Patients, enterprises, and hospitals are three -way perspective, and the story behind the collection is unveiled

8 batches of national drugs and consumables are concentrated in procurement. 234 kinds of drugs have entered a large price reduction, and the average drop in the cardiac stent is 93%. The average price of artificial hip and knee joints is 82%. Yuan ... The centralized band procurement carried out after the establishment of the National Medical Insurance Bureau brought a sense of real gain to 1.4 billion people.

A small medicine, one needle, and one consumables affect the three parties of patients, enterprises, and hospitals. Behind each story is full of the expectations of reform and the heavy entrustment of life.

Patient's: Calendar with more and more pairs

With such a special calendar, I opened it and looked at it with a fork number and a counter -sign. This is the "mood diary" from Aunt Sun from Guangxi.

The story starts from 2020. Auntie Sun, who has been farming in the rural old home, lives bland and happy. Before and after "May Day", the elderly began to cough fiercely. It has not improved for more than half a year, and even accompanied by symptoms such as bone pain and stool bleeding. After turning to several hospitals, Aunt Sun was finally diagnosed with multiple bone marrow tumors.

This is a malignant pulp cell disease. Chemotherapy is the preferred plan, but the cost is high. The doctor calculated a account: the cost of a course of treatment is about 20,000 yuan, and the treatment requires 12 courses; the recommended boradis injection, one is 1518.13 yuan. It costs 12,000 yuan for this course of treatment alone, and it costs nearly 150,000 yuan after the entire treatment.

For Aunt Sun without a fixed income, it was simply a disease of burning money. Her son is farming at home, and she has to raise three children. After taking out 10,000 yuan, she can no longer pay for her mother. Although her daughter has a stable job, she is also unable to support long -term treatment costs. Nevertheless, the children firmly said: even if they sell a house, they have to treat their mother.

In this way, Aunt Sun's chemotherapy began. The cultural level is not high, and she will not use her mobile phone to count the time every day: use a pen to make a mark on the calendar before going to bed. It's okay. " She has always felt that she is the burden of the children, especially after the previous courses, as the economic pressure is getting bigger, Aunt Sun's mood is getting worse and worse. I started to worry about whether she could insist on treating a complete course. After all, many patients have "played once if they have money, and they don't fight without money", which has caused the treatment to be irregular and affect the effect.

Seeing that I couldn't stick to it anymore, at this time Aunt Sun's daughter got a good news from the patient's group. Patients encourage Aunt Sun to insist on treatment in this WeChat group composed of bone marrowoma patients, because boradisome is expected to be included in the collection of medical insurance, and it is possible to reduce the price when they are promoted.

On April 30, 2021, the second batch of centralized batch of batch of batch of batch of batch of batch of batch of drugs in Guangxi, including Bonazimi, enjoys the dividend of this policy in May: starting from the current course of treatment, the unit price of boradisam is reduced to 298.95 yuan, a decrease of 80.31%. The cost of injection used in only one chemotherapy treatment was reduced from the original 12,000 yuan to 2,400 yuan. After the medical insurance reimbursement was reimbursed, it was about 1,000 yuan. The personal burden was "only one of the original."

Talking about this collection, Aunt Sun's daughter is still very excited to this day: "After learning about the success of the collection, the patients were happy to have a" fried pot '! Everyone said the most that she was born in the good era! Thank you The Communist Party! Thanks for medical insurance! After all, a few years ago, Bonazimi did not enter the medical insurance and did not enter the collection.

Aunt Sun, who said "catch up with the good times", successfully finished the remaining treatment, and enjoyed hundreds of patients with the benefits of mining price reductions with her. She also persisted. According to statistics, as of April 30, 2022, Bonazimi's procurement in Guangxi was 29,442, which saved a total of 35.9 million yuan in procurement compared to the previous collection. Behind this number is hundreds of beneficiary patients and families like Aunt Sun.

In the words of her daughter, today's Aunt Sun has returned to the earliest "not getting up, wearing urine, not wet, and inseparable from others." It only costs a few hundred dollars for a monthly medicine to see a doctor.

