Did pharmaceutical companies win 81 hospital pharmacies in three provinces to promote ＂separation of medicines＂ or a wolf in sheep’s clothing？

With the deepening of the reform of "separation of medicine" and the arrival of the Lunar Year of the Horse, pharmaceutical circulation enterprises (hereinafter referred to as "pharmaceutical companies") have started a "enclosure" drama to seize the hospital drug supply market. Kangmei Pharmaceutical Co., Ltd. (hereinafter referred to as "Kangmei Pharmaceutical") announced that it has won the pharmacy custody rights of 81 hospitals, involving Guangdong, Jilin and Liaoning provinces. Can this move really realize "separation of medicine" and solve the problem of "supporting medicine with medicine"? Or is it just a wolf in sheep’s clothing, as public opinion says?

Kangmei Pharmaceutical has won 81 hospital pharmacies.

Pharmacy trusteeship: the best way to solve the problem of "supporting doctors with medicine" or poison?

From January 31 to February 12, in just 13 days, Kangmei Pharmaceutical issued four announcements in succession, announcing that it had won the pharmacy custody rights of 81 hospitals, involving Guangdong, Jilin and Liaoning provinces. Kangmei Pharmaceutical said that all drugs used in these hospitals are uniformly supplied and distributed by Kangmei Pharmaceutical, and the contract period is mostly as long as 15 to 20 years.

In the first announcement announcing the signing of contracts with nine hospitals in Puning, Guangdong Province, Kangmei said that the reason why hospitals entrusted pharmacy management was to realize the separation of hospitals’ medicines and gradually alleviate the problem of "difficult and expensive medical treatment" for the masses. When this statement came out, public opinion was in an uproar.

Kangmei Pharmaceutical has won 81 hospital pharmacies.

Liao Xinbo, deputy director of Guangdong Provincial Health Department, told the reporter that pharmacy trusteeship is not the reform direction of "separating medicine from medicine", but an intensified "taking medicine to support medicine". Pharmacy trusteeship only changes the managers of pharmacies, and does not really separate medicine. Under the profit-sharing contract between hospitals and pharmaceutical companies, the two sides will form a community of interests. Liao Xinbo bluntly said that pharmacy trusteeship, which tried to "separate medicine" and solve the problem of "expensive medical treatment", was actually a wolf in sheep’s clothing.

In the face of controversy, on February 10th, the spokesman of the National Health Planning Commission cautiously said: "The phenomenon of separating pharmacies from outpatient clinics in some areas will play a certain role in cutting off the direct interest relationship between medical and health personnel and drugs."

Pharmacy trusteeship, is it a sheep or a wolf?

Nanjing experiment regarded as a failure case

"Pharmacy custody and pharmacy stripping are completely two concepts!" Mingde Yu, president of China Pharmaceutical Enterprise Management Association, said, "Stripping refers to the complete separation of people, finances and materials, while pharmacy trusteeship has never cut off the interest relationship between hospitals and drugs."

"Pharmacy trusteeship refers to the hospital handing over the pharmacy to a third-party enterprise for operation and management without any change in the ownership of the pharmacy." Wu Chun, a special health care partner of Boston Consulting Group, said, "In other words, the hospital did not sell the pharmacy, but paid the pharmaceutical company to take care of it."

The first announcement of Kangmei Pharmaceutical shows that its pharmacy trusteeship model with nine hospitals in Puning is as follows: the hospital entrusts the company to operate and manage the pharmacy in an all-round way, the ownership of the pharmacy remains unchanged, the identity and functions of employees remain unchanged, and the performance appraisal and salary payment methods remain unchanged; The hospital provides a drug list, and the drugs used are uniformly supplied and distributed by the company.

In fact, before Kangmei Pharmaceutical hosted 81 hospital pharmacies, Nanjing Pharmaceutical Co., Ltd. (hereinafter referred to as "Nanjing Pharmaceutical") also launched a vigorous pharmacy hosting operation under the leadership of the Nanjing Municipal Commission for Discipline Inspection. In February, 2006, more than 100 medical institutions below the second level in Nanjing entrusted the pharmacy to Nanjing Medicine, and Nanjing Medicine returned 35% of the operating income of the pharmacy to the hospital as the custody fee every year.

"The main purpose of implementing pharmacy trusteeship in Nanjing at that time was to curb commercial bribery." Liao Xinbo told reporters that the pilot originally hoped to achieve a win-win situation for all three parties: on the premise of ensuring the basic interests of the hospital, it would not only enable the trusteeship enterprises to obtain meager profits, but also squeeze out some profit space, thus reducing the economic burden of the people.

