The spine consumables have been reduced by about 70%, and the orthopedic gold is gone in 20 years?

It is another year of golden autumn. On September 27, the third game of consumables nationwide launched in Shanghai.

The collection of orthopedic spine consumables this time. "Board", "Nail", "Baseball", "Bone Cement"; "Cervical", "Lumbar Septeem", "Thoracic Lumbar"; "Aterior Road" and "Hou Road" ... 173 companies, 14 product systems, 3 years of procurement cycle, 3 years Stability and continuation almost exhausted the spinal products.

The final result is that the overall decrease of about 70 % -In the first orthopedic consumables in 2021, 90 % of the trauma consumables and 80 % of joint consumables, this "battle of the finals" is not gentle Essence "The bracket is abandoned, the trauma is abolished, and the joints can be stretched." In the industry sound of the hustle and bustle, the spine consumables successfully landed.

Of the 14 spine consumable systems, the minimum decrease was mostly 60%to 70%. Among them, Libell's "separate cervical fusion system" 450 yuan won the maximum decrease of 93%.

At the scene, many enterprises handed over the "standard answer" according to the wind of the Medical Insurance Bureau. Before the bid opened, there was also a group B company that told 8 o'clock Jian Wen, "prepare 40%and lie in."

The so -called 40%price is expected to report the "thoracic lumbar back road open rod fixed fusion system" with the largest amount of reporting. Can be resurrected.

Gary Chen Zhihao, Director of IQVIA Ai Kunwei Medical Device Consultation, told the eight o'clock Jianwen: This time, the price of collection imports and state -owned enterprises is very close, domestic profit space is good, domestic replacement will accelerate, Weigao, Fulle, and Dabacheng are the biggest winners. How foreign companies resist the stress and keep their share. It still needs to be observed. Because the highest price limit of most categories is higher than expected, and the classification is more detailed, this time, the national collection is more milder than the previous local collection of Anhui.

The origin of the coronary bracket, Wang Hui at the scene witnessed the ups and downs of the high -value consumables industry in the past three years: 2020 trauma consumables have not yet begun, and the twilight dropped. He quickly converted the track and made 3D printing until Last month, the old owner closed completely, and the company's life curve had a long sigh, and there was also a collapse of the earth. A friend of his coronary bracket was quickly dismissed within one month after the company's bid.

Wang Hui, who represents the new company to participate in the bidding of Group C, has a mentality. "The amount of more than 100 is not the main business. It does not matter if it does not win the bid. Facing an industry that was overwhelmed by a big hand, he felt more and more that "once a single product line was eliminated, there was only one dead end, and it was critical to choose the track."

Enterprises participating in the spine collection are divided into group A, B, and C, facing the test papers of different difficulty coefficients, while the packet basis is "complete components" and "supply nationwide".

Both groups A are satisfied, similar to the "guarantee", as long as the attitude of "white volume" can be divided into good resources; Group B is "middle school" and each component is available, but the time is not available or "cannot be available in the country for the whole country "A partial subject, the competition is medium; Group C is" accompanied by running ", the components are not uniform, the price is forces, and if you want to stand out, you need to be lower than the average price of the two groups.

A mature recruitment system means the stability of the supply. From drugs to consumables, the fear of disconnection has promoted the continuous optimization and improvement of the rules. A health economist analyzed the eight o'clock Jianwen. Based on past experience, most of the decline in more than 90 % to the end is mostly deserters. Blind low -cost competition is a loss for enterprises and medical care.

Behind the gentle compromise, there are also dark webs that are tightly talked about.

In response to the high fees of the joint collection of derivatives, this collection has also been patch on the price patch. From the total price of the system to the unit price of the parts, the zero -ranging combination is not available anyway.

It is worth noting that the collection did not group the material in this collection. Yang Jianlong, director of the technical department of the China Medical Equipment Association, introduced to the eight o'clock Jianwen that there is a difference between different materials in the market in the market, but the gap between mainstream manufacturers is not large, and clinical efficacy can be considered to be almost equivalent.

Wang Qiang, an expert in medical device marketing, also said that the price of group A in different groups is higher than B and C. The price floating range of 1.3 times in the same group, all of which reserve the price space of "buffer belt" for different material products.

