Health Times reporter Wang Zhenya
A dental implant, from an average price of 15,000 yuan to about 7,000 yuan, dental implants bid farewell to the "10,000 yuan era", behind this is the Sichuan Provincial Medical Security Bureau for more than a year to lead the national efforts to carry out the collective procurement of dental implant system, and this collective procurement is also known as "the most difficult centralized procurement in history".
Recalling the day of the opening of the bid, many participants said that they were very nervous, like an exam, and some companies were eliminated because of the difference of 6 yuan. Deng Zhengquan, secretary of the party group and director of the Sichuan Provincial Medical Security Bureau, told the Health Times reporter that before May this year, ordinary people can enjoy the price after collective procurement.
Dental implant collection site. Photo courtesy of interviewee
Tense 4 hours, a game of "life and death" collection
"Don't look at your teeth, toothache; After reading the teeth, my heart hurts. "This used to be the personal experience of dental patients, making this feeling a historical watershed, on January 11, the centralized procurement of oral implant systems opened in Chengdu, Sichuan Province.
In the morning, a bid opening room of the Sichuan Provincial Government Government Service and Public Resources Transaction Service Center was full, and representatives of enterprises participating in the bidding, relevant experts, and representatives of medical insurance departments in many provinces were looking forward to the important opening moment. From 8 a.m. to the end of the opening of tenders at 12 noon, witnesses experienced four hours of intense and ups and downs.
Dental implant collection site. Photo courtesy of interviewee
The cost of dental implants is roughly divided into three parts: implants, crowns and medical service prices. "If you want to break the expensive dental implant, you have to step by step reduce the price of these three parts and squeeze out the water." Zhao Yingcheng, director of the Sichuan Provincial Pharmaceutical Equipment Bidding and Procurement Service Center, told the Health Times reporter that the success of the collective procurement bidding for dental implants also determines whether the price of dental implants can really be reduced, so the competition is also very fierce.
According to the implant material, it is divided into two product system categories: four-grade pure titanium implant product system and titanium alloy implant product system.
"On the day of the collective procurement, there were 58 eligible enterprises, but 55 companies were present, and 3 companies did not show up." Recalling the scene on the day of the opening of the bid, Shi Yacheng, president of Sichuan Hongzheng Boen Dental Technology Co., Ltd., felt that it was like experiencing an exam, there was no negotiation process, directly quoted, and was selected in order according to the price ranking. Not only that, both groups of products have a unified price limit of 2380 yuan / set and a 15% price reduction requirement.
Bottom of the ranking, exceeding the highest valid offer, falling by less than 15%... In the eyes of bidders like Shi Yacheng, these three conditions make the collective procurement process very tense, and there is only one opportunity to quote, how much price is quoted, how much the company ranks, how the same group of competitors quote, these unknown factors make the result like opening a blind box, many participants sighed in response to the phrase "things are in people, things are in the sky."
In the end, a total of 55 companies participated in the two groups, of which 39 were to be selected, with a winning rate of 71%, which should be said to be fully competitive. For example, a group A titanium alloy system of the well-known foreign brand Straumann has a total price of 3517 yuan, exceeding the limit price of 2380 yuan, essentially abandoning the product bidding.
In the category of pure titanium implant product system, there are many imported products involved, and the competition is extremely fierce. After 10 o'clock on the day of the opening of the bid, the notary began to count the bids, and the envelopes of each enterprise were opened, ranked according to the quotation, and the top 30 bids were won. "The 31st place is an import company, which is 6 yuan away from the previous one, and it is out." Shi Yacheng said that at that time, the face of the enterprise personnel was ugly, and there was a feeling of "heart like death".
In the final results of dental implant collection, the average winning price dropped to more than 900 yuan, an average reduction of 55%. The implant systems of Straumann, Dunsberg and Norboco, which had higher prices before centralized procurement, dropped from the median purchase price of 5000 yuan to about 1850 yuan, and the median price of Aoyutai and Denteng implant systems, which have the largest market demand, dropped from about 1500 yuan to about 770 yuan.
For the first time, the national oral implant data was surveyed, and 18 million pieces of data were collected
Deng Zhengquan, secretary of the party group and director of the Sichuan Provincial Medical Security Bureau, was interviewed by reporters. Photo by Wang Zhenya
In 2021, the Sichuan Provincial Medical Security Bureau received the task of preparing for the establishment of an inter-provincial alliance to carry out implant centralized procurement from the National Medical Security Bureau, and opened the tender in Chengdu on January 11, 2023, "from preparation to the final opening of the bid, which lasted for more than a year." Deng Zhengquan, secretary of the party group and director of the Sichuan Provincial Medical Security Bureau, told the Health Times reporter that because of the difficulty, the pressure on medical insurance workers is very great.
Different from the previous centralized procurement of drugs and consumables, 80% of dental implant surgeries are concentrated in private medical institutions, not in public medical institutions, that is, private medical institutions account for the absolute majority of implant use. The Sichuan Provincial Medical Insurance Bureau has always adhered to the principle of "opening the door" for centralized procurement, extensively listening to the opinions of public and private medical institutions, domestic and foreign, established and new enterprises, and cracking the "most difficult centralized procurement in history" with the greatest common divisor of win-win for medical insurance, medical treatment and medicine.