Speaking of that calendar, Aunt Sun laughed with full face: "The fork number has gone, it's all right!" Now she is waiting for a few months after a few months of review. "I want to live well, wait for the update to update The treatment method is developed, waiting for more good medicine to reduce the price! "

The national organizational pharmaceutical medical consumables are procurement for more and more commonly used drugs and high -value medical consumables. While continuously reducing the burden on the masses, product quality and medication can also be significantly improved. /Xinhua News Agency

Enterprise: The emotions and expectations of a consumables practitioner

Filial procurement, hanging online procurement, negotiating procurement, and volume procurement ... For Li Yan (a pseudonym) who entered consumables in 2008, behind the recruitment of vascular intervention consumables, behind each familiar keyword History of exploration of consumables. And her company and department also fluctuated with the process of my country's medical reform, from no special recruitment positions, to recruiting commissioners, establishing a recruitment department, and renamed the market access department. The development and change of my country's reform.

In the first year of participating in work, she just caught up with the first time for the former Ministry of Health for the national medical consumables enterprises, aiming to supply centralized procurement of products for non -profit medical institutions across the country. "At that time, there were four types of products: cardiac pacemakers, electrical physiology, heart intervention, and surrounding blood vessel intervention. The next year made a supplement and then stopped. Because the purchase is not available, the price decrease 25%-30%. "Since then, she has successively experienced provincial tendering and provincial -level networking stage. Until October 2020, the National Medical Insurance Bureau organized the procurement of coronary arterial brackets. Overseas procurement is officially launched. More efforts, more efficient, more transparent, and more standardized are Li Yan's repeated emphasis on this round of collection and previous collection.

—— greater strength

In the collection of coronary arteries, the products of Li Yan's enterprises were selected smoothly. The average price of brackets has been reduced from the previous 13,000 yuan to about 700 yuan, and the average price of products is 93%. "This bargaining is not just 'back cuts', it is simply to cut the‘ foot and neck ’. After this battle, the price of the bracket is almost squeezed.”

In her opinion, "with quantity" is the biggest difference from the previous episode -whether it is bidding for bidding, bringing a volume linkage, or negotiating with quantity, but no longer simply negotiate, but to exchange the price.

Government departments exchange for a price, and pharmaceutical companies are also willing to fight with price. For many companies, this is a competition that must be involved in the long -term development strategy, and it is also a cost -effective "buying and selling". Although the price of single items seems to have dropped a lot, at the same time, there is "gray The cost expenditure such as marketing can also be guaranteed by market procurement and supply channels. The market size will be further expanded than the original. Even if the price is lower, there is still room for surplus.

"Especially some medium -sized enterprises have good products and technology, but it is really difficult to expand the market with the original sales mechanism and market share share. If it can be selected, the huge demand brought by the collection will be far away. It is far more than the market resources that companies can develop only by their own strength in the past. "Li Yan told" China Medical Insurance "that" so everyone's attitude is very positive and willing to take the initiative to embrace this reform. "

—— More efficient

"In the past, the collection of collection was their own camps, each line, and the provincial bids and city standards. There were county standards after the city bids, and large -scale hospitals had to do it by themselves! There are many bidding subjects. The ministry's home is often meal. "Speaking of the previous bidding experience, Li Yan couldn't help vomiting. Her most exaggerated business trip experience was the bidding across the three provinces of the east, middle, central and western provinces within a week, and was tired.

Not only that, because it was previously submitted on the spot, many of the energy of Li Yan and colleagues were used in process work such as writing, printing, binding, stamping, and declaration. "Sometimes the bidding information can be more than one meter high, and a male colleague can help move. Because there are too many files and too tight time, we often stamp on the way to bidding." The same information is the same information. " Repeatedly submitted, and different rules were studied repeatedly. These have greatly consumed the energy and time of her and colleagues, so that colleagues laughed at themselves "either in the bidding or on the road of bidding."

"In recent years, it has been much better. After the provincial tendering, a provincial recruitment is more convenient after the provincial alliance, and it can be declared online to greatly save time and economic costs." As the recruitment work is increasingly standardized Li Yan's focus of work has also changed, and there is more time to study medical insurance and price policies. Signing, implementation, and platform information maintenance with hospitals have become her main work content.

—— More transparent

"Eliminate the soil sold by gold", "strong squeeze medical rebates space", "more transparent medical environment" ... Many people in the industry evaluate the effect brought by this collection. In this regard, Li Yishen realized: "Not only patients, but companies are also suffering from gold sales."