Compared with the repeated struggles of the enterprise, this year's doctors will no longer discuss the world, and the orthopedic collection has become a boat. A spine surgeon who was studying in the Sixth Hospital of Shanghai did not even know that the spine collection was about to open the bid at the scene of Shanghai today.

The water in the pond is even more quiet, and the daily limit of the loser board is replaced by the popularity of the stock market.

If the clinical training path of a orthopedician is restored, the outline is roughly: the most basic is trauma. After a few years, contact the joints. Some people are set here because they are dealing with nerves. The surgery is complicated and the risk is also high. It is the "crown" in orthopedics.

A high -value consumable industry, which is constantly gaming in the murder, is still difficult to profit. Where is the myth of the 20 years of orthopedic gold?

Late night operating room "Orthopedic Street", suddenly the joints of joints were missing

In a three hospital in Guangdong, from 10 pm to 4 or 5 am the next day, a number of orthopedic operating rooms were brightly lit, and they were ridiculed as "orthopedic streets". If you do an extra operation, you will have an extra consumables. The high -age doctors are not willing to let it go. Even if you sleep in the operating room, you ca n’t want to do more surgery. However, since the articular joints of April 30, 2022, the situation has changed, the situation has changed -the operating room is still brightly lit.

The change happened a little bit.

Orthopedic consumables have been launched since the autumn of 2021, and the first type of trauma and joint consumables for "surgery". The joint consumables encountered "knee cuts", with an average price of 35,000 fell to 7,000 yuan, and the average price of knee joints dropped from 32,000 to 5,000 yuan.

For patients waiting for surgery, this will save them a lot of costs.

In the last "Gold Window" before the collection, in large hospitals in first -tier and second -tier cities, the amount of orthopedic surgery rose. Doctors and manufacturers quickly pushed a wave of imported consumables before "tightening the waist".

Gary Chen Zhihao, Director of IQVIA Ai Kunwei Medical Device Consultation, told the eight o'clock Jianwen that the number of joint surgery in the first few months of purchasing the purchase rose by about 10%. Do the surgery first, and you can clear the inventory. "

As of January of this year, the new trauma and joint consumables were implemented. The orthopedics of orthopedics of large hospitals in various places gave negative reactions as soon as possible: no surgery can be performed. Conservative treatment.

Jacking products means that the surgical volume and market size are limited. Judging from the relevant data provided by IQVIA, the market size of trauma and joints was only 2%and 6%from 2020-2021, while spine and sports medicine that have not been integrated with each other are 25%.

Therefore, there is a vivid scene depicted in the Anesthesiologist of Wuhan Tongji Hospital, a vivid scene depicted in Zhihu's answer:

"In the past ... the orthopedic area of ​​the operating room was brightly lit in the early morning, and the orthopedic doctor finished McDonald's after eating the manufacturer.

"After the collection of collection ... there are more Buddhas, and the bitter people ranked in orthopedics are mostly to get off work on time ..."

However, the situation is not all. For more than half a year after the price of joint consumables landed, in some small cities and hospitals, the amount of orthopedic surgery has increased a lot, and the economic price after the purchase of volume benefits more offline cities.

"The chicken ribs of the small hospital", bite or not to bite?

Compared with the top three, there are not many hospitals with three or below the second, and you must pay close attention to serving local patients.

When the price of orthopedic consumables landed, the big three can choose not to perform certain surgery and turn to other diseases or techniques; or continue to perform high -value surgery. Anyway, some patients are willing to pay at their own expense. However, almost 90%of the income of "small hospitals" depends on medical insurance, and can only wake up the spirit of the new collection of new collective rules.

At first, choosing a small hospital that continued to continue to perform orthopedic surgery, it seemed that the days after the collection were not as difficult as expected. Taking Anhui as an example, the province's implementation of consumables was earlier than one year of the country. In 2019 and 2021, the two orthopedic consumables collection prices were reduced by 53.4%and 54.6%respectively, but the package price of orthopedic surgery was only 10-20%. Finally, it was implemented on the patient's head, and the actual payment number did not decrease significantly.

The reason is that other related products, such as the amount of auxiliary materials, nuclear magnetic resonance, navigation, and artificial bone, has risen to a certain extent.

