Author: Swallow
Recently, Chen Jinfu, deputy director of the National Medical Insurance Bureau, said at the briefing that this year's high-value medical consumables collection will focus on orthopedic consumables, drug balloons, implants and other varieties.
These consumables collection has been expanded from the pilot to the whole country, what will be the impact of the relevant departments?
After the joints and trauma are collected, the spine is then operated
As a large consumable household, this is not the first time to sharpen the knife to the orthopedics.
According to the 2020 Blue Book of Chinese Medical Devices, the scale of the orthopedic implant market in mainland China in 2019 is about 30.4 billion yuan. The national artificial hip and knee collections that began last year seem to have closed the pages for the golden age of orthopedics. In Shandong, Jiangsu and other places where the collection pilot is carried out. Orthopedic consumables have dropped by an average of 33%, and the price of some key varieties has been reduced by nearly 90%.
Screenshot of Tianjin Pharmaceutical Procurement Center
Lian Feng (pseudonym), an orthopedic doctor at a top three hospital in Shandong, which is in the pilot area, told Ding Xiangyuan that in the past 10 years, the cost of joint replacement surgery has not increased, but the performance bonus of the department after the collection is almost cut.
"For a knee replacement level IV procedure, only a physician of the deputy senior level or above normally has the surgical authority, and the cooperation of one attending physician or two residents is required. After a single operation, the cost of surgery in a normal orbit is less than 3,000 in addition to the equipment consumption." According to Lian Feng's recollection, the surgical fee was also this price when he first joined the company in 2008. Nowadays, Lian Feng's department has become less active in the implementation of replacement surgery.
In addition, due to the complexity of the operation of the instruments of joint replacement surgery, for departments that carry out more replacement surgery, instrument manufacturers will often allocate an engineer to enter the surgical team to carry out instrument assistance, disinfection assistance and other work. As the salary of the manufacturer becomes lower and lower, many engineers choose to leave and change careers in desperation.
The joints are uneven, and the traumas are rising again.
In the second half of 2021, an inter-provincial alliance of 12 provinces led by Henan Province will collect orthopedic trauma medical consumables, including bone plates and supporting screws, intramedullary nails and accessories, hollow (hollow) screws and other medical consumables.
Due to the wide variety of trauma consumables, Henan Alliance collection and procurement of them into three procurement packages, bone plate and supporting screw composition system, bone plate system including ordinary bone plate system and lock pressurized bone plate system (including universal), intramedullary nail and its accessories composition system. Enterprises only need to select representative products in each package for quotation, after the selection, other products in the package according to the same reduction as the representative products, the final average decline of 88.65%, the highest reduction of 95.78%.
The Henan Alliance completed the price reduction, followed by the Beijing-Tianjin-Hebei "3 + N" Alliance in February this year, involving orthopedic trauma medical consumables such as bone plates and supporting screws, intramedullary nails and accessories, hollow (hollow) screws, etc.
The ripples continue to widen, and after artificial hip, knee and trauma classes, it is the turn of spinal consumables this year.
According to the analysis of Southwest Securities, the mainland orthopedic market maintains the characteristics of the first (30%), the trauma category second (28.6%), and the joint category second (27.8%). The opposite is true of global market structured joints (37%) > spine (18%) > trauma (14%). This knife must have been fisted to the flesh.
Image source: Screenshot of Southwest Securities
According to the briefing of the Medical Insurance Bureau, considering the complex composition of orthopedic consumables products, information standardization is currently being carried out, and special research will be conducted with the joint procurement office of high-value medical consumables, and the opinions of clinical experts and enterprises will be widely listened to, and it is expected that a preliminary plan will be introduced in the first half of the year, and the bid will be opened this year when the conditions are ripe.
Press the gourd to float the scoop, and the stent is collected before entering the drug balloon
In November 2020, the first round of coronary stent collection landed, the average price of 10,000 yuan stent dropped to 700 yuan, a drop of more than 90%, the lowest winning price is only 469 yuan, it is also at this quotation site, the company representative issued a "planted eyelashes are more than this point" golden sentence sigh.
Coronary stent collection site
Image source: Lilac image
Press the gourd to float the scoop. At the briefing of the National Medical Insurance Bureau, it was mentioned that after the collection of stents, it was found that the use of drug balloons in various places increased significantly.
Compared with the stents that have now fallen to the level of 100 yuan, data from the GF Securities Development Research Center shows that the price of drug balloons is about 20,000 yuan. According to this briefing, the Health Insurance Bureau, in order to "block the space for inflated prices", this year's collection focus was then included in the drug balloon.
At the same time, some of the challenges facing the clinic have gradually emerged.
Dong Khan (pseudonym), attending physician of the Department of Cardiology of a third-class hospital in Sichuan, obviously felt that the clinical use of balloons increased, but in addition to the interest factors, he believed that there was another layer of reasons.