As we all know, the source of high pharmaceutical prices lies in huge operation and business costs, complex sales and circulation links. A consumables often enter the hospital from a platform dealer, first -level dealer, second or even third -level dealers, and need various markets, sales, business and public relations personnel. "In this sales model, the bracket with a cost of only a few hundred dollars passes through the price increase, and finally it becomes more than 10,000 yuan in the patient's hands." Li Yan admitted that in fact, the money really fell into the pocket of the manufacturer is not considered counting. Most, most of them are spent on distribution and circulation, pharmacists and pharmac generations have taken away large pieces of cakes.

As the price is squeezed, the sales link is simplified, and the consumable industry is also facing a reshuffle. Li Yan said that in order to cope with the new situation, her company has increased technical training for sales staff. "Compared with medicines, there are many types of consumables, diverse specifications, and complex models, especially the use of high -value consumables has a certain technical threshold. Sales staff must promote the technical characteristics of the product in combination with clinical use."

In her opinion, from the past simple product suppliers to today's products and service providers, while the enterprise changes the role, it also brings better services to hospitals and patients.

—— More standardized

The recruitment work cannot be monitored without price monitoring, which requires the enterprise to collect price information in time, comprehensively, and accurately. In the past, the product price summary table was Li Yan's most scratching.

Due to the uniform names and the inadequate classification standards, the same consumables are different in different provinces, cities, and even different hospitals. "When we do price analysis, sometimes the minimum procurement price of our own products is not allowed, let alone compare with other products." Li Yan said that not only enterprises, but also the staff of the collection management agency I often complain about this problem. After the establishment of the National Medical Insurance Bureau, a unified and standardized medical consumable classification standards and code system were released. The problem of opaque information was solved. "Compared with comparison" provides great convenience for enterprises to analyze market analysis and participate in bidding; "Applying in one place, universal nationwide" has greatly reduced the pressure and burden of repeatedly submitting product information when participating in the recruitment of various places.

"Tracinkable" is a great recognition of Li Yan's online collection of consumables. If you log in to the account of the company, you can see the relevant price information, and all data can be seen at a glance. "In the future, we hope that the country can build a national unified price database and truly realize price information sharing. This is also the expectation of all consumables."

Hospital: The last mile of a relay match

If Ji Cai is a relay match, then the large price reduction of drugs and consumables with quantity can only be said that the first half is running, and the baton in the second half is held in the hospital. Only every participant can go all out can the patients be able to ensure that patients can afford both, but also buy, use, and safely.

Gao Ling (pseudonym) is the director of the pharmacy department of a three -section of Beijing in Beijing, and it is also the "gripper" of the hospital participating in this relay match. Earlier, her main responsibility was to promote the rational use of the hospital and ensure the safety of medication; since the "4+7" pilot in April 2019 landed in Beijing, she had another job - It is necessary to ensure the reasonable medication needs of patients.

It sounds like this incident does not seem to be difficult. It is not easy to implement it. "Fortunately, the hospital specially supports this reform. After the Beijing March 23rd in Beijing held a working conference in Beijing, the hospital immediately established a leading group. The plan has established a number of working groups such as pharmaceuticals, medical management, information, publicity mobilization, training, and finance. It can be said that it is the cause of the whole hospital to do this cause of this benefit and the people. "Gao Ling recalled.

After several investigations and repeated discussions, the hospital has determined a long -term mechanism: beforehand, organize medical staff to learn and train, to learn from patients, and improve everyone's understanding of policies. Precise supervision with amounts, closely monitor the adverse reactions of drugs to ensure the safety of medication; afterwards, incentives to medical staff through the assessment mechanism.

"The last mile of Ji Cai's landing was in the hospital, and the doctor's internal medicine was finally replaced by the doctor. Only by ensuring that the clinician" knows it and knows why "can they ensure that they are more actively cooperating and executing." To this end , Gao Ling and her team carefully prepared the training outline, including the original intention and goals of the state's formulation of policies, the specific plan, execution time and scope of reform, the varieties and related adjustments involved in the hospital, the way of communicating with patients to communicate with patients The wording, response measures when emergency situations, and so on. Colleagues have set multiple levels in actual training, and conduct special special training for key departments (such as cardiac centers, neurology), key positions (such as outpatient team leader and nurse chief consultation desk).

In order to ensure the smooth progress of the work, the hospital also comprehensively considers the usefulness of the drug specifications, the economy of drugs, the appropriateness of the drug packaging, and the credibility of the drug quality. All the bidders involved were included in the hospital's drug directory, which increased the ratio of the amount of varieties; the selected drugs were listed in the first line of all the medicines under all the medicines under the general NATO, and the doctors were encouraged to choose the selected medicine first.

