Hospital Loses Payment Settlement Authority Medical Insurance Bureau to Make Efforts to Purchase with Quantity

Release time:


▍ Medical insurance direct settlement of payment, a big chess game
On November 15, the National Health Commission issued the ''Notice of the State Council Leading Group for Deepening the Reform of the Medical and Health System on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City, ''which clarified that in 2020, in accordance with the unified national deployment, the national organization will be expanded. The scope of centralized procurement and use of drugs. The pilot provinces of comprehensive medical reform should take the lead in promoting the settlement of payment by medical insurance agencies directly with drug production or circulation enterprises, and other provinces should also actively explore.
The health insurance department will settle payments directly with pharmaceutical companies and businesses.
Cheng Botao, secretary general of the Hubei Pharmaceutical Industry Association, told Cyberlan,HospitalDrug companies are in serious arrears. In the past, hospitals could increase their sales by 15% on the basis of the purchase price, and hospitals still made profits from drug sales. Now that the mark-up has been canceled, hospitals have no profit from drugs, and hospitals still have procurement logistics costs and management salaries. Hospitals without drug benefits will further default on drug payments and gain benefits in disguise (drug payment will be diverted to hospital construction, equipment purchase and other expenses).
For a long time, hospital payment is the slowest link in the whole medical insurance payment process, resulting in limited room for enterprises to reduce prices due to cost considerations. However, the current direction of medical reform is to reduce drug prices to benefit people's livelihood. Therefore, medical insurance has made direct payment in order to promote a wider range of reforms.
▍ Layout comprehensive recruitment and procurement integration, with volume procurement
The author analyzes that the attitude of "the medical insurance agency directly settles the payment with the drug production or circulation enterprise" in the document of the Health and Health Commission actually dispel the concern of drug companies that the payment recovery cycle is too long. For the timely settlement of the return, but also the national band procurement program, as well as the provinces to implement the band procurement expansion of the focus.
In short, it is to give drug companies reassurance: don't worry about the price reduction, the sales volume is guaranteed and the payment is settled on time. The document of the Health and Health Commission requires the pilot provinces of medical reform to take the lead in promoting the settlement of medical insurance payments, showing that the layout of the reform of medical insurance payment methods is becoming more and more obvious.
Nanjing Music MedicineEntrepreneurshipGuo Xinfeng, a partner of Investment Management Co., Ltd., told Cyberlan that opening up the payment link and reducing the hospital's share of money is the necessity of the medical insurance bureau's leading recruitment and purchase of a large amount of money. The hospital should not have been involved in the drug payment. The medical insurance bureau is the purchaser and payer. The medical insurance bureau, as the medical insurance payer, is on the verge of reforming the payment link.
He analyzed that reducing one payment link, improving payment efficiency, and centralizing payment links through commercial companies would lay the foundation for the formation of a unified market and the integration of recruitment and procurement, and also prepare for the local version of 47-band procurement.
However, the hospital lost the authority to settle the payment, and the health insurance bureau bypassed the fragmentary single hospital (the repayment link, the hospital owed the longest drug payment, ranging from 30 days, 45 days to 3 months, 12 months), and centralized the payment link through commercial companies, laying the foundation for the formation of a unified market and the integration of recruitment and procurement.
▍ Local version 4 7: No generic drugs have been evaluated, and drug prices have dropped significantly.
In fact, the Notice of the State Council Leading Group on Deepening the Reform of the Medical and Health System on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City by the National Health Commission shows that by the end of September 2020, the pilot provinces of comprehensive medical reform should take the lead in exploring and adopting separate or cross-regional alliances, in accordance with the requirements of volume procurement, integration of recruitment and procurement, priority of quality, guaranteed usage, guaranteed collection and payment, etc.
According to the plan, the national organization combined with the provinces to explore the implementation of volume procurement, will be the highlight of next year's medical reform, but also the volume procurement from 47 pilot to cover the whole country node, after which will be more perfect, deep cultivation, the impact on the pharmaceutical industry will be more and more certain.
Guo Xinfeng revealed that at present, the National Health Insurance Bureau and the Provincial Health Insurance Bureau have a relatively clear division of labor in the organization of volume procurement: over-evaluationDrugsNegotiations are organized by the National Health Insurance Bureau, while the procurement of unevaluated drugs is led by the provincial health insurance bureaus.
Under the policy promotion, the local health insurance bureau to lead their own volume procurement, will also take the volume for price, low price winning way, pharmaceutical companies will be significantly reduced to ensure that the selection, the final evaluation of generic drug prices will be significantly reduced-its model and 4 7 as well as the expansion of the same.
In fact, on November 12, the Hunan Provincial Public Resources Trading Center issued the "Announcement on Special Centralized Procurement of Antimicrobial Drugs in Public Medical Institutions in 2019" and announced the purchase volume of 52 antibacterial drugs, comparing prices and selecting drugs.
▍ A large number of homogenized drugs will be eliminated
This is good for powerful pharmaceutical companies, polarization will be more obvious, well-known.MedicinePeople Zhou Jiuping told Cyber Blue.
He judged that after the health insurance agency mastered the drug collection and payment, the use of health insurance funds will be more efficient, winning the bid.EnterpriseThere is a better guarantee for the return of funds, and the concentration of the industry will increase rapidly. In contrast, a large number of homogeneous drugs will be eliminated-this is actually the effect of volume procurement.
The quantity purchase will continue to expand, and the living space of homogeneous products is becoming more and more limited. me too is no longer good. At least it should be mebetter, and it is better to innovate. Zhou Jiuping said bluntly that this is consistent with the current direction of the entire country's supply-side reform and industrial upgrading. The previous homogenization of pharmaceutical companies was too serious, and the low level of overcapacity was repeated. The reform of the pharmaceutical industry is also in line with the general direction of the country's supply-side reform and is doing industrial upgrading.
In fact, this trend is not difficult to judge, Guo Xinfeng said, did not comment on generic drugs in the volume of procurement, recruitment and procurement of the local 4 7 collection, in order to compete for the market will be a fierce price game. For example, Guangzhou GPO, esomeprazole for injection has the lowest price to reach 39 yuan.
From the national version of the volume of procurement negotiations, the price war is inevitable. Those generic drug companies with low production capacity, high cost, and the same drug quality but no price advantage will face elimination.
However, for the full implementation of the trend of purchasing with volume, there are also medical people who say it is more difficult for Cyberblue. If you have other opinions, please leave a message to discuss.