Traditionally, the most conservative indications for drug balloons have only been intrastentary restenosis as an alternative to poor coronary stents. "However, some of the collected coronary stents were used, and the incidence of restenosis in the patient's blood vessels increased, and they had to follow up with the drug balloon." However, some doctors said that their hospitals had not heard of the increase in the incidence of stent rupture, and there was no difference between quality and quality before.
Image source: Figureworm creative
In addition, manufacturers often pay attention to the overall quantity guarantee when supplying, without considering the differences in clinical use of each model, And Lilac Garden understands that some clinicians may encounter a situation where the supply of commonly used models is not sufficient.
Wang Qiu (pseudonym), deputy chief physician of the Department of Cardiology at a tertiary hospital in Guangdong, told Lilac Garden, "Sometimes there is no most suitable stent to match the needs of patients, and such a situation may occur several times to more than ten times a month." At this time, the doctor needs to adjust the stent implantation method to achieve satisfactory results, which may increase the difficulty of the operation to a certain extent."
Although doctors can remedy short-term shortages through surgical solutions, manufacturers have significantly reduced their enthusiasm for supply after meeting the requirements of collection indicators. "A phone call used to arrive, but now the delivery is slow, we don't know who the supplier is, and sometimes it does delay the progress of the operation." Dong Khan said.
The structure of the income of the stomatology determines that the degree of influence may be the lowest
According to the briefing of the National Medical Insurance Bureau, the national level of dental implant collection and collection has been deployed and explored since the beginning of last year, and the interprovincial alliance has organized Sichuan to study the procedures, and now the program is basically mature.
Although before Sichuan, various places have also been testing the price reduction of dental implants to varying degrees, for example, as early as 2015-2016, many places in Zhejiang Province have supported the use of medical insurance personal calendar year balance account funds to pay for dental implants. In August last year, Ningbo, Zhejiang Province, issued a plan to further reduce the price on the basis of local medical insurance to undertake dental implants, but these documents only make requirements for the price of dental implants, and do not mention "quantity", so they are not strictly collective.
Source: Ningbo Municipal Medical Insurance Bureau
In November last year, Sichuan issued the "Notice on Carrying out The Information Collection of Some Oral High-value Medical Consumables Products", which represents the first real dental implant collection.
In the previous Sichuan pilot collection, the target has been placed on the entire implant system - that is, almost all of the exclusive consumables needed for dental implants can be "collected". These consumables that enter the collection are also often the most expensive part of dental implant surgery. According to information provided by oral implantologists, consumables other than surgery fees, anesthesia fees and crowns account for about 40 to 70%.
Source: Centralized procurement of pharmaceutical equipment and pharmaceutical price supervision platform in Sichuan Province
It is worth noting that in Sichuan's previous exploration, although the price of consumables was depressed, the scope of declaration only involved "medical consumables that make up part of the oral implant system", and did not involve the packaging of medical service costs. Based on this feature, the main income structure of oral implant doctors determines that unlike most departments, implant collection may have little impact on doctors' income.
Yan Xiao (pseudonym), an implantologist at a third-class hospital in a first-tier city, told Lilac Garden, "For implantologists, the part of the income derived from consumables is very small, almost none. The tradition of the oral cavity is that it is rare to get income through consumables, and the income is mainly based on the rules of the medical institution to get bonuses, and there will not be too much relationship with the equipment manufacturer."
Beyond the aftermath
Despite many unexpected aftermaths, many doctors said that the sharp drop in the price of consumables after the collection did make clinical communication more smooth.
Zhao Zizhuo (pseudonym), an attending physician of the Department of Cardiology at a large tertiary hospital in Guangdong, told Ding Xiangyuan, "In the past, in order to save money for patients, we used a balloon repeatedly, but repeated use would increase the operation time and even increase the risk of surgery. On the contrary, after the balloon is cheap, if we encounter a bad situation, we will change a new one, the cost has not increased significantly, the operation is safer and more efficient, and the patient's long-term effect is also good. Talking to patients is now easy, and when the high cost is no longer a shackle, the patient's cooperation with the treatment has become higher."
When the embarrassment of treatment is gradually broken with the shackles of cost, the question that arises is, when will the shackles of income structure be broken?
There is a saying in the medical world: "Except for the dentist himself, all departments feel that the income of stomatology is high."
Doctors in other departments aspire not necessarily to the salary level of the dentist, but to the salary level they bring through the diagnosis and treatment behavior itself. Judging from the situation in the pilot areas, in the face of the big wave of collection, the income structure of dentists is indeed easier to gain a foothold at the tide.
As Dr. Lian Feng shared with us a comment by the old director of the department: "An era has passed. It is foreseeable that the former orthopedic pyramid is quietly collapsing; in the future, it will not be the price of consumables used for surgery that will determine the doctor's income, but your own diagnosis and treatment ability and technical level."
Caption: Visual China
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