Nevertheless, Gao Ling's hospital has encountered two major difficulties in the actual implementation process. First, clinicians' concerns about the efficacy of generic drugs are mainly concentrated in the treatment of acute diseases and critical illnesses. In this regard, the hospital focuses on the classification and management of clinical departments and patients, while ensuring the implementation of mixed mix tasks, and ensuring the treatment of patients with critical condition. Gao Ling has repeatedly emphasized that it is necessary to fully consider the patient's needs for efficacy and safety, especially patients with basic diseases or severe complications, and they must be particularly cautious when replacing drugs, and we cannot simply damage the health interests of patients to complete the task. Second, patients' concerns about the quality of drugs. When Ji Cai just landed, patients generally had the mentality of "one penny, one penny", and "the quality of generic drugs are not as good as the original medicine". Introduce the collection of mining policies to explain that the country has very strict requirements for the quality and efficacy of shortlisted drugs, and allows patients to replace it voluntarily.

The benefits brought by the collection are real, and the patient quickly experienced it. Uncle Chen is a patient with coronary heart disease who needs to take antiphantal medicines (chopisal deresanate tablets) for a long time. He remembers very clearly that when he was sick in 2002, a box of 7 pieces of 7 pieces of medicine cost more than 140 yuan, and an average of 20 yuan was 10 yuan. The average medicine per tablet was about 15 yuan; after the collection of 2020, a box of medicines dropped to 24 yuan. "Now the price of a box of medicine is equivalent to a piece of medicine in the past. I take four boxes a month, and I can save almost 500 yuan per month. It will be 6,000 yuan a year." I sent a pension for more than a month. "Auntie Li was also feeling the same. As an old illness with high blood pressure for more than 10 years, her long -term nifed nifeding paddling tablets, the original box of medicine costs 38 yuan, only 20 yuan now; The yuan dropped to 54 yuan.

While doing a good job of guidance, Gao Ling and her team also paid special attention to the risk assessment and adverse reactions monitoring of medication. One is to strengthen the prescription review and reviews of related alternative drugs, especially the relevant alternative drugs to ensure the reasonable use of the medicine; the second is to strengthen the strengthening of the medicine; For the risk management of a multi -regulation and multi -regulation, through various methods such as personnel training, drug placement, and information reminder, avoid risk of adjusting errors; the third is to strengthen the monitoring of drug quality inspection and adverse reactions to ensure that problems are found in time. "After the collection, it is not only the price reduction of generic drugs, but also the price of the corresponding non -selection of original drug research drugs. The significant reduction of prices has greatly improved drugs and patients' drugs, which also indirectly improves the rationality of medication."

Three years ago, Gao Ling's team had performed a data analysis. The first three months after the "4+7" landed, compared with the same period of the previous year, the average cost of medical insurance patients with volume procurement varieties was from 686.7. The yuan dropped to 413.1 yuan, and the total cost of drugs in the same general name and the same pharmacological role in the hospital dropped from 22.918 million yuan to 13.3138 million yuan, and both decreased by about 40%.

After more than three years of operation, Gao Ling's hospital has completed the procurement tasks with quantitative varieties steadily and orderly, and no negative public opinion and drug adverse incidents have occurred. In 2021, a total of 136 college mission tasks were performed by the entire hospital, with a total of 150 million procurement amounts of bidders and the same type of drugs, and 34.37%of the proportion of the use of bidders.

In Gao Ling's view, the value and significance of collecting collection are far from the price reduction, but also brings a decline in the proportion of drug costs, and the internal income structure is optimized. Furthermore, reducing drug costs of common diseases and chronic diseases can alleviate the impact of national negotiating drugs and innovative drugs on the average drug costs; for medical institutions that implement total medical insurance budget management and DRG paid reform Medical insurance funds are used for the use of new technologies, new methods, and new drugs. "In the long run, Jicai also promotes the unity of the drug catalogs of medical institutions at all levels, and it will also help patients sink from third -level medical institutions to grassroots medical institutions. It can be said that the small incision of Jacky has leveraged the big medical reform."

Today, the seventh batch of drug collection of drugs organized by the National Organization was officially launched. Gao Ling and her team have already learned to respond calmly: "Ji Cai is the new normal of medical insurance. Looking back at the situation encountered in the implementation of the implementation before, it feels like climbing. After turning over the hill, we don't have to think about the original difficulties. What we have to do now is to climb the next mountain to welcome greater challenges. "

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