When we re -examine the current drug tender control policy，We are more affirmative to the conclusion: under the current control policy，This round of bidding is being ongoing may be a provincial bidding。If it is 2014，Our judgment is based on national macro policy，So，Now，Our judgment is based on the incidents that occur in the pharmaceutical circle and the judgment made by the policy of the State Council.。

 

  I, the self -revolution of the bidding for the New Deal

 

  2015，The General Office of the State Council issued the "Guiding Opinions on Improving the Public Hospital's Centralized Procurement Work" (National Office [2015] No. 7，The following referred to as "Opinions")，This is a document related to the purchase of medicines，Bidding documents issued by the documents in the form of the State Council for the first time，The height of its specifications is unprecedented，The industry is called No. 7，This has also become the most important policy in the bidding field。At that time，Everyone changes soup without changing medicine，I don’t think there is too much revolution。

 

  Then July this year，Zheng Hong, who had just retired from the post of Director of the Director of the National Health and Family Planning Commission, explained the No. 7，The topic of the lecture is "Give full play to the market mechanism through classified procurement guarantee drug supply"。Although Zheng Hong has retired，but，As the leader of the pharmaceutical government department，Its bidding、Interpretation of pharmaceutical policy，Actually very authoritative。

 

  First，The topic of the speech is actually hidden mysterious machine，Zheng Hong said，No. 7 and the previous documents are not a simple change，Is a great reform and innovation，Many drug prices in the past are determined by the bidding price，Document No. 7 emphasized the market，Determine drug prices through the market。

 

  Second, we look at the later classification purchase:

 

  Total purchase amount accounts for 20%，Drugs that account for 80%of product regulations，Implement direct hanging network purchases。

 

  Some patented drugs and exclusive production drugs，Establish a price negotiation mechanism。

 

  Total purchase amount accounts for 80%，Product regulations accounting for 20%of medicines，Integrated into the scope of bidding and procurement，About 200 & mdash; 300 medicines。

 

  When the scope of bidding and procurement is two or three hundred medicines，Direct hanging network、Price negotiation will become the normal state，How powerful will this bidding control?

 

  Two, secondary bargaining: subversion of provincial bidding price control

 

  Since 2015，The most troublesome in the industry is & ldquo; Two bargaining & rdquo;，A big three hospital、A medical consortium，A city，Anyway，is a sentence，Out of the price without the price，This makes many medical people very painful。Although，Relevant persons of the National Health and Family Planning Commission explicitly stated in an interview with a health report，Only pilot cities in the medical reform can be negotiated in the second time，but，After the implementation of zero difference rate sales，The hospital compensation mechanism does not have，Fiscal subsidies are not in place，Second bargaining in various places is in My stake betting appfull swing，It is difficult to curb。

 

  Everyone knows，The previous provincial tenders were mainly to establish two major regulations: drug procurement selection right control and procurement price control，That is, the hospital can only purchase medicines that win the bid in the provincial bidding at the bid price。Now，When the second bargain blooms everywhere，The price control of the provincial tender is failed。

 

  3，Medical Reform Star Sanming New Deal: Or completely subverts the bidding control

 

  Sanming is the most dazzling star in this round of medical reform，Earlier this year，Approved by the State Council meeting，Sanming of the whole country。From November 25, 2015，Comprehensive reform training course for public hospitals in the country is held in Sanming, Fujian Province，Reform of medical reform、Finance、Public Hospital Comprehensive Reform Pilot City Related Departments and President Public Hospital President and Public Hospital Dean for centralized training。3 days per period，It is expected to train more than 1,700 people。

 

  If the secondary bargaining breaks the price control of the provincial bidding，So，This year，A policy of Sanming City is to completely subvert the control system of drug bidding and procurement.。

 

  June this year，Sanming City Deepening the Reform of the Medical and Health System Reform Leading Group issued the "Notice on Encouraging Medical Institutions to actively carry out drug consumables bargaining and related account treatment" (Ming Medical Reform [2016] No. 20)，Proposal & ldquo; Encourage medical institutions to be based on the city's joint price limited procurement，Carry out bargaining work at the existing pharmaceutical consumable supplier manufacturers (not subject to the constraints of 10%lower than the limited price)，You can also choose other manufacturers to negotiate for bargaining purchase at 10%of the price limit purchase。& rdquo;

 

  Just say，Save the standard price regardless of the price (you can discuss again，As long as you have the ability to cut lower)，The winning manufacturers of the provincial target can also be controlled (if the price is sufficient，You can also purchase other manufacturers)。So far，Two controls of the selection and prices of drug bidding and procurement varieties are completely subverted。

 

  4，Pharmaceutical Tube Platform: It will become a national drug & ldquo;

 

  The pharmaceutical pipe platform is the State Health and Family Planning Commission in recent years.，August，The "Notice on Promoting the Standardized of Unicom of Pharmaceutical Purchase Purchasing Platform Uniminals" issued by the National Health and Family Planning Commission is circulating in WeChat circle，Data centralized procurement platform data Unicom enters the 3.0 era，In fact, everyone doesn't care much，Even if you enter the 7th era，Not iphone，Everyone is not very concerned。