"Private medical institutions basically have no procurement records on the bidding and procurement platforms of drugs and devices in various provinces, which requires us to adopt a new way to obtain and understand the true price system of implants." Deng Zhengquan told the Health Times reporter that the National Medical Insurance Administration carried out the investigation and registration of basic oral implant information in the country, and the national medical insurance system made a thorough survey of the basic information of oral implantation in the country for the first time in accordance with the requirements of "horizontal to the edge, vertical to the bottom, and full coverage", laying the foundation for subsequent measurement data.
"A total of 18 million pieces of data were collected this time, and in addition to allowing medical institutions across the country to fill in the data online, we also adopted the method of on-site visits and spot checks." Deng Zhengquan recalled that during the time when the data was sorted, almost everyone in the Medical Insurance Bureau was sent out to learn about the brand and price of implants in dental medical institutions on the streets.
In order to ensure the authenticity and validity of the data, the Sichuan Provincial Medical Insurance Bureau not only organizes medical institutions to declare the demand for implants, but also requires them to fill in the transaction price and quantity of previously purchased implants, and after layers of checks and repeated verification, and after eliminating abnormal transaction price information, set, calculate and compare massive data in multiple dimensions to determine the effective procurement low price of each manufacturer's products one by one.
Deng Zhengquan told the Health Times reporter, "It is precisely because the historical transaction price system of implants is collected, verified and calculated clearly, that we have the confidence to determine the effective procurement low price of each manufacturer's products, and for the first time in the collective procurement of the relevant price system to the public." ”
As an official "centralized purchaser", after solving data such as the market price of dental implants, it is also necessary to solve the problem of "carrying volume" and procurement funds. In the past, centralized procurement was supported by medical insurance funds, and the Medical Insurance Bureau was both the payer and the purchaser, but dental implants were different, and dental implants were not included in the centralized procurement and were not reimbursed by medical insurance. How to form a better centralized procurement "resource" and attract Chinese and foreign enterprises to participate, that is, to make the "quantity" bigger.
The Sichuan Provincial Medical Insurance Bureau's approach is to form the largest inter-provincial alliance for centralized procurement of consumables. Deng Zhengquan told the Health Times reporter that this is to invite all provinces (municipalities, districts) and the Xinjiang Production and Construction Corps to form an inter-provincial alliance for implant centralized procurement, forming a national "one game of chess" centralized procurement pattern, dispelling the wait-and-see mentality of some enterprises.
"Not participating in collective procurement means losing the national market." Zhao Yingcheng said that 14,000 private medical institutions participated in the report, accounting for 80% of the total number of medical institutions, forming a total demand of 2.87 million sets, accounting for about 72% of the country's annual dental implants.
Grasping the national demand in one hand and the industry price data in the other hand are the key two steps to break the "most difficult centralized procurement in history", and it is also an important reason to attract foreign enterprises to widely participate in the centralized procurement of dental implants. Although foreign companies account for more than 90% of the dental implant market share, once they voluntarily withdraw, it is equivalent to ceding the existing market to domestic enterprises. Moreover, the cycle of dental implant collection is 3 years, and in the case of the general participation of public and private medical institutions across the country, not participating will mean that the vast majority of medical institutions will not be available.
At present, the penetration rate of dental implants in mainland China is only 25 / 10,000 / 10,000, compared with the penetration rate of 100-200 / 10,000 in developed countries, the probability of "blowout" after collection is very high. Relevant enterprises are optimistic about the "excessive" use of implants after centralized procurement, which also prompts them to actively participate in the bidding of centralized procurement.
Avoid "lying down to win", squeeze out moisture, and innovate the rules for collective procurement
"We are a team in the deep waters of reform, which will leave a memory of this era for the great people and make dental implants history." On January 11, after the results of dental implant collection were released, Zhao Yingcheng wrote such a paragraph in the circle of friends.
As a witness and witness of history, Shi Yacheng, chairman of Sichuan Hongzheng Boen Dental Technology Co., Ltd., said: The most memorable point is that there are many innovative places in this collection, although there is only one quotation, but the overall rule design is very intelligent. The results of the collective procurement are consistent with the company's original intention of "making Chinese people able to grow teeth and grow good teeth", and the company is more confident that the implants manufactured in China's Tooth Valley will benefit the masses.
Different from the previous centralized procurement, the centralized procurement of dental implants has innovated many bidding rules for centralized procurement. For example, set effective procurement low prices, at least 15% reduction, K value method, etc.
The price of imported implants is high, the market price is 56,000 sets, but the maximum effective declaration price set for centralized procurement is uniformly set at 2380 yuan / set. Deng Zhengquan told the Health Times reporter that this is to prevent inflated products from crowding out the winning opportunities of other products with normal pricing.
