Medical representatives are not allowed to sell drugs, they have to be really tight.

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Core ReadingThe State Office issued relevant opinions, and put forward clear requirements for purifying the pharmaceutical representative industry team and rectifying the drug circulation market.

Experts believe that medical representatives should be allowed to exercise their duties of information exchange in terms of responsibility setting, and access to funds and warehousing and distribution should be prohibited. Encourage real academic conferences and prohibit fake academic gifts. At the same time, it also needs comprehensive reform measures, such as reforming the doctor's salary system, strengthening the management of occupation and industry.

In people's impression, these gray words seem to be inseparable from the figure of medical representatives.

Recently, the opinions issued by the State Council stated that "medical representatives can only engage in academic promotion, technical consultation and other activities, and shall not undertake drug sales tasks". How will the combined effect of the two-vote system for drug circulation plus the filing system for pharmaceutical representatives, as well as the increasing number of measures to reduce drug prices, prompt the transformation of pharmaceutical representatives? The reporter interviewed Fu Hongpeng, a researcher at the Health Development Research Center of the National Health Planning Commission, and Wang Hongzhi, a consultant at Peking University.

Ask how to distinguish between marketing and promotion.

Job setting distinguishes between the two, drug generation does not touch funds and warehousing and distribution.

Reporter: How to define the boundaries between marketing and academic promotion? How to regulate?

Fu Hongpeng: It is difficult to make an absolute distinction between academic promotion and sales promotion. The document says that medical representatives are not allowed to undertake sales tasks. This can be distinguished from the company's internal post setting and assessment, which can also be supervised. Of course, supervision is more difficult. In terms of behavioral performance, the main features of current drug marketing are kickbacks and disguised bribery with gold sales. The emphasis on academic promotion is mainly to prohibit kickbacks and bribery-style sales promotion. On the other hand, if it is an academic activity, the cost is also standard and can be audited.

Wang Hongzhi: There are two understandings of not being allowed to undertake the task of drug sales. One is to analyze from the perspective of job responsibilities. A complete sales requires at least the exchange of information flow, capital flow and logistics. Medical representatives are not allowed to undertake sales tasks. It can be understood that medical representatives can only exercise information exchange duties (technical services and consulting), but cannot contact funds and warehousing and distribution, which is equivalent to the role of supermarket promoters. According to the relevant laws, medical representatives should assume the above-mentioned responsibilities, but some of the so-called medical representatives who use the reserve price agency model also assume the responsibilities of capital exchange and warehousing and distribution, which should be prohibited as well as prohibited. The other is analyzed from the perspective of performance management. It can be understood that the performance appraisal of medical representatives is not linked to the sales of drugs. If understood from this point of view, it is difficult to supervise the drug sales task.

Reporter: In the past, some academic conferences and activities were held for the purpose of selling drugs. Now medical representatives are not allowed to sell drugs. How can such conferences and activities be held?

Fu Hongpeng: The ultimate goal should be distinguishable from the goal of a single activity, at least there is a difference between direct and indirect effects. I think the new regulation does not prohibit academic activities, but prohibits red envelope bribery and other gold-bearing sales in the name of academics. Academic exchanges that should be held can still be carried out normally, but doctors' lecture fees, labor fees, travel expenses, etc. should be paid according to standard academic activities.

Wang Hongzhi: in the early stage of reform and opening up, doctors' knowledge update mainly came from medical representatives, who played a very good role in popularizing drug knowledge and guiding doctors to use drugs rationally. At present, some enterprises carry out gold sales in disguise in the name of academic conferences, visits and tourism, which is not allowed by the policy. Funding doctors to attend academic conferences should not be linked to the amount of drugs used. Real academic conferences should be encouraged.

Ask if the drug substitute does not sell the drug, can the price of the drug be reduced?

It may not directly lead to a decline in drug prices, and reform requires comprehensive measures.

Reporter: Medical representatives can no longer promote drugs. Will drug prices fall?

