The National Health Insurance Bureau Has Proposed A New Deal To Curb The Sale Of Gold Belt.

In December 6th, the National Health Insurance Bureau launched a seminar on the construction of integrity system and disciplinary system in public hospitals. The project leader, Wang Hongzhi, partner of Beijing longitudinal management consulting group, told reporters on twenty-first Century economic report that the study will be completed within two months.

It is reported that in the future, the National Health Insurance Bureau will focus on the two stages of drug procurement in public hospitals, and build up the integrity evaluation system and disciplinary system. According to the above credit evaluation results, we set up a graded disciplinary plan for the dishonest production enterprises within the framework of the contract law.

Including the newly revised Drug Administration Law in December 1st, the National Health Protection Commission and other medical anti-corruption as the core of medical reform. However, Wang Hongzhi pointed out that in the past, disciplinary measures mainly focused on bribes and bribe taking. In addition to GSK, no production enterprise was found to have been prosecuted by the judiciary for bribing. Therefore, it is hoped that the establishment of evaluation and disciplinary system can also trace the source of corporate behavior.

The National Health Insurance Bureau will establish a credit evaluation system and a disciplinary system for dishonesty. It will link drug kickbacks with illegal punishment, drug bidding and procurement, and drug prices. Shi Lichen, Beijing Ding Chen medical management consulting center, pointed out to the twenty-first Century economic news reporter that the core of the national health insurance agency is still for "bargaining". The size of the medical insurance fund is limited, and the medical insurance bureau on the one hand is making room for maneuver, and on the other hand, it also saves more funds through bargaining.

Curb "gold sales"

"Selling with gold" has long been called the cancer of the pharmaceutical industry. Weng Linjia, deputy director of the State Medical Insurance Bureau's price and tendering Procurement Division, pointed out at the meeting that the history of gold sales over the past 20 years has not been fundamentally resolved.

For the industry "cancer", the relevant ministries and commissions of the state have also frequently attacked.

In July 2018, the national health and Health Commission held the twentieth meeting of the inter ministerial joint meeting to correct unhealthy practices in the field of medical purchase and sale and medical services. This is the first time that the national medical rectification conference has been held since the National Conference on medical rectification and medical consumables special rectification.

A month later, the nine ministries and commissions of the state jointly issued the notice on printing and distributing the key points of rectification work in the field of rectification and purchase of medicine in 2018 and unhealthy practices in medical services. In order to clean up the circulation order and advocate centralized procurement, it is necessary to strictly enforce the record of drug procurement integrity and the market retreat system.

In December 1st, the new version of the drug administration law, which was formally implemented, formulated a penalty clause of up to 3 million yuan for the issue of kickbacks in the purchase and sale of drugs. The briber will face the punishment of prohibiting drug production and operation within 5 years.

This time, the national health insurance agency has begun to launch. In Wang Hongzhi's view, as the organizer of procurement, it is the main payer, the national health insurance agency is more effective, and as an organizer, the establishment of credit evaluation system and disciplinary system is the key.

The study will mainly cover the following three contents: investigation and Research on the phenomenon of dishonesty in the centralized purchase of public hospitals, such as the sale of gold, and so on. Taking the people's courts as the source of the case, taking the gold sales as the main breach of credit, combining the opinions of experts and stakeholders, the hierarchical weighting method is adopted to build the evaluation index system of the integrity of production enterprises, and the disciplinary system of dishonesty is established. Based on the above credit evaluation results, a graded disciplinary plan for dishonest behavior is designed, and its rationality, legitimacy and feasibility are demonstrated.

The structural model of credit system and disciplinary system includes three parts: information collection, processing, credit evaluation and application of credit results. Information collection and processing will mainly come from the information of judicial documents, discipline inspection information and market supervision information. Credit evaluation will be incorporated into the credit scoring of manufacturing enterprises in accordance with the new drug administration law and CSO's illegal discipline.

By using the referee's calligraphy, we establish a credit evaluation system for pharmaceutical enterprises and listed licensors. Based on the above evaluation system, we establish a graded punishment system for enterprises. On the one hand, we use the open source to evaluate the credit of pharmaceutical enterprises. On the other hand, after the establishment of the evaluation system, after the evaluation results are made, the pharmaceutical enterprises are graded and punished.

