New trends of focusing on health care reform, \"two votes\" can destroy drug prices deficiency fire?

Our reporter Li Gongmei

08:43 December 05, 2016 source: People's Daily - the People's Daily

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Recently, my state forward \"opinion\" to further promote deepening medical and health system reform experience, clearly put forward to deepen reform has entered the deep waters and GongJianQi, summed up to promote early deepening health reform to create good practice and ripe experience, and beneficial to improve the basic medical and health system, realize the goal of everyone will have access to basic medical and health services. Starting today, we will continuously reported the new exploration in the process of reform, the new trend, for the next step in the reform to provide some reference and reference.

Recently, my state forward \"opinions\", for public hospital drug procurement gradually implement the \"two votes\", namely the production enterprise to open an invoice of enterprises and circulation enterprises to open an invoice of medical institutions. Before the state issued by the health reform key tasks are put forward in 2016, the comprehensive reform pilot provinces throughout the province to implement the \"two votes\".

Drug prices artificially high reviled already a long time, the circulation on the implementation of the \"two votes\" can bring what change? Can reduce the false high drug prices?

Compressed layers of premium sales agent

Recently, the health care management committee of fujian province office notice, clear pharmaceutical production material supply and distribution enterprises do not implement the \"two votes\", will enter the \"blacklist\", be disqualified from the supply or distribution. Fujing is considered to be a real implementation of the \"two votes\" one of the earliest provinces.

12 provinces, it has introduced the implementation of the \"two votes\" policy, including fujian, anhui, shaanxi has officially fall to the ground.

\"Two votes\" why so popular? From drug companies, \"two votes\" changed the circulation pattern of profit distribution. In our country, there are two main types of drug sales model, is an independent sales, agent for the sale. Part of the big drug companies have their own sales channels, can sell drugs directly to the terminal, such as hospitals, pharmacy, etc. Most production enterprises to adopt agent sales model, through layers of agents, eventually to go to the hospital or retail pharmacies, etc., and sold into the hands of the patients. Agent for the sale mode, from the production enterprise to go to the hospital or pharmacy, through the layers of the agent, layers of premium, intermediate after three votes, four votes, and even more, huge difference between ex-factory price and the final sales price, \"\" call\" ticket \"and other illegal phenomenon is widespread.

\"Two votes\" is aimed at agent sales model, the compression in the middle of the tickets, let independent distribution and drug production enterprises, or just select a distribution company, supply directly to the hospital. Has a strong distribution capabilities of large circulation enterprises will surely win, a dime a dozen in the small and medium-sized agents or eliminated or transformation. \"Two votes\" prior to the implementation, channel, terminal by agents to control, many pharmaceutical production enterprise does not grasp the terminal. \"Two votes\", pharmaceutical production enterprise will be responsible for shipping. Zhejiang even called for a \"votes\", directly by the pharmaceutical production enterprise is responsible for the delivery.

Some remote areas allow an additional invoice

According to the national food administration of drug safety statistics, as of the end of November 2015, the national total of pharmaceutical wholesale enterprises, 13508, the top 100 pharmaceutical wholesale enterprises advocate business wu income accounted for 68.9% of the national medicine market total scale at the same period. The drug circulation area small, scattered and disorderly phenomena can be seen.

School of public health, wuhan university, dean of zong-fu MAO analysis, if the \"two votes\" implementation in place, a revolution in medicine circulation industry will occur, is likely to be the country with only a few large circulation enterprises, circulation enterprises concentration greatly increased, \"a ticket money laundering\" phenomenon disappears, reduce drug prices artificially high, circulation environment purification. The entire circulation becomes simple and transparent, regulation is more convenient.

However, pharmaceutical affairs management at the Beijing university school of medicine and clinical director of the department of pharmacy, medicine management Shi Lu think, director of the center for international studies \"two votes\" while it is possible to shorten the circulation chain of excess, eliminate redundant price factors, but can not execute in place, depending on the local economic development level. Is always less developed area, distribution enterprise network is relatively complete, can be \"one vote\" distribution in place. And in the low level of economic development in the region, medicine circulation enterprises tend to be more, little messy situation is more serious, the drug is difficult to \"one vote\" distribution in place. Such as xinjiang, Tibet, qinghai and other places, the implementation of the \"two votes\" may be difficult.

, according to the Commerce Department reports the industry there are only three years sales 1 size exceeds one hundred billion yuan, annual sales of over 50 billion yuan of national medicine circulation enterprises, 24 with annual sales of ten billion yuan of regional medicine circulation enterprises. Dispersed distribution in object more, more than 120. These large circulation enterprises to build perfect drug distribution outlets, including the network extends to the more remote areas, high cost, also need technology, supply chain management mode innovation, challenge enterprise coping capacity.

Reporter looked at the provincial issued relevant documents, found around really considered regional differences, such as anhui, pharmaceutical trading enterprises to drug sales to remote mountainous areas at the grass-roots level of public medical institution, permit on the basis of the \"two votes\" to open a pharmaceutical sales invoice.

Still need to synchronous adjustment of medical service prices

\"Two votes\" shortened circulation, prices go down? In fact, the hospital in the government centralized bid procurement price has determined that a zero rate of public hospital in accordance with the price in the purchase. In a new round of centralized bidding, the price will not be because of the \"two votes\", need to see the next step policy.

Countries have clear, all public hospital should implement zero rate, so some places pay price coupled with the implementation of health, will have the effect of falling prices? Zong-fu MAO believed that medicare pay price is very good, but the medicine cure cycle of reversed, can perform well paid.

In fact, to supplement the medical public hospital is still the dominant mode in our country. Statistics show that the hospital medicine proportion is about forty percent. In this case, the \"two votes\" alone is difficult to shake the high drug prices. \"Must emphasize 3 d linkage, in the implementation of\" two votes \"at the same time, the synchronous adjustment of medical service prices, manifest the value of the medical staff services technology, return the value of medical service. When the hospital do not need to generate income from drugs, but a reasonable income channels, price nature is down in the competition.\" Zong-fu MAO said, he went to the 3 armour hospital to see orthopedic surgery expert, registered only 30 yuan, distorted labor technology value.

Shi Lu wen stressed that even if the two votes to drug prices down, but the medical expenses can not down. If you can't set up to promote the hospital and medical staff take the initiative to return to the law of medical system and mechanism, the hospital in order to develop, also will have the means to obtain the unreasonable income. So, still should be emphasized in public hospitals nonprofit scientific and rational budget income, to completely put an end to \"press the gourd float gourd ladle\" phenomenon.

Zong-fu MAO thinks that the policy will continue to improve and adjust medical service prices to a reasonable interval, reform health care, to strengthen supervision. As long as the reform in \"3 d linkage\" way forward, reverse the medicine for the medical system, drug firms gradually change little messy vicious competition situation, the drug will eventually return to a reasonable price.

The People's Daily (20 December 05, 2016 edition)