 

  but，Its core is that all 170,000 drug data of the drug supervision bureau are standardized，All medicines encoded into the platform。The National Health and Family Planning Commission will plan to be in province August 18、September 13th provincial database data normative docking。

 

  After the establishment of the National Pharmacy Platform，& ldquo; The era of drug prices & rdquo;，Anyway, everyone knows the purchase price in a place。but，Dang & ldquo; The price of drugs ran naked & rdquo;，The function of saving for drugs & ldquo; price intervention & rdquo; will be greatly weakened。What is the price of this drug in the future，The national pharmaceutical pipe platform will be checked。Who is the price? Two -time bargain。

 

  Five, the medicine recruitment office will not return to the Health and Family Planning Commission

 

  Beijing、Anhui、Hunan、Hubei、Henan、Ningxia、Yunnan、Guizhou、Centralized Pharmaceutical Purchasing Purchasing Platform in Hainan and other provinces has been transferred to the Public Resources Trading Center，Pharmaceutical collection is also incorporated into public resource transactions.。

 

  There are already places to issue documents requesting the purchase of public resource trading platforms for transactions，For example, the purchase of Anhui Drug Purchase just recently stake online sports bettingentered the trading platform，Public resource trading platform undertaken by the Development and Reform Commission，How to merge with the drug procurement platforms of various places，At the same time, reduce duplicate construction，Is an important problem at present。Will the procurement of drugs in various places be handed over to the Development and Reform Commission? After being left to the Development and Reform Commission，How to play for drug purchases，It will also become unknown。

 

  6，There are more important thing,，A series of policy documents issued by the State Council in 2016，It will accelerate the disintegration of the current bidding control policy

 

  1. First talk a very important，But the policy document that may not pay much attention to the medical circle。The document of the document of the State Council's & ldquo; Guofa [2016] No. 34 & rdquo; the document is "Opinions of the State Council on the establishment of a fair competition review system in the construction of the market system"。

 

  This file，On the surface，It seems that there is no direct relationship with the current bidding control policy in full swing，But as long as you read it carefully，I will find it，The relationship is too big。

 

  The file clearly proposes & ldquo; Fair competition is the basic principle of the market economy，It is an important foundation for the efficient operation of the market mechanism。With the continuous deepening of economic system reform，The national unified market is basically formed，Fair competitive environment is gradually established。But at the same time, I have to see，Local protection、Regional blockade，Industry barriers、Corporate monopoly，illegal giving preferential policies or reducing the interests of market entities that do not meet the phenomenon of building a national unified market and fair competition still exist。

 

  To regulate the government -related behavior，Prevent release of exclusion、Policies and measures to limit competition，Gradually clean up and abolish regulations and practices that hinder the unified market and fair competition in the country，Now the establishment of a fair competition review system on the construction of the market system。& rdquo;

 

  The file proposes 18 review standards，From the perspective of maintaining the national unified market and fair competition，Review according to the following standards:

 

  Market access and exit standards.

 

  (1) Do not set up unreasonable and discriminatory access and withdrawal conditions;

 

  (2) Announce the list of chartered operating rights directory，and without fair competition，Do not grant the operator's franchise right;

 

  (3) Do not limit the operation、Buy、Use products and services provided by specific operators;

 

  (4) Do not set up approval or pre -filing procedures without laws and regulations;

 

  (5) Do not allow industries other than the negative list of market access、Field、Business and other setting approval procedures。

 

  Free flow standards for products and elements.

 

  (1) Do not allow foreign and imported goods、Service implementation of discriminatory price and discrimination subsidy policy;

 

  (2) Do not limit foreign and imported goods、Services enter the local market or hinder the shipping out of local products、Service output;

 

  (3) Do not exclude or restrict foreign operators to participate in local bidding and bidding activities;

 

  (4) Do not exclude、Restrictions or forced foreign operators to invest or set up branches locally;

 

  (5) Do not implement discriminatory treatment for foreign operators in local investment or establishment of branches，Evilling its legitimate rights and interests。

 

  Affects production and operation cost standards.

 

  (1) Do not give preferential policies to specific operators in violation of the law;

 

  (2) Arrangement of fiscal expenditure is generally not linked to the tax or non -tax income paid by the enterprise;

 

  (3) Social insurance costs that specific operators need to be paid must not be exempted from illegal;

 

  (4) Do not require the operator to provide or detain the operators' various margins。

 

  Affects the standards of production and operation behavior.