Fu Hongpeng: From a dynamic point of view, this cost has been reduced, but enterprises may use other methods in disguise to add the cost. The return of drug prices to normal needs to see whether the comprehensive management measures are matched. From a single policy point of view, this regulation can reduce the cost that once existed before, especially cut off the current gray transaction chain, and promote the reasonable price of drugs.

Reporter: public hospitals to cancel the drug mark-up, this year also to implement the drug circulation two-vote system, plus now do not allow medical representatives to sell drugs, doctors can not get this income, the hospital is also missing a large piece of income, the hospital after how to develop? On the one hand, is it necessary to establish a reasonable salary system for doctors, on the other hand, the price of medicine has dropped, will other charges come up, the cost of medical treatment or not come down?

Fu Hongpeng: These problems may exist. Drugs are only one of the income-generating channels for hospitals. The income from drugs is less. There are other medical service income and government subsidies. Of course, it will also affect the income of doctors. Therefore, the comprehensive reform of public hospitals is extremely important. The hospital compensation mechanism, medical staff salary system, distribution system, and management system all need to be coordinated and comprehensively reformed.

Wang Hongzhi: Whether medical representatives can only engage in technical consultation or the performance appraisal of medical representatives is not linked to sales volume, even if it can be done, it may not directly lead to a drop in drug prices. Reform requires comprehensive measures. At present, drug rebates have become a part of the income of some doctors, and the decline in drug prices will inevitably affect the enthusiasm of these doctors. This needs to be solved by reforming the hospital salary system.
The reform of the salary system is the key to the medical reform. Recently, the four departments issued the "Guiding Opinions on Carrying out the Pilot Work of the Salary System Reform in Public Hospitals", which clearly "allows medical and health institutions to break through the current salary control level of public institutions, and allows medical service income to deduct costs and follow The funds are mainly used for personnel rewards after being withdrawn according to regulations," and "autonomous distribution within the approved total salary". The funds for the reform of the salary system have come from vacating cages for birds, the price of medicines has dropped, and the price of some services has risen, so as to form a reasonable income level for doctors. This is actually more reasonable and efficient than collecting rebates to obtain income, and is more in line with the law of industry development.

In addition, from the experience of foreign countries and Taiwan, we should use the way of government led and market mechanism, such as the reform of payment mode, to form a reasonable salary system, rather than relying more on administrative means, so as to reduce the space for kickbacks.

Ask what to do if you don't sell drugs.

Have the value of existence, from relational to technical

Reporter: How many medical representatives are there in the country at present? After not selling, will they all lose their jobs?

Fu Hongpeng: There are no official statistics on the number of medical representatives across the country. According to different statistical standards, there are 1 million and 3 million statements.

Wang Hongzhi: The profession of medical representative still has value, and pharmaceutical technical services and consultation are still needed. In the past, medical representatives were mainly engaged in developing and maintaining the relationship with hospital doctors (relationship type) and trading with hospital doctors (transaction type). With the advancement of medical reform, medical representatives need to change from "relationship type" and "transaction type" to "technology type.

Reporter: How do other countries manage medical representatives? What good experiences do they have to prevent gray transactions between medical representatives and hospitals?

Fu Hongpeng: Many countries have drug marketing or promotion norms, emphasizing that medical representatives can only introduce the efficacy and use of products, and must not further interfere with doctors' decisions. The other is to severely punish enterprises and doctors. There is also the doctor's salary is reasonable, and the occupation, industry management is more strict, the red envelope is not worth the loss. The social environment of the wind is also very important. Judging from our experience in investigating Hong Kong, the other party not only "dare not corrupt", but has reached the point of "not wanting to corrupt.

Wang Hongzhi: Some developed countries strictly supervise the sales of pharmaceutical companies, regulate them legally and can issue huge fines. The high cost of illegal activities makes pharmaceutical companies pay more attention to their legal operation. There are special compliance departments within the enterprises to conduct self-examination. This is worthy of our reference. (Li Hongmei)