; the cost of repair materials is 1200-2500 yuan, accounting for 10%; the remaining 5% is the cost of the crown.
Li Yanqi told the author that if you look at the terminal consumer price, the price of light implants can account for 70%; but in fact, from the cost side of the stomatological hospital, the cost of implants accounts for only 10%-20% of the entire implant, the cost of other consumables accounts for about 10%-20%, and the rest are technical costs, of which the technical cost of implant doctors will account for about 30% or 40%.
A survey data from Guohai Securities also shows that the purchase price of implants only accounts for about one-tenth of the cost of implants. In the consumer terminal 5000-10000 yuan of Korean brands, the purchase price of the stomatological hospital is 500-800 yuan; in the consumer terminal price of more than 20000 yuan, the purchase price of the stomatological hospital is 1800 yuan - 2300 yuan.
Taking Jiahong Dental as an example, the prospectus shows that the average price of the Dunsberg implant it represents in 2019 is 1038 yuan, the domestic brand is 400-450 yuan, and the average purchase price of the implant is 775 yuan.
Can collect and collect the price?
Mr. Wang, from Chaoyang, Beijing, had three teeth extracted a few months ago. According to the original plan, after the doctor measured his bone mass before the New Year, he would start implanting teeth, which was expected to cost a small amount of 50,000 yuan. After the news of the dental implant collection came out on January 10, he decided to wait until the policy was in place. "It should save you a fortune." He calculated.
After the implant is collected, what part of the cost is reduced? How much can it end up dropping? This is the topic that the market and consumers are most concerned about. In addition, unlike the high-value medical consumables that have been collected before, dental implants are not within the scope of medical insurance, which is also its particularity.
According to Chen Jinfu, the collection of implant dental implants will start from local exploration, and will be deployed from the beginning of last year, and the inter-provincial alliance will be organized by Sichuan to study the procedures for collecting dental implants. The reform of the local collection alliance is actually a layout under the leadership of the state, and a collection method is explored in dental implants.
"In fact, in the future, the collection is more important than the rules, the characteristics of different bidding targets are very complex, need to meet the requirements of product quality, but also to meet the clinical needs, but also to effectively allow enterprises and patients to share the results of reform." Chen Jinfu said.
According to the above analysis, the actual cost of consumables for dental implants accounts for a low proportion of the overall treatment cost, even if the price of consumables such as implants is reduced by 90%, the decline in overall treatment costs is not obvious, and it does not meet the expectations of consumers.
Previous cases of price reductions in coronary stents may provide a reference. China Times has reported on its cost composition: the cost of a single coronary stent is 400 yuan, the factory price is 2,000 yuan, and the terminal price is more than 10,000 yuan. Insiders involved in the collection of coronary stents pointed out that about 8,000 yuan of a stent that costs more than 10,000 yuan is consumed in the circulation field. From manufacturers to hospitals, there are national general agents, provincial, prefectural and municipal levels, etc. Each additional layer of agents, circulation costs will rise.
The head of the Department of Pharmaceutical Price and Bidding and Procurement of the National Medical Insurance Bureau previously mentioned in an interview that in addition to achieving economies of scale and reducing purchase prices and other functions similar to those in the world, drug collection and procurement also undertakes a special phased function: canceling "gold" sales. According to expert analysis, half of the sales cost of the drug is a rebate, which is included in the price of the drug.
Bai Tingting told the author that in the pricing system of the stomatology department of public hospitals, the doctor's surgical cost is very low, so some of it will be implicitly attached to the cost of consumables, which is one of the reasons why the terminal cost of consumables will be much higher than the actual cost. If the collection of consumables costs "fractures", it means that the doctor's income will be reduced accordingly.
Miao Zhixu, the doctor of the Department of Stomatology of Chongqing Huamei Plastic Surgery Hospital, is more optimistic, in his view, the implant collection will make the unit price drop on the one hand, and on the other hand, it will also make more people accept this form. He expects that once they enter the collection, the amount of planting in their hospital will at least double. Therefore, it will not have much impact on the overall revenue of the hospital.
Exchanging quantity for price is the biggest feature of collection. Taking coronary stents as an example, according to the data released by the Joint Procurement Office, 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.
