In 1952, Professor Branemark of the University of Gerdburg in Switzerland screwed a small section of a column made of titanium into the thigh bone of a rabbit. A few months later, it was unexpectedly discovered that the implants had become tightly bound to the bone tissue.
He called this phenomenon "osseointegration."
Unbeknownst to Mark, the experiment would be the most important discovery of his scientific career. He was not only nominated for the Nobel Prize twice, but also became recognized in the industry as the "Father of Oral Implantology".
Dental implants are known as "the third pair of teeth of mankind" and are an ideal substitute for missing teeth because of their aesthetics, comfort, non-damaging adjacent teeth, strong chewing function and high stability.
Because it is just in need of services, the outside world believes that the industry in which dental implants are located is profitable, and even profitable. But high prices, complex markets, uneven products... Dental implants, is it really so good?
Today we are going to talk about the collection of dental implants. It's about beauty and health, choice and substitution.
How expensive is a tooth implant for a suite?
All said, a mouthful of small white teeth, a small BMW. How expensive are dental implants?
A research report from Pacific Securities put it this way:
In Germany, the price of a tooth is around $4,000;
South Korea was once almost as expensive. Until 2000, the local brand Oretai went public, pulling the price to $1500;
In China, the price of a tooth ranges from $1,000 to $4,000, with its domestically the cheapest, followed by South Korea, and Europe and the United States are generally expensive.
If you compare this number with the number of missing teeth per capita, the burden on a single person is very large.
A data in 2018 shows that the average number of middle-aged and elderly people in the mainland is 5.9 missing teeth, and the average elderly population is missing 9 teeth; the proportion of people over 55 years old with teeth missing is more than 50%.
In other words, as long as you live long enough, there is a need for teeth.
The demand is huge and the unit price is high, and dental implants have become a well-deserved "fragrant feast".
Taking tongce medical, the "leading" target of the mainland's oral cavity, as an example, in recent years, the stock price has risen like a rocket. Before 2018, each stock stabilized at twenty or thirty yuan.
After the stock broke through the 100 yuan mark in 2019, it has made great strides. Until June 2021, the highest rose to 421.99 yuan.
Some people have calculated an account: Tongce Medical has increased by more than 70 times in 12 years from 2008 to 2020. In the same period, Guizhou Moutai rose only 17 times.
Therefore, Tongce Medical is also known as "Dental Moutai".
However, the stock price does not rise all the time.
On 24 August 2021, the Ningbo Municipal Medical Insurance Bureau of Zhejiang Province issued the "Plan on Further Clarifying the Medical Insurance Calendar Year Account Payment Dental Implant Project (Draft for Comment)", which clearly states that "the current dental implant price system should be broken".
The Draft for Comments mainly reveals two pieces of information to the outside world:
First, dental implants may be covered in medicare.
Second, dental implants will be collected, and price reductions are just around the corner.
For a time, the industry was moved. On August 26, 2021, Tongce Medical fell by 8.25 percentage points. So far, it has fallen all the way, falling to a low of 143.5 yuan on February 8 this year. In just five months, the market value fell by 43%.
So, why can dental implant collection cause an uproar? Let's first clarify two concepts:
First, why has dental implants not been reimbursed by Medicare?
Second, what does it mean to collect dental implants?
Why has dental implants been unable to report medical insurance?
Dental implants have long been defined as "medical beauty", and around the world, cosmetic dentistry cannot be included in basic medical insurance, even in Australia, where universal medical care is free, it has been suffering for a long time.
This is mainly to ensure the fairness and effectiveness of the health insurance fund.
For a long time, the role of basic medical insurance has been to "protect the basic". That is to say, within the scope of the affordability of the medical insurance fund, it meets the most basic and urgently needed medical protection.
In the face of missing teeth, there are many restoration options, such as the cheapest movable dentures – the dentures that your grandmother saw when you were a child had to remove before going to bed.
This denture treatment costs less, ranging from $100 to $500 per tooth. Even if you make a full-mouth denture, it is probably only seventeen thousand yuan.
At the same price, if you want to choose high-end implants imported from Europe and the United States, you may not even be able to do one.
Personal choice, there is no reason for universal health insurance to bear.
Therefore, medical insurance in the mainland has always been able to reimburse therapeutic dental programs, such as root canal treatment, periodontal disease, and gingivitis.
Why can dental implants be covered by medicare again?
At present, the aging is intensifying, the concept of national health is deeply rooted in the hearts of the people, and all sectors of society can more and more see the value of dental implants. Behind this is not only about aesthetics, but also about health.
According to a study supported by the National Health Public Welfare Research Fund of the Ministry of Health published in the Journal of Chinese Geriatric Stomatology, missing teeth not only affect facial, chewing and pronunciation functions, but also cause temporomandibular joints and gastrointestinal damage for a long time, and even cause a variety of diseases.