 

  (1) Do not force operators to engage in the monopoly behavior stipulated in stake betting appthe "Anti -Monopoly Law of the People's Republic of China";

 

  (2) Do not disclose illegally or require operators to disclose sensitive information of production and operation，Provide convenient conditions for operators to engage in monopoly behavior;

 

  (3) Do not exceed the pricing authority for government pricing;

 

  (4) The price level of the price of goods and services that implement market adjustment prices must not be intervened illegally。

 

  No law、Regulations basis，Each region、All departments shall not formulate policies and measures that reduce the legitimate rights and interests of the main body of the market or increase their obligations; they must not violate stake betting appthe "Anti -Monopoly Law of the People's Republic of China"，Formulate exclusion、Policies and measures to limit competition content。

 

  Files and clearly required & ldquo; The policy formulation authority is in the process of policy formulation，To strictly conduct self -examination of the review standards。After review, it is considered not to be excluded、Restricting competition effect，It can be implemented; with exclusion、Restricting competition effect，It should not be introduced，or adjusted until it meets the relevant requirements。No fair competition review，No promulgation。& rdquo;

 

  People in the medicine circle，Go to control the control policy according to the bidding of drugs in various provinces，Comparison，18 Standards，What are the inconsistent things? The author will not analyze it one by one here。

 

  2. There is also the disintegration of drug bidding control policies & ldquo; fatal & rdquo; policy，January 12, 2016 & ldquo; Guofa [2016] No. 3 & rdquo; file，That is, "The State Council's Opinions on Integrating the Basic Medical Insurance System of Urban and Rural Residents。The file clearly proposes & ldquo; perfect payment method。

 

  System Promotion Payment at the first person、Pay according to the disease、Pay for daily fees、Reform of a composite payment method combined with a variety of payment methods such as prepaid methods，Establish and improve the negotiation and negotiation and risk sharing mechanism of medical insurance agencies, medical institutions and medical suppliers，Promote the formation of reasonable medical insurance payment standards，Guide the standardized service behavior of fixed -point medical institutions，Unreasonable growth of controlling medical expenses。

 

  When the procurement of drugs is supplied by the medical insurance agency、When medical institutions and suppliers negotiate freely，The current drug bidding control policy，What will happen? Moreover，If the medical insurance determines the payment standard in accordance with the single disease type，How to limit the use of doctors to use or not use some drugs? The freedom of the drug should be fully returned to the doctor's diagnosis and treatment decision，instead of being tied up with a restricted directory。

 

  3. June 29, 2016 ，The Ministry of Human Resources and Social Security released & ldquo;，That is "the Ministry of Human Resources and Social Security about actively promoting medical care、Medical Insurance、Guidance Opinions of the Reform of Medicine "。

 

  Deted & ldquo; Actively explore and play the basic role of medical insurance in medical reform & rdquo; This method is more novel、It is also very important，and require speeding up medical insurance overall planning，Give play to the basic role of medical insurance; continue to deepen the reform of medical insurance payment methods。The reform of the payment method should be put in the prominent position of the medical reform，Give play to the payment method in standardized medical service behavior、Active role in controlling unreasonable growth of medical expenses，Strengthen the reform of public hospitals、Price Reform and other parties linkage，Simultaneous promotion of medical treatment、Supply -side reform in the field of pharmaceuticals，Provides necessary conditions for the reform of deepening payment methods。

 

  Combined with the Budget Management of the Medical Insurance Fund，Comprehensively promote the total payment of payment，Accelerate the advancement of disease、Payment by first -class payment，Actively promote the application of paid stake sports betting app(DRGS) in groups of disease，The combined application of the total control and point method of exploration，Establish a composite payment method，Promoting benign competition between medical institutions，Inspired medical institutions to strengthen self -management，Give full play to the incentive and restraint of medical insurance payment on medical institutions and medical staff。

 

  The author does not need to make specific analysis here，In short，Once the medical insurance department makes force，What will happen to the current drug bidding control policy? Let's judge it yourself!

 

  Of course, there are many many policies from the State Council、Policies of various ministries and commissions，I think，It also has a greater promotional role in disintegrating the current bidding control policy，It will not be listed here。

 

  Future prediction:

 

  The National Health and Family Planning Commission is in the latest tender，Determine attitude，Respect local innovation，Actively raise local experience into national experience，It is expected that future medical reform，There will be greater autonomy，It is difficult to reproduce in a national control mode in the future。The country can establish a typical、Model，but，Points will have selective learning。

 

  In this case，After the bidding of this round，It is more certain that the original provincial bidding control mode is difficult to continue，and in detail:

 

  Conservatives: Plane saving will become a market threshold for pharmaceutical companies，Price linkage will become a common form，The provincial standard will no longer determine the price，The highest price of the drug is determined by the price linkage，Winning status or more will continue the previous round of bids or hospital drug companies，Large -scale bidding bidding will no longer be available，All places will determine the winning bid price through the second bargaining bargaining，The company does not accept the price，Abandoned the label，Other companies of the same variety obtain the market through bidding;

 

   Auditer: Ru San Ming，Hospital medication becomes an open market，Can I enter，Through the negotiation of both parties。The price of the national pharmaceutical management platform or public trading platform will be the highest line。Another is，Once the ministries and localities，If a document will be issued in the future, if you want to conduct a fair competition review，Similar to some existing control policies，I ca n’t come out at all!