The core of high drug prices is in the hospital 
    Double -directional monopoly created the drug price to float 
    "The retail price of sky -high asparagus tablets is 13 times the price of the factory price.，I even have 400 times the example at hand! There are two or three hundred medicines on the market. In fact, the cost is only five or six hair。"A pharmaceutical person revealed to the" Economic Reference News "reporter recently。
"The two -way monopoly of the hospital in the circulation and retail session created the drug price and floated。A box of medicines with a profit of 100 yuan，Hospital and doctors conservative estimation can take 50 yuan to 60 yuan。"The above person said。
Recently, the media exposed some new drugs after entering the medical insurance catalog and quietly increased the price，The relevant person in charge of the Price Department of the National Development and Reform Commission said on the 17th，At present, the National Development and Reform Commission has launched the price of the newly entered version of the 2009 national medical insurance directory drug，Drugs priced independently of some companies，Specific identification standards and procedures for studying "anti -profits"。
However, industry insiders also tell reporters at the same time，The core of the most important drug reform is still the change of the hospital system。Only the implementation of the management office to form a diverse medical pattern，Let various types of hospitals fully join in market competition，Only by competition to adjust the changes in normal market prices。
The gross profit of the grievance industry does not exceed 8%
"The average gross profit margin of my country's pharmaceutical circulation industry has not exceeded 8%in the past five years，Net profit margin is less than 1%，"Niu Zhenggan, vice chairman of the China Medical Enterprise Management Association, revealed to the" Economic Reference News "reporter，"Some big companies，Ru Kyushu、The average gross profit margin of these large -scale pharmaceutical companies in China Pharmaceutical Stake Sports BettingGroup is lower，May not exceed 6%。”
Niu Zhenggan believes that the current medical circulation situation in my country is passively trapped in a vicious cycle，People often point their spear heads to circulation when they are accusing the sky -high drugs，But this is not the root cause of the problem。　
According to Niu Zhenggan, Introduction，A box of asparagus with a factory price of 15.5 yuan is in the process of selling at 213 yuan，The profit of the pharmaceutical factory and dealer is not what people call "huge profits"。The direct raw material cost of asparagus tablets is 6.83 yuan，Cost cost during management and other periods，A total of 13.6 yuan，The net profit of the pharmaceutical factory is only 1.9 yuan。The distribution session mentioned the price to 19.5 yuan，Industry insiders said that this is a normal market behavior。When the drug of 19.5 yuan has a government bidding process of up to 185.22 yuan。According to CCTV report，One of the boxes of the medicine to the doctor is 80 yuan，After the hospital earns about 27 yuan through 15%drug bonus。In other words，In the difference from 19.5 yuan to 185.22 yuan，Hospital and doctor obtained a total of about 107 yuan on a box of asparagus tablets，The remaining part also includes the Department of Pharmacy for Hospital、Drug Bidding Office and other links of many links or divide in many links，In addition, there are nearly 30 yuan taxes。
Niu Zhenggan said: "Although the situation between medicine and medicine is different，The proportion of interest distribution will also change，But who made a profit at a glance at this process。"" He thinks，Public opinion is not transparent enough or fair in the judgment of this incident，Therefore, it will cause the government to ignore the essence of the problem in the circulation of drugs。
The boss of a well -known pharmaceutical circulation group revealed to the "Economic Reference News" reporter，In 2007, the settlement of the Ministry of Health and the Ministry of Health of the Development and Reform Commission，In the past two years, the price increase obtained by medical institutions in the past two years is about 47 billion yuan per year，42%of the purchase amount of the drug，The price increase rate is actually 42%，It is far higher than the 15%increase rate allowed by the state。That is to say，42%of the retail price of a box of medicines are earned by the hospital。This is just the profit on the bright side。He also revealed，Generally, a box of medicine doctors can get about 30%of the rebate when they are opened，That is to say，In the sales of such a box of medicines，Hospital and doctors can earn 72%of retail prices。and only 28%left，It covers the pharmaceutical factory for research and development、Buy raw materials production、Equipment depreciation、Sales、Delivery、Employee salary and other costs。
Reporter calls executives at a three hospital in Beijing，The other party denies the 42%actual price increase rate。
"Obviously，Most drugs are taken away by the hospital。"The boss is a little angry，He has inspected the American pharmaceutical market. He uses similar data in the United States to compare，On the American pharmaceutical market，The hospital occupies only about 20%of the market share，The remaining 80%of them are occupied by retail institutions such as pharmacies。Statistics published by the American Chain Pharmacy Association (NACD) indicate the number of statistics indicates，Among the 2004 US $ 100 drug sales revenue，Pharmaceutical companies get $ 76.5，Wholesalers get $ 3.4，retailers get $ 20.1。"The huge differences between this set of data from China and the United States can clearly see the strong position of medical institutions in the domestic pharmaceutical market。"The boss said。
Niu Zhenggan also thinks，Excessive or too little circulation links，It is unfavorable to the development of the industry，Key to respect market laws，Promoting a behavior that reduces the circulation or cancel the circulation link is a behavior that does not understand the laws of the market，This approach will not only solve the problem of high drug prices high，Instead, it will increase the cost of drug distribution and hospital management drugs，Then it will further raise the price of drugs。
System Hospital two -way monopoly
Graduation of a doctor of medicine、What should doctors who have obtained independent diagnosis after two years of internship period should have it income? Zhu Hengpeng, a researcher at the Institute of Economics of the Chinese Academy of Social Sciences, calculated the account for the reporter of the Economic References，"If he takes 40 patients a day，Registered fee 5 yuan meter，According to 22 working days，A professional doctor who has received eight years of medical professional training and two -year clinical practice can only bring 4,400 yuan to the hospital a month! "
"In addition, there are nurses equipped with doctors，Administrative personnel who are roughly equal to medical staff，"Zhu Hengpeng asked reporters，"Do you think a team of four or five people only contribute 4,400 yuan to the hospital every month to balance the hospital's income and expenditure?!"