In addition, some studies have pointed out that there is a positive correlation between tooth loss and the occurrence of Alzheimer's disease and cardiovascular disease. That is, missing teeth increases the risk of developing related diseases.
Speaking of which, we have to talk to everyone about the concept of science - opportunity cost.
This is an economic concept that generally refers to the maximum value of giving up another choice when making a choice or decision.
For example:
The 60-year-old coach is missing 5 teeth and spends 50,000 yuan to grow teeth. If properly maintained, the old man can live a healthy and healthy life and will not cause other diseases due to lack of teeth.
But if he had given up on implanting teeth at that time, 10 years later, the old man might have caused some other chronic disease because of problems with his teeth. The development of the disease makes it possible that the old marshal may have suffered from cardiovascular diseases and need 300,000 yuan in medical expenses.
Because disease occurs slowly, we join the dimension of time. The value of the old man's choice of dental implant is 300,000 yuan (300,000 yuan after 10 years), and the value of choosing to give up dental implant is 50,000 yuan (not 50,000 yuan at present).
The old coach may have other 1234 options, but of all the options, the value of saving 300,000 yuan is the largest, then the "opportunity cost" of the old coach choosing to give up dental implants will be 300,000 yuan.
This example is about extreme cases. However, from the perspective of public health, the calculation of overall medical costs should not only look at the individual burden of a single treatment, but should emphasize the management of the whole life cycle.
Of course, the state understands this account, so it is quite motivated to promote dental health for all. After all, although dental implants do not cost medical insurance money, other medical costs derived from it have to be borne by medical insurance!
However, dental restoration has always been a medical beauty. There is also no reason for the State administration to interfere.
To this end, Ningbo, Zhejiang Province, came up with a problem-breaking idea - using medical insurance money.
Speaking of this, there may be friends who are confused: Didn't you just say that dental implants cannot be reimbursed by Medicare? So why spend money on health insurance?
In fact, the medical insurance mentioned here is not the pooled fund for hospitalization reimbursement, but the personal account fund of medical insurance.
The Medical Insurance Personal Account Fund is a 2% of the medical insurance fund paid every month and transferred to the "Medical Insurance Personal Account". Initially, the money could only be used for out-of-pocket medical expenses for health care card holders, such as going to outpatient clinics and going to designated pharmacies to buy drugs. Similar to the special funds.
According to the 2021 China Medical Insurance Statistical Yearbook, in 2020, the current balance of the personal account of the mainland employees' medical insurance was 165 billion yuan, and the cumulative balance was 1,009.6 billion yuan.
It should be reminded that the word "employees" reveals that the demand for medical treatment and medicine in this part of the population is not very large, which makes the use rate of the balance of 1 trillion yuan quota not high. You know, the money that flows is called money, so in recent years, the state has vigorously expanded the scope of rational use of medical insurance personal accounts.
According to Document No. 14 of 2021 of the General Office of the State Council and the Guiding Opinions on Establishing and Improving the Outpatient Mutual Assistance Guarantee Mechanism for Basic Medical Insurance for Employees, the scope of application of personal accounts has been expanded.
On the one hand, families work together. An individual health insurance account can pay a reasonable medical out-of-pocket fee to family members, such as your spouse, parents, children, etc.
On the other hand, explore the scope of use. For example, it can be extended to individual contributions such as the purchase of basic medical insurance for urban and rural residents.
Local health insurance bureaus are more active.
Zhejiang Province has issued a policy to allow the use of employee medical insurance personal account balance funds to pay for reasonable clinically necessary medical services such as ordinary registration, tooth cleaning fees, and decoction fees.
The medical insurance account payment attempted by Ningbo refers to the "medical insurance calendar year account", that is, the balance of personal account funds except for the current year.
From the perspective of the general direction of the country in recent years, this is also a relatively innovative attempt.
Since medical insurance has a certain willingness to pay for dental implants, then the medical insurance bureau as a payer and the price of the equipment manufacturer have become a matter. Who wouldn't want to buy a cheap, cost-effective product?
In fact, since the establishment of the National Medical Insurance Bureau, the "quantity procurement" of drugs and medical consumables that has been promoted, which is what we commonly call the collection, has begun to play a role.
What is Collection?
Speaking of collection, we must first talk about the pricing and circulation of drugs on the mainland.
In the past, the price of drugs was once limited to the maximum retail price of the same generic name. As long as it does not exceed this maximum retail price, whether a drug can treat 1 patient or 10,000 patients has nothing to do with the pricing, so it is easy to cause a "gray transaction".