In view of the "selling with gold", most of the punishment measures in China are doctors. Before this, under the anti-corruption storm led by the health protection committee, the Discipline Inspection Commission and the supervision committee, a large number of hospital directors and directors of departments have been sacked. Public information showed that more than 300 doctors were publicly treated in 2018. "At present, punishing measures mainly focus on bribes and bribe taking. We have not retrieved the production enterprises because of bribery, which was prosecuted by the judiciary, except for GSK." Wang Hongzhi said.

In view of enterprises, the Ministry of Finance and the joint health insurance agency conducted an account check on 77 pharmaceutical enterprises in June this year, covering six major sub fields: chemical pharmaceuticals, biological products, medical devices, medical services, medicine and commerce, and Chinese medicine preparations. The authenticity of sales expenses is the key point, but up to now, there is not much information published.

Bargaining is the key.

In Shi Lichen's view, to curb the "gold sales" has a long way to go and requires cooperation from many departments. "And the national health insurance bureau is more for" bargaining ". The medical insurance fund is limited. As a payment, the National Health Insurance Bureau needs to constantly move room and squeeze water.

The head of a generic pharmaceutical company told the twenty-first Century economic report reporter that the company invested a lot of money in the aspect of consistency evaluation, and hoped that the medical insurance fund could be tilted in the purchase of 4+7 quantity, while many innovative pharmaceutical enterprises and multinational pharmaceutical enterprises executives expressed the hope that more opportunities for innovative drugs would be offered, and even pharmaceutical companies would propose that the directory of medical insurance should be fully dynamic adjusted, that is, not limited to once a year, but based on the new product listing for health insurance negotiations.

An industry expert told the economic news reporters in twenty-first Century that how to move more space is a question that the national health insurance agency needs to consider. The national health insurance directory negotiation and 4+7 purchasing with quantity have the same effect, and they all exchange more markets through bargaining.

In June 2019, the first batch of 20 countries focused on monitoring the list of rational drug use, and the new version of the national health insurance directory published in August 20th, through dynamic adjustment, there is progress, drug structure has undergone major changes. A total of 150 varieties were transferred, and 20 medicines were monitored in all the transferred varieties.

According to IQVIA estimates, there are nearly 20 varieties of the large scale sales of over 1 billion yuan. The varieties transferred by western medicine can save about 25 billion yuan of the medical insurance fund, and the varieties transferred by Chinese medicine can save 15 billion yuan of the medical insurance fund, which can save at least 40 billion yuan.

Xiong Xianjun, director of the medical service management division of the state health insurance bureau, pointed out that this action may affect the production and operation of individual enterprises, but it can make room for more life-saving drugs and emergency medicine.

In addition to moving space, the national health insurance agency is still squeezing out more space through "bargaining".

In September 2019, the results of the pilot scale expansion of the centralized procurement and use of drugs in the state organization were shown. Compared with the minimum purchase price in 2018, the average price of the selected drugs decreased by 59%, compared with the median price in the "4+7" pilot area. The average price of the selected drugs dropped by 25%.

The results of the national health insurance negotiations announced recently showed that a total of 150 drugs were involved in the negotiations, and a total of 97. Among them, 70 of the 119 new drugs were successfully negotiated, with an average price drop of 60.7%. The average dosage of three kinds of HCV was over 85%, and the average rate of treatment for cancer and diabetes was about 65%. Of the 31 renewals, 27 were successful, with an average price drop of 26.4%.

Xiong Xianjun pointed out to the twenty-first Century economic report reporter that through this negotiation, the cost of drugs has been significantly reduced. By playing the role of "strategic buyer" in the medical insurance sector, the cost of drugs has been greatly reduced by changing the price.

"The national health insurance agency has its own psychological base price in the negotiations, and the price is calculated by the experts in pharmacoeconomics according to the efficacy and the price of similar products at home and abroad, and medical insurance experts carry out the comprehensive stress test according to the medical insurance fund." Xiong Xianjun said.