The price of domestic implants is low, and there is a possibility of "lying down" in collective procurement. Zhao Yingcheng said that in order to prevent low-priced products from "lying down to win", this collective procurement set effective procurement low prices one by one. Accurately calculate and announce the effective procurement low price of each manufacturer's products, and match the shortlisted calculation formula with at least 15% price reduction and a certain elimination rate.
What makes many industry experts applaud is that this collective procurement innovation introduced the rules for the selection of the K-value method. Jiang Changsong, assistant dean of the National Institute of Medical Security and director of the price procurement room of Capital Medical University, told the Health Times reporter that simply put, the K value coefficient method is to ensure that the reduction of high-priced products is larger, and the reduction of low-priced products is smaller, that is to say, the original price is inflated, the price reduction is large, the original price reduction space is not so large, the price reduction will be less.
Before the opening of bids, the state counts the lowest purchase price of each product in the market to form a "benchmark price". The ratio of this "base price" to the lowest benchmark price in the auction unit is called the "K value". Before the quotation, each product of each company will receive a "K value". According to the procurement rules, the quotation of the enterprise shall not exceed the benchmark price × (100%-√K×15%).
Taking group A of the four-grade pure titanium bidding unit as an example, for example, the lowest benchmark price of 742 yuan for the products of domestic enterprises becomes the reference value of the group, and the K value is 1, which is the lowest in the same group. This means that the product only needs to reduce the price by 15%. In contrast, imported products with a benchmark price of up to 3,373 yuan in the same group must be reduced by at least 32% to be shortlisted.
Deng Zhengquan said that using the K value method as the core control method of centralized procurement can increase the control of the shortlisted prices of products with large price differences, and guide products with inflated prices to take the initiative to increase the reduction rate, which successfully achieved this goal on the day of bid opening.
Before the landing of the whole country in May, hospitals that have "done poorly" will be exposed
After the collection of dental implants, the relevant regulations on the price of medical services were introduced, and one tooth did not exceed 4,500 yuan, and the last link was the crown body bidding network, which is what the Sichuan Medical Insurance Bureau is doing. Deng Zhengquan told the Health Times reporter that before May, the results of the collective procurement of dental implants will be implemented across the country, and the people will enjoy the reduced price of the whole set.
Before centralized procurement, public medical institutions purchase high-end brand implants for 4000~6000 yuan per set; Most of the crowns are more than 1,000 yuan, and the price of homemade crowns is higher. The cost of medical services nationwide exceeds 6,000 yuan, and the cost of some provinces and cities exceeds 9,000 yuan.
For the high cost of medical services for dental implants, relevant regulations have been introduced across the country to control the price below 4,500 yuan.
In Henan, from February 10 this year, the price of a single conventional implant dental service is 4,300 yuan, and the cost of the whole process of a single conventional implant is not higher than 97% of the control target. The Guangdong Provincial Medical Insurance Bureau also proposed that the maximum price of a single conventional dental implant in the whole process should not exceed 4,500 yuan, of which the highest price in 12 cities in eastern Guangdong, western Guangdong and northern Guangdong should not exceed 4,300 yuan.
In Hunan and Hebei, the "price control of dental implants" began on January 31. The total cost of medical services and drugs for a single conventional dental implant in a tertiary public medical institution in Hunan Province does not exceed 4,300 yuan. Hebei Province has set a regulatory target of 4,300 yuan for provincial-level public medical institutions.
In Anhui, the total cost of medical services and drugs for a single conventional dental implant in a provincial tertiary public medical institution does not exceed 4280 yuan...
Zhao Yingcheng said, "We will learn from the experience of collective procurement of dental implants, collect the historical data of the purchase of dental crowns by Sichuan medical institutions, and conduct comprehensive research and analysis based on the price data of the preliminary on-site visit to production and operation enterprises, reasonably set the effective procurement low price, shortlisted ratio, etc., and finally form a crown bidding and listing plan." In terms of work progress, we have communicated with relevant manufacturers on the crown bidding net framework plan, which has been widely recognized. ”
Since most of the dental implants are in private medical institutions, the National Health Insurance Administration has also designed a working idea to ensure the quality and supply of dental implants after centralized procurement.
The National Health Insurance Administration issued the Notice on Carrying out Special Governance of Oral Implant Medical Service Charges and Consumables Prices, which made special arrangements for related work. The medical insurance department will publicly release the selected price of this collective procurement to the public, and publish the selected price of implant collective procurement and the price of private medical institutions participating in the collective procurement on the portal website for a long time, so as to guide patients to seek medical treatment at reasonable prices.
At the same time, medical institutions that maintain inflated prices, unreasonable charges, and false publicity will be publicly exposed, and private medical institutions will be guided to formulate reasonable prices that meet the laws of market competition and the expectations of the masses, so that patients can truly enjoy the benefits of centralized procurement and price reduction. Zhao Yingcheng introduced that we will fully show the publicity of "doing well" to the masses so that it can develop better; Expose "poorly done" ones to sunlight and avoid inducing patients.
"One tooth, one suite" will become history, let us hope that ordinary people can afford to grow teeth and grow good teeth.
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