Ten Major Changes in the Medical Device Circulation Field in 2019

I. Consumables“Two-ticket system”National implementation is accelerating

As of2018By the end of the year, a total of four provinces implemented the consumable two-ticket system, namely Qinghai, Shaanxi, Anhui, and Tibet. In addition to the province-level implementation, many cities and counties have also pioneered the pilot program of the consumable two-ticket system. Among them, the Sanming Alliance is a representative. As of the end of the year, the Sanming Alliance members covered2018provinces15cities and counties. According to the Sanming Alliance agreement, member units must implement the consumable two-ticket system.53In addition to the provinces and cities that have already implemented it, there are also

provinces that have also clearly stated that they will implement the consumable two-ticket system. Among them, Fujian Province and Zhejiang Province, as advanced provinces in medical reform, are leading the country. Fujian's17Sanming Model“and Zhejiang's”Three-stream integration“drug and medical device procurement platform are the focus of the national authorities' medical reform pilot policy research in recent years.”And this year

month, Xinyu and Yichun in Jiangxi, and Jiaozuo in Henan1City successively implemented the consumable3! This seems to set the tone for the“Two-ticket system”year's2019implementation:“Two-ticket system”The whole country will accelerate the progress in2019year!

In provinces that have not yet implemented it, the selection of consumable distributors must implement“Two-ticket system”A large number of hospitals have begun to implement it first!The selection of consumable suppliers in Guangxi Bone and Joint Hospital, Heilongjiang Provincial Red Cross Hospital, and Dujiangyan No. 2 People's Hospital, etc., all clearly must implement“Two-ticket system”And the normalcy of large-scale circulation enterprises winning bids has emerged.

II. Nationwide cancellation of medical consumables surcharges will be basically completed within the year, and price reductions will continue

Previously, nearly20provinces(municipalities directly under the Central Government)have announced the cancellation of surcharges on medical consumables. Since the beginning of the year, with the efforts of medical reforms, Beijing, Qinghai, and Zhejiang3provinces and cities, nearly 10,000 medical institutions will cancel the consumables surcharges!

6month4day, the State Council issued the "Deepening the Reform of the Medical and Health System2019Key tasks for the year", once again requiring the National Health Commission, the Medical Insurance Bureau, and the Drug Administration to comprehensively promote the cancellation of consumables surcharges in national public medical institutions, included in2019year's medical reform key tasks! The cancellation of consumables surcharges is expected to be basically completed within the year.

With the nationwide spread of the cancellation of consumables surcharges, it means that no matter in bidding and procurement, circulation links, or in-hospital use, as long as there are unreasonable profits, they will be exploited layer by layer!

III. Medical device circulation”Hundreds of billions club“Expansion, small and medium-sized distributors are being rapidly merged

Judging from the financial reports released by listed pharmaceutical circulation companies,2018year, Guoyao Medical Devices, Rekang Pharmaceutical, and Jiuzhoutong have all joined the medical device circulation“Hundreds of billions club”。

Medical device circulation giants“Guoyao Medical Devices”The first annual achievements after business integration,2018year achieved revenue of approximately494.7billion yuan; as the largest private pharmaceutical circulation enterprise in China, Jiuzhoutong released2018annual report shows that its medical device circulation business has increased dramatically from48.71billion yuan to112.21billion yuan in the past three years;2018year, Rekang Pharmaceutical's medical device distribution business achieved operating income of128.76billion yuan, an increase of75.58%。

Not only that, in order to meet the“Two-ticket system”implementation, these pharmaceutical circulation companies are also accelerating the promotion of“Direct sales model”This means that the survival space of a large number of small and medium-sized distributors is continuously compressed, and the concentration of the circulation field will continue to be improved.

IV. The number of consumable suppliers in public hospitals is strictly limited, and a large number are being eliminated

Recently, the National Health Commission issued the "Management Measures for Medical Consumables in Medical Institutions (Trial)", which clearly states: For consumables in the supply catalog, the number of supplying enterprises for medical consumables with the same or similar functions will be strictly limited.

This will change the status quo of hundreds of suppliers in a hospital. For the circulation link, distributors and agents will usher in a new round of reshuffle!

V. The Medical Insurance Bureau takes over the Bidding for Consumables, and the Era of Medical Insurance Negotiation and Pricing Begins

The medical security bureaus from the national to local levels have received much attention since their establishment! As of now, the national31provincial medical insurance bureaus have been established successively. As of now,28provincial medical security bureaus have participated in centralized procurement work to varying degrees, and many provincial medical insurance bureaus have directly started to reduce the price of high-value consumables!2019year, medical consumables officially ushered in"Medical insurance control price reduction”era!

And the National Medical Insurance Bureau“Drug and medical consumables procurement and management subsystem”is about to go online. Regarding this system, the official positioning is“Construction of a national medical insurance drug and medical consumables procurement and management subsystem to provide national-level drug and medical consumables bidding and procurement application support for the National Healthcare Security Administration”This means that the national-level procurement management system is about to go online!

