Recently, Hainan Medical Insurance Bureau issued the notice on the implementation of centralized procurement of artificial joints organized by the state, which made it clear that the centralized procurement of artificial joints organized by the state will be implemented in Hainan on March 25. A total of 35 medical institutions participated in Hainan, with a total procurement of 3356 sets in the first year.
The medical insurance bureau of Guangdong Province also issued the notice of the Medical Security Bureau of Guangdong Province on doing a good job in the procurement and use of centralized artificial joints organized by the state, specifying that the selection results of centralized artificial joint procurement will be implemented from April 15, 2022, and requiring relevant medical institutions to do a good job in the preparation of relevant varieties.
According to the information of the National Medical Insurance Bureau, a total of 48 enterprises participated in the national centralized procurement of artificial joints, and 44 were selected, with a success rate of 92%. The average price of hip joints decreased from 35000 yuan to about 7000 yuan, and the average price of knee joints decreased from 32000 yuan to about 5000 yuan, with an average price reduction of 82%.
According to combing, the selected products involve Johnson & Johnson, Jiemai, Stryker, Weigao, Aikang medical, Chunli medical, minimally invasive medical and other Chinese and foreign enterprises. In the first year, 540000 sets of artificial joints are intended to be purchased, accounting for 90% of the total demand of medical institutions in China. According to the purchase price in 2020, the purchase amount of artificial hip and knee joints in public medical institutions is about 20 billion yuan, accounting for more than 10% of the high-value medical consumables market.
At present, what problems should be paid attention to in the process of national centralized procurement of orthopaedic artificial joints? A relevant person in charge of a medical equipment enterprise told the 21st Century Business Herald that the volume procurement of trauma consumables has been implemented for several months, but there are insufficient informatization of centralized procurement platform in some regions and the price of medical service items has not been adjusted in time. The landing of artificial joints may also need to pay attention to these problems.
whether it will “press the gourd and scoop again”
An industry expert told the 21st Century Business Herald that in the process of purchasing medical consumables with quantity, we may pay attention to the problem of “pressing the gourd and lifting the ladle”, such as whether the balloon is used too much and whether the FFR (blood flow reserve fraction) is significantly increased after the centralized collection of coronary stents. We should carry out multi-party coordination through medical insurance payment and other ways to truly benefit patients.
It is understood that in January 2021, the national centralized procurement of coronary stents began to land nationwide. The performance report of 3 Shenzhen Sed Industry Co.Ltd(000032) 021 in the first quarter showed that the business of traditional stents decreased significantly, but degradable stents, drug balloons and cutting balloons all achieved very significant growth.
At the same time, the balloon began to be collected on a large scale. In October 2020, Hubei Province completed the volume procurement, and the price of the successful coronary artery dilation balloon decreased by 96%. In November 2021, the alliance of Jiangsu, Shanxi and other 12 provinces carried out volume procurement of drug coated balloon, with an average price reduction of 70%.
In addition, in February 2022, Chen Jinfu, deputy director of the national medical insurance administration, said at the regular policy briefing of the State Council that because the drug balloon was not included in the centralized purchase, there was room for price, so this piece also had falsely high ingredients. Last year, the collection of drug balloons was carried out in Jiangsu and other places. This year, it will be expanded to the whole country to block the space of virtual height.
Will a similar “plot” also occur in the process of artificial joint centralized mining and landing?
According to PubMed data, the penetration rate of knee arthroplasty in the United States is 258.7 cases / 100000 people and that in China is 13.5 cases / 100000 people. The penetration rate of knee arthroplasty in China is still at a low level, and the high price of artificial joint is an important reason for the low penetration rate. Therefore, after the collection of artificial joints, there may be a significant increase in the number of joint replacement operations.
However, some insiders have told the 21st Century Business Herald that doctors above the deputy director are generally required to perform total hip and total knee arthroplasty. At the same time, studies have shown that doctors need to complete 200 ~ 300 operations to master total knee arthroplasty. It usually takes 10 years of operation experience to reach a high level in the industry.
In this context, will the use of Siasun Robot&Automation Co.Ltd(300024) in orthopedic surgery increase significantly?
Studies have shown that the Siasun Robot&Automation Co.Ltd(300024) intelligent operation of orthopaedic surgery can simplify many difficult surgical operations and reduce the physical consumption of operators during operation. Clinical application also has many advantages, such as minimally invasive operation, less damage to patients, rapid recovery, shortening hospital stay, etc.
In addition, according to the analysis of Kaiyuan Securities Research Report, affected by the aging population, the number of arthritis patients increases year by year, resulting in an increase in the demand for joint replacement Siasun Robot&Automation Co.Ltd(300024) surgery and a rapid growth in orthopaedic surgery Siasun Robot&Automation Co.Ltd(300024) surgery.
Source: Chinese Journal of bone and joint surgery
However, orthopaedic surgery Siasun Robot&Automation Co.Ltd(300024) also has some shortcomings, such as high price and relatively high operation cost. According to media analysis, the average cost of using orthopedic Siasun Robot&Automation Co.Ltd(300024) surgery in the hospital is about 11000 ~ 15000 yuan. If the Siasun Robot&Automation Co.Ltd(300024) use of surgery increases, will the cost of joint replacement surgery for some patients increase at the same time?