For upstream manufacturers, purchasing with quantity also means that challenges and opportunities coexist. Zhenghai Biologics, a manufacturer of prosthodontic materials, mentioned in the annual report that the challenge is that the procurement with volume will directly affect the profitability of the product, and once it fails to win the bid, it will lose most of the market share in the region during the procurement cycle; the opportunity is that the procurement with volume promotes the increase of industry concentration, and the effect of exchanging the price for volume after winning the bid is conducive to the improvement of the company's sales volume, and then obtains the "channel" effect and expands the brand influence.
In addition, the particularity of the dental implant market is that the market share of domestic brands of implants is too low, and it has not even entered the stomatology department of some well-known public hospitals. Once the domestic brand can win the bid, and whether it can be generally accepted by public hospitals after winning the bid, it is still unknown.
Domestic brands are at the bottom of the "chain of contempt"
Bai Tingting told the author that in the field of implants, "European and American brands - Korean brands - domestic brands" is a strict "chain of contempt".
As the originator of the implant field, European and American manufacturers began to study implants as early as the 50s of the last century, after 70 years of continuous update and iteration, now whether in materials or technology, there are incomparable advantages, in the forefront of the "chain of contempt". Representatives of european and American high-end brands include Straumann in Switzerland, ITI, Nobel Biocare in Sweden, and Friadent in Germany. Straumann's financial report data shows that in 2018, Strömann ranked first with a market share of 25% in the world, followed by Norbaco with 19%.
Korean brands focus on the low-end market and cost performance, representing brands such as Osstem, Dentium, etc., which occupy 7% and 4% of the global market share respectively.
The author learned from a number of dentists that the price difference between European and American brands and Korean brands is 1.5 times to 2 times, for example, the terminal price of Ortona in China is 67,000 yuan, while the price of Nuobaoke is generally 13,000-15,000 yuan. It is also because of the price relationship that the market of high-end brands in Europe and the United States is dominated by public hospitals, and Korean brands are focusing on private hospitals and dental clinics.
Research data from a number of brokerages show that imported brands now account for more than 90% of China's implant market. In contrast, domestic brands are at the bottom of the "chain of contempt" in terms of popularity and price.
If it is in some well-known dental public hospitals, the share of imported brands will be higher, or even close to 100%. Bai Tingting told the author that their hospital currently only uses the brand of Noboco, and even some repair materials will be imported first. After all, for doctors, more consideration is given to clinical efficacy, if the implant can not live, or some complications in the follow-up, smashing their own signboard. In terms of effect, there is still a big gap between domestic brands and needs to catch up. "At present, in addition to being cheap, the domestic ones are really not very easy to use."
According to the author's understanding, the domestic implant system is basically listed around 2015, by the end of 2020, there have been 15 domestic enterprises and institutions approved implants, of which Meijiajing, Allianz and Coix Titanium Technology are three from Taiwan, Beijing BLB, Beacon BKT, Jiangsu Chuangying, Weigao implant brand recognition is relatively high.
Guohai Securities analysis said that the positioning of domestic implants is close to that of Koreans, but it started late and was suppressed by Korean prices, and its market share is expected to be at 7%. The total revenue scale is 200-300 million yuan, the largest revenue is about 50 million yuan, and there is no large-scale implant enterprise.
In Li Yanqi's view, Korean brands have made the price low enough, domestic brands to reach the basic technical threshold, the price is not low anywhere. As a brand-new brand, if there is no special case base, no special technology and performance, "it is still a little difficult to break through."
As the two gold mines of the oral industry, implants and orthodontics are generally considered to be the most promising areas for oral development. However, in terms of import substitution, the two show obvious differences.
In the field of orthodontics in China today, brace brands have both international brands such as Invisalign and domestic up-and-coming stars such as Angel of The Times, which can compete with international big brands in terms of market share. According to the statistics of China Insight Consulting, the number of cases reached by Incosigma and Angelalign in 2020 was 138,900 and 137,600 cases, respectively, with a market share of 41.4% and 41% respectively, and the industry is in the stage of duopoly competition.
However, it seems very difficult to achieve import substitution in the field of implants. Miao Zhixu told the author that the development of implants has a long history, materials and technologies have been very mature, and it is difficult to make revolutionary innovations in a short period of time. In addition, compared with Angel of Time, which has been established for nearly 20 years, the establishment time of domestic implant brands is short, and it is a long way to go in terms of import substitution.
According to him, the proportion of European and American implants in their hospital is one-third, but it contributes two-thirds of the income, and the remaining two-thirds are Korean implants, "domestic production is basically not used."