Zhu Hengpeng estimation，A doctor must bring 50,000 yuan in income to the hospital a month，Can the hospital's revenue and expenditure balance，At the same time, let yourself have more decent income。"So，Pharmaceutical medicine has become an important source of income for doctors in public hospitals。"Zhu Hengpeng said。The "rebate+return point" of the media exposed frequently is out of this。
Doctors who worked for seven -year -old hospitals in a third -class hospital in Shanghai told reporters，Personnel preparation of public hospitals is more redundant，Administrative personnel and medical staff are basically 1: 1，"The dean cannot lay off the layoffs，Our labor cost is much higher than private。”
Insufficient stake online sports bettingadministrative subsidies for public hospitals have been criticized by the media as a major reason for the popularity of public welfare，"The country can't afford it at all，The salary of the medical staff is paid by finance，Just raising all public hospitals in Beijing alone，The country spends about 30 billion yuan a year。"Zhu Hengpeng said。
"The" Sky Price Asparagus "incident was ignored by everyone: patients can only from the hospital without buying this medicine from a pharmacy。"Zhu Hengpeng told the" Economic Reference News "reporter。
"Many public hospitals and pharmaceutical companies have oral agreements，Do not sell the medicine to private hospitals or pharmacies。"The dean of a private hospital in Beijing said to the" Economic Reference News "reporter。
"In fact, the hospital is the biggest beneficiary in the circulation field，It has the characteristics of two -way monopoly。"The boss of the above -mentioned pharmaceutical circulation group means deeply said。
Because prescription drug sales account for about 80%of the domestic retail sales of the entire domestic drug，Therefore, the public hospital actually controls the majority of drug retail business，This makes domestic public medical institutions a two -way monopolist in the pharmaceutical market: Facing many pharmaceutical factories，The hospital is in the monopoly position of the buyer，Because it controls more than 80%of the terminal market，Face such a monopoly buyer，Numerous pharmaceutical industrial and commercial enterprises basically have no bargaining ability，Can only meet the requirements of the hospital。
Facing patients，The hospital is also monopolized at the seller，Because it controls the prescription right of most prescriptions、Sales rights and qualifications for public medical and fixed medical insurance，Face such a monopoly seller，Patients have no bargaining ability，Patients who go to the hospital have basically no right to choose，I can only buy medicine from the hospital。
Model changes to the charging mechanism encourages competition
Making money in the face of public hospitals is not，The embarrassing situation that does not make money，Niu Zhenggan said: Although there are some highlights in the medical reform in Beijing recently。For example, actively implement the first payment、Payment by disease or payment mechanism for total prepaid。But compared，The effectiveness of people's expectations is far higher than the status quo。
He thinks，This can curb the problem of high drug prices to a certain extent，At the same time, it can also solve the problem of excessive medication。
"So even if the hospital has not yet achieved the separation of management office，can also play some restraint，The department of the hospital management and paid (social labor security bureau) is separated，Therefore, it will play a certain supervision role with each other。"But he pointed out，The Social Labor Security Bureau is also a government My stake betting appdepartment，Possibly efficiency is limited。If it can entrust the management of the medical insurance fund to the insurance institution in the society，That efficiency may be better。
"In the face of a unified price of the same disease，The hospital will naturally control the medicine prescribed by the doctor，and encourage doctors to use cheap good medicines，Let the patient cure the hospital as soon as possible to save costs，Increasing profit。At this time, no centralized bidding purchase，The hospital will naturally choose the cost -effective cheap medicine to use it。"He said:" These are also viewpoints advocated by some experts and scholars for a long time。If it can be reflected and implemented in the Beijing medical reform plan，That will be a grateful thing。”
In addition，Niu Zhenggan believes，Only doctors take reasonable medication，Medical institutions will buy medicine reasonably，Medical vendors can also sell medicine reasonably，Pharmaceutical companies can make reasonable medicines，Doctors and hospital links are commanders that determine whether the entire industry is healthy，is the key to solving all problems。Of course，Multi -medical management pattern once formed，The competitive pressure brought by private hospitals is also conducive to making drug prices a low trend。
For this，The dean of a private hospital in Beijing told the "Economic Reference News" reporter: "Our purchasing volume is not as good as a public hospital，Theoretically our medicine will not be cheaper than them。But in fact, there are many hidden rules in the process of purchasing drugs in public hospitals。The water for centralized bidding is too large，The government's pricing itself has a high starting point。"He believes，Hospital responsibility is clear，So managers will firmly control the cost，Do not allow doctors to get back。Doctor's salary has no gray income，Pure economic benefits、Evaluation of quality and efficiency and patient satisfaction。"So our purchase is relatively more in line with market rules，The profit given to others，There will also be some benefits for patients，so as to stand firm in competition。"He said。