However, the good times are not long. When the price of the core consumables shrinks, the profit of the manufacturer has shrunk sharply, and the "follow -up price" is far from covering the service. The small hospitals with a long distance, a small amount of surgery, and a high cost of Taiwan are the first to be abandoned by the manufacturers. Essence

Mao Liang, a orthopedic doctor at a subsidiary hospital of Anhui Medical University, recently encountered such troubles: in the past, a phone call was called, and the manufacturers were calling for the call, and the staff of the consumables were available. At present, the joint price is only 3,000 yuan. "Too cheap, people will not do it." But he also understands, "Other people have to make money for business, and you let him run to send you things and disinfection every day.

As a result, Mao Liang could only spend time with the patient, "We do not have this model, we can't perform this operation." The optional surgery can still be cope. In the case of emergency fracture patients, he needs to change the joint, and he needs to spend more tongue. "The manufacturer said that he could not adjust the goods for a short time, and the patient didn't care, and he wanted you to give him early."

When all the interest chains are broken, there are cracks in all aspects, as large as the service and consumable models with Taiwan, and the box lunch during the surgery provided by the manufacturer, has undergone subtle changes.

A orthopedist said that one of his relatives came to Shanghai from Jiangsu Province. He originally contacted well -known experts to perform hip joint surgery. The surgery required a special model of joints, but because there was only a fixed model after the collection, the hospital could not purchase goods. He can only go back to his hometown to continue to wait to see if there is a chance to do it after a year's episode expires.

The "nanny -style" service provided by the manufacturer with special models. One detail is that when the orthopedic doctors are busy on the operating table, there are no manufacturers to make food.

Without service with Taiwan, I had to do it myself. An Anhui orthopedician said that the hospital launched many graduate students and intern doing things with Taiwan. But not all the descendants of the platform can be solved by themselves. Orthopedic instrumental consumables have continued to innovate, especially under high -load surgery, only manufacturers represent the latest models. The main doctors have high dependence on them and can hardly replace them.

Although the spine products of this collection are concerned, it is not as dependent on the joint of the Taiwan.

Large hospitals have a large amount of surgery and are located in large cities. It is often a heavy layout of manufacturers. Personnel and consumables can be easily mobilized. However, there is no convenience for small hospitals.

A former practitioner with 10 years of orthopedic experience told the eight o'clock Jianwen to provide services to small hospitals, and the cost of equipment logistics and manpower was very high. Not only had to prepare for consumables, but also to send someone to the past.

Nowadays, orthopedics have been regarded as a chicken ribs market by manufacturers, and they have been abandoned tasteless. There are also some small hospitals, "it is a chicken rib, but you can bite it."

Orthopedic gold twenty years

In a sense, two rounds of national orthopedic consumables since 2021 have made orthopedic gold in China for 20 years.

Since 2000, as international orthopedic equipment consumables have entered China, the domestic treatment level has gradually been in line with international standards, and the field of orthopedic surgery has continued to heat up. By around 2010, the industry's outlet came. Large -sized hospitals have deployed orthopedic surgery, medical insurance coverage has gradually advanced, and patient needs and surgical volume suddenly magnify.

Zhang Zhengfeng, a spine surgeon, recorded in his personal public account: "A large number of beds are expanded, and the department's income is exclusively in the hospital. The orthopedic meeting is as many as cow, and the orthopedics are as many as cattle, and the orthopedics doctors enter the hospital leadership." Various signs show that orthopedics has become a pig that has been drifting on the wind for a long time.

In addition, of course, there is a high buckle brought by orthopedic consumables.

The manufacturer pushed the doctor, the doctor pushed anesthesia and patients, and the orthopedic diseases that were ignored in the past went to the center, and continued to sink. Discosittim surgery went to the countryside, and joint surgery hospitals were popular. The original long development curve was repeatedly shortened by the catalytic of interests.

Today, after two years of consuming collection, when all the interest chains are broken, doctors, manufacturers, and agents, each group is severely damaged.

The "front wave" that was most directly shocked, but the most calm is the expert director. They already have a solid economic foundation, and they do not worry about channels and resources to expand their additional income.

For the "Zhonglang" hovering on the edge of the deputy, it is a high -age doctor who is about to become a "master" and "expert". A former orthopedic practitioner described it as "I have seen others eating meat, but knowing that I can only drink soup."