Because the cost of drugs is actually closely related to the number of patients, the number of annual sales, and the pharmaceutical process. The greater the number of patients, the lower the marginal cost of producing drugs, and the more profitable pharmaceutical companies are at the same price.
Medicines are not commodities, and patients cannot decide for themselves what to take, mainly relying on the doctor's prescription. Therefore, some unruly pharmaceutical companies will not hesitate to make a fuss about sales, so that hospitals and doctors can sell more of their drugs, so as to obtain higher profits. This is called "selling with gold" and "gray trading".
One of the effects of collecting is to make gray trading invisible.
The basic logic of collection is "volume for price".
Each shortlisted drug first went through a consistency evaluation, and those that passed it mean that under the same generic name, drugs for the same indications are all clinically effective good drugs.
Next, the Medical Insurance Bureau negotiated on behalf of the hospitals in need, and everyone quoted the price, and the low price got it.
In this way, pharmaceutical companies no longer want to engage in gray transactions. But so much purchase volume, how to reduce production as much as possible, what kind of price to get more drug market. In this way, the price of drugs will naturally fall.
The effect of the collection is immediate.
In August 2020, in the third batch of centralized procurement of drugs organized by the state, the "Viagra" often said that "Viagra" dropped the "jump price" - Shandong Qilu Pharmaceutical won the bid at a price of 24.98 yuan and 12 tablets, an average of about 2 yuan per piece, a drop of more than 90%.
Where is the difficulty in collecting dental implants?
Since the collection is so good, why is the collection of dental implants late?
This is directly related to the complex market environment of dental implants.
At present, the cost of implant consumables and surgery in the domestic market is about 4:1, of which the implant + surgery cost is the largest cost, accounting for more than 75% of the total cost.
Source: Pacific Securities;
Usually domestic is cheaper, but because of the late start and less clinical data, doctors are often more willing to use imported dental implants.
A director of a stomatological hospital once said that high-quality implants, if properly maintained, can often be used for more than a dozen or even decades.
However, domestic dental implant companies have only been established for a total of 20 or 30 years, and it still needs time to precipitate compared with enterprises that have been established overseas for a longer time.
In addition, whether a tooth is good or not depends on the doctor's technology.
This is the same as tooth extraction, the same tooth, the doctor with poor technology, pulled out for two hours, stunned is not down, and it hurts you grinning. Skilled doctors may not take more than half an hour to get better, no pain and less bleeding.
The same goes for dental implants. There is a saying in the industry that when you meet a good doctor, you can also grow the effect of high-end implants with low-end implants.
What needs to be seen is the shortage of high-quality dentists in the mainland.
In 2018, the mainland had only 156 dentists per million people. Far less than Italy, France, the United States, the United Kingdom and others have 827, 647, 611, 369 dentists per million people.
Among them, only 11% of dentists are qualified for implant dentists in China. The counterpart is 80% in South Korea and 22% in the United States. All far ahead of China.
Therefore, this time, Ningbo explored a package payment method, "the domestic brand implant fee in the catalog is 3,000 yuan per piece, and the imported brand implant fee in the catalog is 3,500 yuan per piece."
In general, consumables and medical services are grasped together, and it is possible to really reduce the price of dental implants.
Of course, all this is still in the initial exploration. At that time, people in the industry generally believed that after all, it was a draft for comments, and it may take some time to actually land or even roll out nationwide.
The positive news came quickly, though.
On November 17, 2021, the Sichuan Provincial Centralized Procurement and Pharmaceutical Price Supervision Platform issued a notice of recruitment of high-value medical consumables for the oral cavity, and planned to collect some oral consumables, including implants, repair abutments, etc.
In recent days, the leaders of the National Medical Insurance Bureau have released the latest news, "Sichuan organized an inter-provincial alliance to study the procedures for collecting dental implants." Now that the program is basically mature, we have also listened to the opinions of clinical, enterprise and local experts extensively, and are preparing to launch a coalition reform that can be launched in the first half of 2022 to be able to launch local dental implant collection."
Throughout the world, South Korea is one of the countries with the highest proportion of dental implants in the world, up to 600 pills / million people, much higher than the number of 100-200 / 10,000 people in developed countries, and much higher than the mainland.
The pillars behind giving people a good tooth are national health insurance policy support, the rise of local consumables and the high proportion of implant doctors.
In the tide of import substitution, the mainland has also given birth to excellent dental implant companies, such as Beijing Leiden, Zhejiang Guangci, West China CDIC and so on.
It is believed that with the advancement of dental implant collection and the reform of medical service prices to encourage doctors to be more willing to improve their service skills, we are one step closer to "dental implant freedom".
Sources | the health community
Written by | and stars
Responsible editor| Ren Pingsheng