Analysis of the Causes of the High Price of Medical Consumables in China

Business Club April 29 Loss of control of the stent

Inducing stent placement in this patient is one of the manifestations of stent abuse. “Some doctors will say to the patient that you need to open the chest to make a bridge and put a stent on the wound. You decide on it yourself.” Hu Dayi, a famous cardiologist and chairman of the Chinese Medical Association’s Cardiovascular Branch, said that this induces patients to be in the heart of the hospital. Internal medicine is not an isolated phenomenon. In general, few patients need to put more than three cardiac stents, but many patients in our country have been placed more than 10.

Hu Dayi said that whether to choose bridges or stents should be jointly diagnosed by experts from the Department of Cardiology and cardiac surgery and decided according to the specific conditions. Internationally, the ratio of stenting and bypass surgery is 71-81, but in China, the ratio is as high as 121.

Placing stents in patients with "infarct vessels" and irrelevant vessels in patients with myocardial infarction is also one of the manifestations of stent abuse. Hu Dayi pointed out that according to the evidence of a large number of clinical studies in recent years, domestic and international guidelines agreed that the acute phase of treatment for patients with myocardial infarction should be limited to the opening of the diseased blood vessels that cause myocardial infarction, that is, "criminal blood vessels," while other diseased blood vessels exist simultaneously in patients. The assessment should be made after the condition is stable and handled as appropriate. However, many clinicians are now "competently engaged in a battle," and placed stents in the stenosis of blood vessels that are not related to infarction.

The use of bare stents, but with drug stents, is another manifestation of stent abuse. Bare stents cost about half as much as drug stents. Hu Dayi said that in the treatment of acute myocardial infarction patients, the use of drug stents and bare stents in the opening of infarct-related blood vessels, there is no significant difference in effect. “At present, the use of naked stents with low prices is widespread throughout the world. The use of naked stents in the United States accounts for 20% to 30% of the total stent use, and European countries account for about 50%. The 240,000 stents used in 2009 in China The proportion of bare stents is only 3.3%, which is due to the low price of bare stents and thin profits, lack of enthusiasm for production and sales on the part of enterprises, and the reluctance of the hospitals to place orders on the other hand, Hu said.

Yao Zhixiu, director of the Surgical Implants Committee of the China Medical Device Industry Association, said that the abuse of Medical consumables is also very obvious in orthopaedics. For example, a 26-year-old female patient can heal pain only by punching holes in the femur to reduce intramedullary pressure. However, the hospital was asked to do artificial joint replacement surgery. "Not only some general hospitals, general doctors, but some hospital doctors do the same."

Where should the interest chain break from

Irregular use of consumables in cardiac interventions is not inherent. According to Hu Dayi, China introduced coronary artery interventional therapy since the 1980s, but initially it was a simple balloon dilatation. The hospitals that can be carried out are very limited. The consumables used are not separately charged to the patients, and the balloons and catheters can also be repeated. use. In recent years, with the gradual introduction of stent implantation and drug stents, the success rate of interventional treatment has become higher and higher. However, due to the high cost of consumables, stent surgery has become profitable. Pharmaceutical manufacturers, operating companies, and medical institutions are all in the same interest chain.

In this complete interest chain, it is not only the product pricing that needs to be controlled, but also the behavior of using the product. Hu Dayi said that it is imperative to give full play to the role of industry self-discipline by calling experts in related disciplines to formulate guidelines and guidelines for interventional treatment of the heart and to determine what patients should do, what methods to use, and to what extent. At the same time, government regulators should also monitor non-standard medical practices.

External environmental factors can also be ignored. Diaotaitai, head of the discipline inspection team of the Guangdong Provincial Department of Health, said at a meeting that he had seen the textbooks of "public relations training courses" organized by drug companies, which divided the six types of pharmacy directors in detail and summarized how to get doctors. There are 9 ways to agree with the prescribing authorities, and these are the experiences of medical representatives who have been dealing with doctors on the frontline for a long time. "I'm afraid that few doctors can withstand this procedure."

An official in the health administrative department stated that the health department has been coordinating the judiciary to increase the punishment of bribery parties in commercial bribery cases in the medical and health field. At the same time, the “black list system” of bribery enterprises was strictly implemented, and enterprises that were included in the bad records of commercial bribery in the region were resolutely canceled their qualifications for local participation in drug procurement bidding within two years.

Use the power of medical insurance

The high price of Medical Consumables and the abuse of chronic diseases make it difficult for many well-informed people to turn their attention to medical insurance to seek prescriptions. Yao Zhixiu said that the medical insurance department is the spokesperson for the interests of patients and should fight for the rights and interests of patients in price negotiations. Although some places have tried in this area, more mature experiences and practices may be required to find other countries or regions.

The Singapore medical insurance department stipulated that if a doctor puts a stent on a patient who does not need to put a stent, or if he puts more than three stents on the patient, he must state the reasons to a special committee. If the doctor does not give a reasonable reason, not only the medical insurance department will refuse to pay, but the medical qualifications of doctors will also be questioned. Hu Dayi believes that China's medical insurance department should also be reimbursed according to the disciplines and treatment standards, and refuse to pay the cost of excessive medical treatment.

A health administrative official stated that only by implementing medical separation, reforming medical insurance payment methods and implementing single-disease payment and total amount prepaid system based on clinical pathway management can motivate medical institutions to actively control costs and curb excessive medical treatment.

Yao Zhixiu took Taiwan as an example. He said that the Taiwan medical insurance department has set a very low price for artificial hip joints. Although most foreign companies cannot accept it, a company named Zimmer has been accepted to maintain its market position. The company relies on large amounts to achieve financial balance, and the ultimate benefit is patients. This practice also deserves our reference.