Recently, the State Council issued the "Guiding Opinions on Improving the Centralized Purchasing of Drugs in Public Hospitals" (hereinafter referred to as the "Opinions"), and proposed to adhere to the same direction of centralized drug procurement, and all the drugs used in public hospitals should be placed in the provincial centralized procurement platform. The classification and procurement of medicines in public hospitals not only include bidding and procurement, but also methods such as negotiating procurement, direct procurement, and fixed-point production, reasonably reducing the price of medicines, squeezing out high and high moisture, and ensuring the supply of medicines.
The reporter interviewed the person in charge of the Medical Reform Office of the State Council and relevant experts to interpret the Opinions.
Establish a national platform to disclose drug price information
Public hospitals are the main channel for drug sales, accounting for more than 80% of the national pharmaceutical market. The person in charge of the Medical Reform Office of the State Council introduced that after 2006, China will promote centralized procurement of online medicines by province (autonomous region, municipality). However, due to the current centralized procurement of pharmaceuticals at the grassroots and public hospitals, “one platform, two methods”, hospital drug bidding and procurement are out of touch, some drug prices are too high, and drug rebates and frequent commercial bribery cases are still prominent.
The "Opinions" proposes to implement drug classification and procurement, and adopt different methods such as bidding and procurement, negotiating procurement, direct hospital procurement, and fixed-point production for different drugs; improving the settlement method of medicines, and encouraging pharmaceutical manufacturers and hospitals to directly settle drug payment and distribution enterprises. Settle settlement costs, further reduce intermediate links; strengthen drug distribution management, focus on ensuring drug supply and distribution in remote and inaccessible areas, encourage local areas to explore integrated county and rural distribution, standardize procurement platform construction, and expand provincial drug centralized procurement platform function Uniform drug procurement code, disclose drug procurement information, realize drug procurement data sharing and interconnection; strengthen comprehensive supervision and management, and seriously investigate and deal with violations of laws and regulations by hospitals and pharmaceutical production and operation enterprises.
Mao Zongfu, dean of the School of Public Health at Wuhan University, believes that the centralized procurement of drugs cannot be simply denied. There are problems in the centralized procurement of medicines in public hospitals. There are not only the reasons for people's lack of understanding and enforcement of the centralized procurement of medicines in public hospitals, but also the reasons for the mismatching and uncoordinated policies, as well as the impact of the social environment. If the centralized procurement of provincial-level drugs is abolished, it is a denial of the 20-year reform and exploration, and the system has once again given a new hole in the policy of tearing up the hatred of people such as “disorder of drug circulation” and “the wind of improper purchase and sale of drugs”.
Shi Luwen, director of the Peking University Medical Management International Research Center, pointed out that the essence of centralized drug procurement is to control the price of drugs through price-price linkage, which is in line with the laws of market economy and cannot be simply denied. The price that can not be obtained by the provincial drug procurement platform, if the hospital can achieve the second bargaining, is an unreasonable phenomenon that violates the laws of the market economy.
Is the purchase volume and usage of drugs consistent? Which medicinal products are more? The disclosure of important data in these procurements will help to solve the problem of drug-filling mechanisms, curbing high drug prices, and corruption in the medical field. The person in charge of the Medical Reform Office of the State Council introduced that there is still a lack of unified construction standards, functional specifications and procurement codes for centralized drug procurement platforms, and there is not yet a total network between the state and the province. In 2014, the state has started the construction of a comprehensive management information system for drug supply security. At present, it has initially realized up-and-down transmission with five provinces (autonomous regions and municipalities) such as Tianjin. This year, all provinces should achieve interconnection and resource sharing.
First to establish a drug price negotiation mechanism
In response to the situation in the process of procurement, supply and use of drugs, the Opinions proposed five procurement methods.
For the large-scale clinical use, high purchase amount, and the basic drugs and non-patented drugs produced by many enterprises, the provincial-level centralized purchasing advantage will be brought into play. The provincial drug purchasing agency will adopt the double-envelope system for public bidding and procurement, and the hospital as the purchasing entity will win the bid. Purchase medicines at prices. The bidding and procurement methods are adopted for the method of price-price linkage and double-envelope bidding to ensure the integration of recruitment and acquisition and reduce the cost of circulation.
For some patented drugs and exclusive production of drugs, an open, transparent and multi-participating price negotiation mechanism will be established. Non-patented medicines for women and children, urgent (robbing) medicines, basic infusions, drugs with small clinical doses and commonly used low-priced medicines are implemented in a centralized network and directly purchased by hospitals. For drugs that are clinically necessary, small in dosage, and in short supply in the market, they are ordered by the state to be produced and negotiated for purchase. Free drug use for narcotic drugs, psychotropic drugs, infectious and parasitic diseases, national immunization program vaccines, family planning drugs and Chinese herbal medicines are procured according to current national regulations to ensure transparency.
Chen Wenling, a member of the Medical Advisory Expert Committee of the State Council, believes that different drugs have different procurement methods and are in line with the laws of the market economy. The price negotiation mechanism is the practice of playing the role of the market. For public health medicines such as women and children, commonly used low-cost drugs, hospitals can directly purchase, and they play the role of the government.
According to reports, the establishment of a drug price negotiation mechanism was first proposed in the procurement documents. The varieties and scope of the drugs to be negotiated, as well as the principles and objectives of the negotiations, will have specific implementation rules, and the negotiation methods are currently being studied.
Specialized hospitals can jointly purchase
The person in charge of the Medical Reform Office of the State Council pointed out that China has a vast territory and obvious regional differences. The Opinions leave room for local exploration and innovation. For example, encourage inter-regional and regional hospitals to jointly purchase.
Due to the small market share of children's medication, high cost of drug research and development, lack of encouragement and support for relevant policies, lack of children's special drugs. Even if there are varieties on the market, they are often out of stock. Beijing Children's Hospital has set up a medical group, including 15 children's hospitals nationwide. Wang Xiaoling, director of the pediatrics department of the children's hospital, said that the "Opinions" proposed "encourage joint hospitals to jointly purchase", and children's specialist hospitals can explore through groups or medical associations. Direct dialogue with enterprises, the demand for children's medication, the implementation of volume procurement, cross-provincial joint procurement, help solve the current shortage of clinical pediatric drugs.
Li Ling, a professor at the China Center for Economic Research at Peking University National Development Research Institute, said that the Opinions give clear directions and methods for drug reform, but still need the cooperation of medical insurance and medical treatment. The compensation mechanism of public hospitals has not changed. The mechanism of medicine supplementation still exists. The method of paying for medical insurance according to the project is still encouraging hospitals and doctors to open more expensive drugs. The phenomenon of vicious competition of pharmaceutical companies has not improved. It is impossible to completely reverse the situation of high drug prices. It is necessary to link up with the "three doctors" in order to break the mechanism of medicine supplementation, return medicines to a reasonable price, and curb corruption in the field of medicine purchase and sale.