And the young doctor of the "Houlang", they have never tasted the sweetness, and the high income of orthopedics was once a beautiful legend in their hearts. At Yang Di's hospital, a doctorate inpatient who graduated from a doctoral degree, now he is determined to leave to the civil servant system. "He knows that he can rise up so quickly, and he can't see the space and income that can grow in the future."

Now, the intention of transferred to the medical student has even moved forward. At least, orthopedics may not be the best choice in their hearts.

On the other side of the reform, some dark box operations are also quietly carried out:

For example, the Forest Robots purchased by Kerry will increase frequently in the setting of the collection; for example, more and more director experts who go to the "sword" in the field will be. It is normal, and now it is very happy to make three or four thousand. "

In the article "The Dusk of Orthopedics Dealers" in the "Dusk of Orthopedics": On the eve of the collection, the dealers actively launched a variety of high -haired "border materials" for clinical selection in order to make up for the prices of the main consumables. Such as cement, mixer, pulse gun, artificial tadpoles, dressing, dynamic saw blades, etc., can help business with too much blood loss "return blood".

In the industry's words, as long as there are consumables, there will always be a gray space of high profits.

However, these have been discovered and blocked in the coronary brackets and arthropic joints, and they will be sanctioned by DRG/DIP in the future in the future of medical insurance reform.

Back to the essence of the problem is the long -term soul torture faced by the entire medical industry: how much money do doctors take to match their medical costs and labor payments?

For a long time, the consumables that occupy the main part of the patient's consultation costs have also occupied the big head of orthopedician income. Surgical costs that truly reflect the value of medical services have not increased significantly.

For example, a chief physician of a spine surgery, an example of a lumbar spine fusion, used 4 screws, 1 intervertebral fusion, took 3 hours, the surgical fee was 7,000 yuan, and 10-20%was divided into the surgical group to the surgical group. Three doctors, 50%of doctors.

In other words, a doctor's performance remuneration is at least 100 yuan.

The cost -effective disadvantage of surgery allows the "sunshine income" of orthopedics to bottom out in the hospital's performance assessment system all year round.

Of course, the psychological gap between orthopedic practitioners cannot be attributed to collecting collection, and every practitioner knows that huge profits are destined to last.

Jacking is nothing more than a breakthrough weapon for the industry's shuffling.

The choice of returning to the doctor, how can the orthopedist's road go next?

Yang Di, chief physician of spine surgery, is that when others or wait or negative, only more radical is the only opportunity to drive away from his colleagues. The operation is finished as soon as half an hour, and now I will slowly do it better like embroidery. "Innovation is always a real motivation for the continuous development of the industry. "The update iteration of orthopedic device consumables is very fast, one step in 5 years. It is because the industry has profits that everyone is willing to invest in research and development to innovate." Yang Di said.

In Yang Di's opinion, the development of orthopedic medical technology is inseparable from equipment equipment. Imaging equipment, surgical robots, and micro -systems, only these equipment equipment continues to innovate can the surgical type and level improvement. The surgical volume has risen, and equipment manufacturers have made more, but they also promote the development of the industry. There are more opportunities for academic conferences, observation and exchanges, and studying abroad.

Wool comes out of sheep. Back to the patient, the advancement of medicine is still based on the needs of the patient's own needs to solve more undeveloped diseases.

Zhang Kai's ankle surgery is an emerging department established in recent years, and has become the first to become the head of the province. He used the thumb as an example. Few people used to deal with the thumb, and the pain endured. But now the level of living has improved, and patients are unwilling to bear it, and they are more willing to spend money for surgery.

Many of the symptoms that have been ignored in the past are gradually entering the clinical field of vision and gradually solved.

This is not only the story of the 20 years of orthopedic gold, but also the story of the bottleneck of the discipline that is creeted or enlarged by the discipline.

A era is over. When the orthopedic shuffling is in progress, the ups and downs of the entire ecological chain are affected. In this collection game, the biggest winner is the domestic leading manufacturer of importing replacement. Who will be a new winner in the next era of innovative medical equipment?

(In the text, Wang Hui, Yang Di, Zhang Kai, and Mao Liang are all pseudonyms.)

Chen Xin, Yan Shengnan ｜ Writing

This article was first published in the WeChat public account "Eight Point Jianwen", and it must not be reprinted without authorization

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