Medical network on April 12th - April 7, the national development and reform commission released the shenzhen health development planning commission promised to correct the pilot reform of public hospital drug group procurement of abuse administrative power ruled out restrict competition behavior, points out that shenzhen health development planning commission in the implementation of public hospital pharmaceutical group procurement (hereinafter referred to as "the GPO") in the process of the pilot reform, three alleged abuse administrative power ruled out restrict competition behavior, violation of the anti-monopoly law. 

 

Specifically, shenzhen only allows all medicine network pharmaceutical industry (hereinafter referred to as "network") a company provides public hospital drugs; Disguised qualified drug firms only through whole medicine network to offer a public hospital drugs; And qualified pharmaceutical pharmaceutical designated by the medicine distribution enterprise network. 

 

10, shenzhen health development planning commission promised to correct illegal behavior and make three changes: ensure public hospital drug procurement autonomy; Be sure to select drug distribution enterprise autonomy; Ensure pharmaceutical production enterprise autonomy. 

 

"This alleged illegal behavior more than shenzhen, cancel the public hospital drug addition 15% after policy, as concerns from the hospital, more health department to come up with a pile of workarounds." Medicine center of Peking University and management consulting group hong-zhi wang, head of the economy in the 21st century reporter: "so far, at least seven or eight kinds of so-called alternative does not regulate the behavior of drug purchase." 

 

So, is there a satisfy the government's medical reform, and legal compliance, the interests of all parties are not subject to any loss the way at the same time? At least hong-zhi wang believes that there must be, and has formed a research report to illustrate the method. 

 

Monopolies, 

 

Shenzhen push drug group procurement mode, in addition to what was once the only national provincial drug procurement platform, self-built platform to carry out the drug centralized bid procurement, the platform for track high-profile national minimum drug bidding price. 

 

This from the medicine network to drug firms "strategic cooperation intention agreement" can be seen that: all medicine network as party a, "can breakthrough the limitation of provincial bidding platform, with the similar varieties substitute the existing price preferential price unreasonable variety". Production enterprises as a party, "supply product prices should be meet the preferential reduction standard of party a, and guarantee the supply of party a for the lowest price". 

 

All medicine net is the winning shenzhen GPO only a third-party platform, which is the sea king group subsidiary, Neptune group and shenzhen haiwang biological controlling shareholders of listed companies. All medicine, according to the net purchase of shenzhen is medicine network layout GPO the first city to fall to the ground. On February 26, 2016, all signed an agreement with shenzhen health development planning commission, in the same year in July full launch of shenzhen city public hospital drug supply, purchases for the year 8 billion yuan. 

 

Two months later, the medicine network and the reform of the first batch of pilot city and the district of public hospitals, respectively signed commissioned by the shenzhen public hospital pharmaceuticals procurement supply agreement (try out) ", including the shenzhen people's hospital, shenzhen second people's hospital, Peking University shenzhen hospital, shenzhen hospital 25 public hospitals, etc. 

 

To avoid "only low prices" won the bid, shenzhen health development planning commission, according to the reform plan, the city planning commission organized clinical, pharmaceutical and other experts, formulated the group purchasing drugs directory, drug quality level classification rules, the integration of pharmaceutical dosage forms, such as operating rules, and consider, clinical medical institutions and citizens of shenzhen custom with selected high quality and low price of drugs. 

 

At present, the first batch of group procurement directory to a shortage of medicine, low medicine, pediatric medicine clinical care medicine is given priority to, a total of 403 kinds of drug purchase has been completed and start to supply; The second batch of group procurement directory based on Chinese medicines, chemical medicine, biological products, and transfusion medicine is given priority to, negotiation work was completed in recent talks, the expert review determine the suppliers and the public. 

 

But downstream of public hospitals, upstream of pharmaceutical enterprises, the total by the total net a traders, has stirred up controversy in the industry. 

 

A declined to be named, head of the drug companies of the 21st century economic report reporter said: "how this platform with provincial bidding platform, whether how suspected secondary bargaining, standardized operation. Only by fully medicine net, inevitably moved some cheese." 

 

The notice also released by the national development and reform commission (NDRC), according to the enterprise and industry associations, the national development and reform commission and the national development and reform commission of guangdong province survey clear, shenzhen health development planning commission exist three violation of the anti-monopoly law: only allow a group purchasing organization provide drug procurement services; Qualified with whole medicine in public hospitals, pharmaceutical production enterprises in shenzhen city net pharmaceutical services; Qualified pharmaceutical pharmaceutical designated by the medicine distribution enterprise network. Then, shenzhen health development planning commission promised to correct illegal behavior. 