It is noteworthy that recently, a “letter on Soliciting Opinions on the guidelines for the price and relevant policies of auxiliary operations such as” about improving orthopedic surgery Siasun Robot&Automation Co.Ltd(300024) “” 3D printing “(Exposure Draft)” was circulated in the industry.
The above documents show that some places have recently received applications for adding “surgery Siasun Robot&Automation Co.Ltd(300024) ” and “3D printing” medical service price items, and there is a common situation of “double high” in equipment procurement cost and disposable accessories price. In order to encourage the clinical application of innovative general technology and avoid affecting the effect of centralized belt procurement of artificial joints organized by the state, the above documents are drafted after research.
two problems may affect the consumption
According to the procurement document of national organization artificial joint centralized belt quantity issued by the joint procurement platform of national organization medical consumables, during the procurement cycle, medical institutions give priority to the selected product system of this artificial joint centralized belt quantity procurement, and ensure the completion of the agreed procurement quantity. For the part exceeding the agreed purchase quantity, the winning enterprise still needs to supply according to the winning price until the purchase cycle expires.
However, it seems that there are still some problems to be solved on how to ensure the normal volume of the selected products when landing.
Taking orthopaedic trauma consumables as an example, in July 2021, Henan, Shanxi and Jiangxi formed a Procurement Alliance of 12 provinces (autonomous regions and cities) to complete the volume procurement of three categories of orthopaedic trauma consumables, with an average price decrease of 88.65% and a maximum decrease of 95.78%. Since November 2021, some provinces have started to implement it, and it has been more than four months since its implementation.
However, the relevant person in charge of a medical equipment enterprise told the 21st Century Business Herald that there may be problems in the implementation of the volume procurement of trauma consumables in two aspects – the lack of informatization of the centralized procurement platform and the failure to adjust the price of medical service items in time.
The above person in charge said that after the successful selection results are generated, the provincial centralized procurement platform needs to complete the data docking work, open a window for the successful products, and import the specifications and price data of all the successful products. However, the system construction in some regions is not informative and intelligent enough, so it still needs to be entered manually.
“Trauma consumables are very complex, which may involve tens of thousands of specifications and prices, and artificial joints may be equally complex. If all of them are entered manually, the workload and time cost are very high, and the number of staff in some provinces is not enough, resulting in the implementation of volume procurement for several months, but most of the consumables data have not been entered into the system.”
“As a result, doctors are anxious for surgery, but there are no corresponding consumables available in the system, and most of the selected consumables cannot be used normally and in large quantities. Enterprises hope to change the quantity at the price, but the large quantity is obviously hindered.” The person in charge said.
It is understood that as early as June 2015, the former national health and Family Planning Commission has issued the notice of the national health and Family Planning Commission on implementing and improving the guidance on centralized drug procurement in public hospitals, requiring to accelerate the standardized construction of procurement platform, improve the intelligent level of the platform with the help of modern information technologies such as Internet and big data, and adapt to the new characteristics and requirements of signing electronic contracts, online payment and settlement, online electronic transactions and so on.
The above person in charge further told the 21st Century Business Herald that before the implementation of volume procurement, enterprises also need to sign tripartite agreements with hospitals and distributors, and the workload is also huge, because enterprises may have hundreds of agents in each province, which need to maintain information and sign agreements.
“However, some provinces have not yet achieved online signing, and enterprises need to go to the medical insurance bureaus of various regions for offline paper signing, which is inefficient. Moreover, if covid-19 epidemic occurs, the efficiency may be further reduced, which will affect the implementation of consumables with quantity procurement.”
In addition, how to improve the enthusiasm of doctors is also a matter of concern.
In July 2019, the general office of the State Council issued the reform plan for the treatment of high-value medical consumables, which requires reasonable adjustment of the price of medical services, focusing on increasing the price of medical services reflecting the value of technical services, improving the salary distribution policy, and mobilizing the enthusiasm of medical personnel to participate in the reform of high-value medical consumables.
In May 2021, Henan Province, the leading province of the twelve provinces alliance, also said in the volume procurement document of trauma consumables that if the price of relevant orthopedic medical services is obviously low, the price of relevant medical services can be adjusted after evaluation.
According to the information of Henan Medical Insurance Bureau, since November 1, 2021, the price of 165 medical service items in public medical institutions in Henan Province has been adjusted, of which 163 belong to orthopedic trauma and joint surgery. For example, the price of “open reduction and internal fixation of humeral shaft fracture” has been adjusted to 2111 yuan / time for class III medical institutions and 1901 yuan / time for non class III medical institutions.
However, the above-mentioned person in charge said that before the volume procurement, the medical service price of an orthopaedic trauma surgery of the twelve provinces alliance was basically about 800 ~ 1400 yuan, but after the volume procurement was implemented, it seems that only a few provinces have adjusted the price of medical service items.
“Enterprises hope to successfully complete the agreed procurement volume, but now the price of medical service projects in some areas is low, and doctors lack enthusiasm and motivation for surgery, which has become another resistance to the implementation of volume procurement.”