Bai Tingting also mentioned that wearing a braces for two or three years can see the effect, but it takes ten or twenty years for implants to see a long-term stable effect. Therefore, compared with European and American brands that have accumulated decades of rich clinical data, domestic brands have natural shortcomings in this regard.
In view of the lack of clinical data on domestic implants, the advice given by Pacific Securities is that domestic brands should avoid the top public hospitals occupied by European head implant companies and the private hospitals in first-tier cities occupied by Korean companies in market promotion to open up blank markets in second- and third-tier cities. With the accumulation of clinical data, clinical demand feedback to product micro-innovation, to cooperate with more hospitals, expand brand awareness, is expected to cut to more shares, and then achieve import substitution.
It is worth mentioning that compared with the implant market monopolized by imports, the competition pattern in the field of prosthetic materials for the late stage of implants is relatively good. According to the data provided by Pacific Securities, taking the oral prosthetic membrane as an example, the main competitors in the current industry are Swiss Gaishi and the domestic enterprise Zhenghai Biology, of which Gaishi's product sales account for about 70% of the industry, Zhenghai accounts for about 12%, and import substitution has slowly opened.
The blowout of demand for dental implants has spawned a market of 100 billion
In mid-February, at the entrance of an underground supermarket in Qinghe, Beijing, the author saw that the dental billboards of a number of dental hospitals were densely lined up in the passage of more than ten meters, and the fierce competition was evident. Among them, the hospital hit the price of "2980 first implants" to attract attention.
China's oral medical service industry is in a stage of rapid development, the 2020 New Oxygen Oral White Paper shows that about 50% of Chinese residents suffer from various oral diseases, and the demand has remained high for a long time, but according to the severity of the disease, most oral patients have not attracted enough attention.
The white paper cites official data that the number of oral patient visits in hospital outpatient emergency departments increased from 71 million in 2008 to 156 million in 2018, showing a rapid growth trend. Compared with other departments with market-oriented attributes such as otolaryngology and ophthalmology, the degree of marketization of stomatology is relatively higher.
According to the results of the fourth national oral health epidemiological survey, the average number of caries in middle-aged people (35-44 years old) is 4.5, and the average number of missing teeth is 3; the average number of caries in the elderly (65-74 years old) is 14.65, and the average number of missing teeth is 11.
In addition, there is a strong positive correlation between the number of missing teeth and age, and as China's aging degree intensifies, it will further catalyze the growth of the dental implant market. According to the data of the seventh national census, China's population aged 60 and above reached 260 million in 2020, accounting for 18.7%, an increase of 5.44 percentage points over 2010.
Miao Zhixu noticed that in the past few years, he also needed to patiently explain the concept of implants to patients, and now everyone is more and more receptive to implants, and has been regarded as a conventional oral prosthodontic method. "Now that planting has become the first choice, very few people have done traditional porcelain restoration."
According to him, although the number of people affected by the epidemic in recent years has continued to increase, the planting volume of their hospital in 2021 has increased by nearly twice as much as in 2020. Among them, the middle-aged and young people can account for more than 70%.
Li Yanqi felt the same way. According to his recollection, 5-10 years ago, the proportion of patients with tooth deficiency who were willing to accept dental implants was only 20% or 30%, which required doctors to spend a long time to communicate and coordinate; now this proportion has risen to 50%-70%, and at least more than half of patients are willing to accept implants as long as their own conditions permit.
Compared with the huge market demand, the penetration rate of domestic dental implants is still relatively low. According to the above-mentioned research data of Guohai Securities, the number of implants in mainland China is expected to be 4 million in 2020, with a compound growth rate of 30% from 2016 to 2020.
Straumann's financial report data mentioned that the planting volume in developed countries is generally 100-200pcs/10,000 people, and some countries that incorporate dental implants into their own medical security, such as South Korea and Israel, have a planting volume of up to 600pcs/10,000 people, emerging countries such as Russia and Brazil are also 100pcs/10,000 people, while China's planting volume in 2020 is only about 25pcs/10,000 people.
Pacific Securities estimates that with the increase in disposable income and the increase in the number of implant dentists, it is expected that the domestic level is expected to reach 100-200 pills / 10,000 people, a total of 14 million -28 million, with an average price of 10,000 yuan / peps, the market space for implants is 140-280 billion yuan.
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