National Centralized Purchase Of High Value Medical Consumables: Expanding Coverage And Exploring Coordination Of Medical Insurance Payment Standards

        On Friday, the state health insurance administration, together with the national development and Reform Commission, the Ministry of industry and information technology, the Ministry of finance, the national health and Health Commission, the State Administration of market supervision, the State Food and drug administration, and the logistics support department of the Central Military Commission issued the "guidance on centralized procurement and use of high-value medical consumables organized by the state" (hereinafter referred to as the "guidance") to clarify that the coverage will be gradually expanded, Promote the price of high-value medical consumables return to a reasonable level and reduce the burden of patients.

    “ After five rounds of centralized drug procurement, the virtual high price of drugs has been effectively curbed. It is time to expand the experience of national centralized procurement to consumables. " Wang Ying, CEO of Bosia, pointed out that this opinion actually sounded the clarion call of national centralized purchase of high-value medical consumables.

A relevant person in charge of a medical device enterprise in Jiangsu told the 21st century economic reporter: "before the centralized purchase of high-value medical consumables came into effect, as an innovative enterprise, we were very worried about various uncertain factors. However, looking at the guidance, we can see that there are many factors in the policy besides the price, which is good for our innovative enterprises."

On June 2, Chen Jinfu, deputy director of the State Medical Insurance Bureau, pointed out at the second Global Health Expo of Boao Forum for Asia that the strategic purchase of medical insurance fund can give full play to the role of medical insurance, significantly reduce the burden of the masses in all aspects, expand the availability of effective medical treatment, and vigorously promote the supply side reform of medical services, and effectively promote orderly competition in the pharmaceutical industry Technological innovation and high quality development.

The document puts forward relevant suggestions for the centralized procurement and use of high-value medical consumables organized by the state from the six aspects of overall requirements, coverage, procurement rules and safeguard measures. Visual China

Expanding coverage

On July 3, 2020, the State Medical Insurance Bureau issued the letter of soliciting opinions on entrusting to carry out the centralized procurement scheme of national organization coronary stent (Draft for comments), which indicates that the national version of centralized procurement of high-value consumables is about to start, and will lead all provinces to carry out comprehensive and standardized centralized procurement of high-value consumables, It also provides a demonstration for local high-value medical consumables procurement and forms a normalized centralized procurement system.

This year, the first batch of high-value medical consumables were purchased through centralized bidding. The price of the winning coronary stent products decreased from 13000 yuan / piece to 700 yuan / piece, with an average decrease of 93%. It is estimated that the annual cost savings will reach more than 10 billion yuan.

The document puts forward relevant suggestions for the centralized procurement and use of high-value medical consumables organized by the state from the six aspects of overall requirements, coverage, procurement rules and safeguard measures.

The "guiding opinions" clearly pointed out that according to the general idea of national organization, alliance procurement and platform operation, the state should formulate basic policies and requirements, organize various regions to form alliances, take public medical institutions as the executive body, carry out centralized procurement of high-value medical consumables organized by the state, explore and improve the centralized procurement policy, and gradually expand the coverage.

At the same time, the procurement coverage of varieties, enterprises and medical institutions is clarified, and some high-value medical consumables with large clinical dosage, high purchase amount, mature clinical use, sufficient market competition and high homogenization level are included in the procurement scope. All public medical institutions should participate in centralized procurement. Enterprises that meet the requirements of centralized procurement in terms of quality standards, production capacity, supply stability and enterprise credit can participate in centralized purchase.

In fact, according to the national policy of "mining as much as possible", all localities have been expanding the scope of water testing, and the speed is also accelerating.

On May 26, the "notice on the selection results of the second batch of centralized procurement of medical consumables in Fujian Province" was put forward. The varieties purchased this time include double chamber pacemaker, coronary balloon dilator, single focus intraocular lens, disposable cannula puncture device, stapler, hard brain (spinal) patch, inguinal hernia patch, etc.

      The above procurement was jointly studied by Fujian Medical Insurance Bureau, Health Commission and food and drug administration. It took only 44 days from April 12 to May 26. In the first year, a total of 348600 units were purchased.

Benefit enterprises with advantages of "technology and cost"

A person in charge of a medical consumables enterprise in Shandong pointed out to the reporter of the 21st century economic report that with the normalization of national centralized procurement and the implementation of centralized procurement of high-value medical consumables, the industry and enterprises are relatively "aware" of this“ We have sorted out the relevant products, analyzed the advantages and disadvantages of each region, and made corresponding plans in the follow-up. "

The person in charge of the above-mentioned enterprises in Jiangsu said that from the guidance, it was not only about prices, but also about other policies.

For example, it is required in the guidance to ensure the priority of centralized purchase products. Medical institutions should give priority to purchasing and purchasing selected products in a centralized way, formulate the in-hospital diagnosis and treatment path for preferential use of selected products, and complete the agreed procurement amount according to the procurement contract.

At the same time, it also ensures the payment. Based on the total budget management of medical insurance fund, the settlement should be carried out, and the prepayment mechanism of centralized purchase with quantity should be established. The medical insurance fund should be prepaid at a ratio of no less than 30% of the annual agreed purchase amount, and the advance payment should be gradually offset from the medical expenses applied for by medical institutions according to the procurement progress of medical institutions.

For example, we will explore collaboration of medical insurance payment standards. To improve the incentive mechanism of medical institutions, the cost saved by centralized purchasing can be retained by medical institutions in a certain way on the basis of assessment, so as to promote the rational use of high-value medical consumables and give priority to the use of selected products.

Wang Ying said that different from drugs, high-value medical consumables are unified identification, first do centralized purchase. Moreover, the national centralized purchase must be a product with large scale and mature technology. In the way of purchasing, high-value medical consumables are also used "one product, one policy". Considering the quality level, function attribute and market structure of purchasing high-value medical consumables, the evaluation group is determined. According to the product competition pattern, the winning enterprise and the winning price are generated by bidding, bargaining and negotiation.

"For large and medium-sized enterprises, the advantages of cost and technology are good. It is good to win the bid through centralized procurement and to develop the market scale; But for the relevant foreign enterprises, it is not a good thing. Foreign enterprises have technical advantages but no cost advantages. This can be seen from the results of bracket procurement. " Wang Ying pointed out to the 21st century economic reporter.

Wang Ying also pointed out that in this context, once the enterprise fails to win the bid, it will probably face the industry cleaning up. Through reducing the sales price of equipment and consumables by a large margin, volume procurement compensates the winning enterprises with larger market share and smaller sales promotion demand. The unsuccessful enterprises will be forced to fight in the remaining small market share and face greater business risks and even survival crisis.

In addition, we will explore the coordination of medical insurance payment standards. To improve the incentive mechanism of medical institutions, the cost saved by centralized purchasing can be retained by medical institutions in a certain way on the basis of assessment, so as to promote the rational use of high-value medical consumables and give priority to the use of selected products.

Sun Yuanyuan, an analyst at Societe Generale Securities, believes that similar to the centralized purchase of drugs, this scheme has a greater reference significance for the subsequent centralized purchase of high-value consumables. Based on the large quantity of intention purchase and the fact that the imported domestic products are not grouped, we believe that the import substitution will be realized in the subdivision areas where the proportion of domestic products is not high, such as some subdivision tracks in orthopedics.

"In the short term, although product prices may face a certain impact, import substitution is still expected to bring a price for volume dividend. In the long run, domestic leading enterprises with independent innovation capability, diversified business layout, or single product with high technology content and high added value and obvious advantages in differentiated competition are expected to benefit from industry reshuffle. " Sun Yuanyuan pointed out.