 

More illegal 

 

Alleged illegal than shenzhen. 

 

In August 2015, the national development and reform commission sent a letter to bengbu in anhui health development planning commission, said the provincial drug bidding alleged illegal "anti-monopoly law"; In December 2016, price bureau, nanjing city, jiangsu province, nanjing who planning commission in the process of drug bidding procurement, do STH without authorization in the name of the donor to drug companies' capital takes up preferential benefits compensation and scale ". In April, 2017, shandong liaocheng commission for discipline inspection, the city's eight municipal hospital pharmaceutical companies, organization staff and self-governance in pharmaceutical companies according to the proportion of share out bonus, drug offline purchase, etc.; Also AnWei wuhu, for example, after the cancellation of 15% drug addition, drug supply companies for as much as 20% of the value-added service, the hospital drug price difference of revenue more than before the reform... 

 

Why is drug purchase will become a major disaster area of violation? 

 

In hong-zhi wang opinion, cancel the public before the drug addition, public hospital drugs on the basis of the actual purchase price plus 15% as the retail price, after the reform of hospital sell drugs at a purchase price, no longer earn price difference. Widespread concern from the hospital, combined with the policy allows the pilot city to city as the unit to purchase, thus some pilot cities in under the condition of centralized purchasing appeared again at the provincial level negotiation and procurement. 

 

His research found that there are at least six of seven kinds of irregularities is common, including to set up the special account, through public welfare funds, pharmacy trusteeship, logistics, extension, concentrated distribution and the GPO. These workarounds are pointing to a goal: for hospital to bring extra income. 

 

Among them, the pharmacy trusteeship, logistics, extension, concentrated distribution and GPO have three things in common, one is through the enterprise upstream suppliers bargaining, 2 it is enterprise's market share increase even monopoly, three is the enterprise to provide services but pay the fee to the hospital. 

 

"GPO or pharmacy trusteeship, for example, the only designated procurement enterprise or the trustee, can rent, custody, such as form, pay the hospital costs, namely the rebates, income to make up for the hospital," hong-zhi wang told reporters, the 21st century economic report "originally for hospital services, service charge should be, but now is pay the fee to the hospital, isn't it upside down?" 

 

And aimed at introducing market behavior, to break the administrative leading the GPO, in the former officials who planning commission of guangdong province liao new wave, is not a real GPO, "shenzhen GPO just upgraded provincial bidding, the essence of them, are the government control limited bidding, it is difficult to achieve the purpose of the bidding price optimal. Real GPO should be several GPO competition at the same time, namely, GPOs." 

 

He further pointed out that: "the GPO in pharmaceutical sales platform must have legal protection. The GPOs running under the legal framework, on pain of punishment, convicted and removed out. In order to ensure fair and authority of the GPO and the legitimate rights and interests of hospitals, patients, the United States, an area each GPO shall operate a hospital all procurement, allow the GPO rebates to hospital, but shall not exceed 5% of the profits." 

 

Is there a solution? 

 

Is there a satisfy the government's medical reform, and legal compliance, the interests of all parties are not subject to any loss the way at the same time? Hong-zhi wang thought at least. 

 

After the cancellation of drug addition, the state council imagined two ways to make up for the hospital income: first, the article 11 provisions of the state council, the public hospital compensation by the service fee, drug addition income and fiscal subsidy three channels to service fees and financial aid two channels, can be summarized as "three channels become two"; Second, the article 38, and provisions of the state council, deepening the reform of medical insurance payment and regulating the behavior of drug use and health measures, straighten out the public hospital medical service price, build system of compensation in accordance with the health care industry characteristics, known as "vacate basket change a bird". 

 

North latitude of 21 public hospital financial data calculate discovery, the hospital sell drugs on the economy is not cost-effective, with medicine cure against law, economic if reduce drug costs, improve the medical service price, can achieve the hospital income unchanged, while earnings multiplier. The calculation is based on the economics of the marginal rate of return, the higher this value, on behalf of the more profitable. 

 

Study also compares the hospitals to take "three channels become two" and "vacate basket change a bird" under earnings, according to the results, the bird in a cage type room under the premise of reform can be done in a constant income (burden of patients and health care will not increase), yields have close to 20% of the increase, and three channels become two type reform has no similar effect.