Currently, the positioning of this system may still be“qualification interoperability, price sharing”etc., that is, taking action on unified data standards, connecting product data of medical consumables across the country, making prices more transparent, and facilitating efficient supervision by relevant departments. In addition, it may also play a positive role in national negotiations and volume-based procurement of a very small number of drugs (consumables), facilitating management and monitoring!

VI. Continued development of the medical device registration system

The medical device registration system can be said to be a major reform from the top of the industrial chain, and the improvement of product R&D efficiency directly accelerates the pace of product innovation.

The medical device registration system since2017year since its inception in Shanghai, has attracted much attention from the industry. After more than a year, Guangdong and Tianjin have successively allowed the implementation of the medical device registration system, and now it has expanded to Beijing, and the rapid spread speed is enough to show its positive promoting effect on the industry.Under the promotion of positive effects, the pilot scope of this system will continue to expand.

VII. Increased efforts to govern high-value consumables,"4+7"volume-based procurement will usher in pilot programs in multiple places

For the volume-based procurement of high-value medical consumables, Qinghai Province2019year's medical reform plan and Nanjing Municipal Medical Insurance Bureau clearly proposed that it should learn from the national"4+7"experience in centralized volume-based procurement, and reform the centralized procurement methods for drugs and medical consumables.At the national level,6month3On the day, the National Healthcare Security Administration's research team conducted research at the Shandong Provincial Public Resource Trading Center, clearly revealing that the practice of lowering the inflated prices of high-value consumables will learn from4+7drug volume-based procurement.

In2018year, the Medical Insurance Bureau implemented"4+7"drug volume-based procurement, it is expected that2019year, high-value consumables will become the next focus of centralized procurement by the Medical Insurance Bureau.

First, high-value consumables are a relatively easily standardized category in medical devices;

Second, the impact of price reduction of high-value consumables on the profitability of hospitals is relatively small, and the price reduction pressure suffered by manufacturers can also be partially transferred to the circulation link. For hospitals, the fees for surgical and other medical services have been increasing, and the decline in the profitability of consumables is within an acceptable range; for manufacturers, due to the large profit margin of distributors before centralized procurement, the price reduction pressure of centralized procurement is partly borne by distributors, and the extent of price reduction transmitted to manufacturers is reduced.

However, even if the volume-based procurement of high-value consumables is launched, it will require a certain amount of preparation time, and due to the large number of specifications and parameters, it is unlikely to be exclusively awarded like drugs. However, the concentration in the high-value consumables field will inevitably usher in a significant increase, and the circulation field is expected to be the most affected link.

VIII. Large public hospitals are promoting the use of medical consumablesSPDmode is spreading, consumable suppliers only need1-3home

SPDUnder this mode, hospitals can achieve post-use settlement, zero inventory management, and refined management, reduce logistics management costs, reduce waste, and achieve full traceability. It is also becoming an important consideration factor for major hospitals in selecting consumable distribution companies after canceling the consumable surcharges. After all, when consumables change from revenue to cost, the previous extensive management and distribution must also shift to refined management.

And this model is becoming increasingly prevalent nationwide! The Sixth Affiliated Hospital of Sun Yat-sen University, the First Affiliated Hospital of Sun Yat-sen University(East Hospital)and other large tertiary hospitals, even the entire Guangdong ProvinceSPDThe service model is prevalent, and we can see that all consumables in a hospital are distributed by1-3companies is no longer news, and even1companies win1city's more than a dozen hospitals' distribution rights.

Taking Kangmei Pharmaceutical as an example,2016-2018years, Kangmei almost won the Guangdong Province every yearSPDUnder the service model, more than a dozen or even dozens of hospitals5-10years of consumable distribution rights.

SPDThe number of distributors under the mode has also been greatly reduced! Hospitals only need to select distribution companies with higher strength that can help hospitals achieve internal and external supply chain management and information maintenance. From major hospitals“medical consumablesSPDservice provider selection”Judging from the bidding results, almost all large circulation companies have won the bid.

IX. Nationwide rectification of clean procurement of equipment and consumables, affecting a large number of hospital suppliers

“Kickbacks are the cancer of the entire medical and pharmaceutical industry and the culprit behind incorrect medical practices.”Sanming medical reform operator Zhan Jifu pointed out that the essence of the new medical reform is anti-corruption,and after the establishment of the National Healthcare Security Administration, it will further“crack down on”pharmaceutical representatives and medical device sales, so that all medical personnel dare not and have no opportunity to take kickbacks.

X. The cost of supporting consumables becomes an important condition for purchasing equipment, and the bundling of consumables with equipment is coming to an end

Recently, the National Health Commission issued the "Management Measures for Medical Consumables in Medical Institutions (Trial Implementation)", and the procurement of medical equipment in public hospitals should take the cost of supporting medical consumables as an important entry condition. The lower the cost, the higher the probability of being purchased!This will undoubtedly block the path for suppliers who want to obtain high profits from consumables by providing free gifts, leasing, or placing medical equipment in hospitals and signing exclusive, long-term consumable procurement agreements!

The health industry is a public welfare enterprise related to national economy and people's livelihood, and it is also the focus of the country's current industrial policy. The major policies formulated by the central government will accelerate the development of medical enterprises.