However, such a reform test, which had high hopes and seemed to realize "separation of medicine", finally failed.

Liao Xinbo said that at that time, many hospitals in Nanjing didn’t want other companies to intervene in pharmacy operation and management, but they had to accept it because of the policy. However, there are policies above and countermeasures below. For example, when doctors in a hospital prescribe antibiotics, they will give up other varieties and only prescribe penicillin with a profit of only 4 cents, so as to force the trustee to lose money and force him to quit.

The rising cost of custody is also an important factor that eventually led to the failure of pharmacy custody. Wu Chun told reporters that the custody fee originally agreed between medical institutions and Nanjing Pharmaceutical was 35% of pharmacy revenue. As more and more bidding enterprises later participated in pharmacy custody, the proportion of return proposed by hospitals is getting higher and higher, and some even reached 50%. In addition, pharmaceutical companies have also made a commitment to the government to reduce the drug price by 5%~10%, which makes the custody cost of pharmaceutical companies continue to increase.

According to media reports, Nanjing Pharmaceutical lost more than 10 million yuan in single pharmacy trusteeship in 2007. Since 2008, Nanjing Pharmaceutical has been reluctant to mention the once sensational pharmacy trusteeship. In 2009, the Health Department of Jiangsu Province asked medical institutions above the second level to implement centralized drug procurement by province, which officially marked the failure of custody of Nanjing pharmaceutical pharmacy.

Government pandering, hospitals dumping burdens, enterprises grabbing positions.

Why are Kangmei Pharmaceutical and 81 hospitals willing to try again?

"At that time, when Nanjing implemented pharmacy trusteeship, it was more of a top-down administrative order, without taking into account the wishes of medical institutions below the second level. Nowadays, under the background of implementing the zero difference rate of drugs, pharmacies have gradually changed from the original income department to the cost department of hospitals, and hospitals are out of ‘ Throw away the baggage ’ The purpose is also beginning to be willing to trust the pharmacy. " Liao Xinbo said.

"The original drug revenue can account for 40%~45% of the hospital’s total revenue. Now, after the drug addition is cancelled, the hospital’s income is significantly reduced, but the state does not give subsidies, so pharmacy custody appears." Geng Hongwu, business president of Jiuzhoutong Pharmaceutical Group Co., Ltd. said that both hospitals and pharmaceutical companies are now implementing pharmacy trusteeship for survival, which has nothing to do with "separation of medicines".

"The purpose of the hospital to entrust the pharmacy is to continue to maintain its normal operation through the returned money. For pharmaceutical companies, after taking over the operation and management of pharmacies, it can also monopolize the supply and use of drugs in hospitals. " Yan Hongwu said.

Can "medicine trusteeship" realize "separation of medicine"?

“‘ Taking medicine to support doctors ’ The hat was heavily buckled, and the hospital was unwilling to bear these pressures, so it simply entrusted the pharmacy out. In fact, in the final analysis, the essence has not changed at all. As long as you seek profit in the process of drug management, you are ‘ Taking medicine to support doctors ’ 。” Mingde Yu said, "What is ‘ Separation of medicine ’ ? Is to completely separate hospitals from medicines economically. So that hospitals can’t rely on drugs to make profits. After the implementation of pharmacy trusteeship, hospitals don’t have to buy and sell drugs themselves, but use bonuses and kickbacks to make profits. Instead, they hand over the pharmacy to the enterprise and then ask the enterprise for money to subsidize the money that will be less income after not selling drugs. This is still ‘ Taking medicine to support doctors ’ ！” Mingde Yu said.

Why did Kangmei Pharmaceutical, which is headquartered in Guangdong and mainly produces Chinese herbal pieces, win the custody right of 81 hospital pharmacies across the three provinces of North and South? With the lessons of Nanjing Pharmaceutical, what new cooperation modes will Kangmei Pharmaceutical and the hospital have? How to divide the pharmacy income?

The reporter called Kangmei Pharmaceutical for interviews several times, but as of press time, he has not received a positive reply.

However, Mingde Yu, who has been engaged in drug production and circulation management for a long time, told reporters that according to his understanding, the enthusiasm of pharmaceutical companies for pharmacy custody is not too high.

"The purpose of the enterprise is very simple, that is, to survive. Since the relevant government departments have proposed to carry out pharmacy custody, enterprises must compete for custody rights in order not to lose their positions. As for whether there will be losses and when the losses will be made up, those are neglected. Because once there is no custody, the life of the enterprise in this hospital is equivalent to termination. " Mingde Yu said.

"A hospital can only entrust a pharmacy to one enterprise. Originally, 50 enterprises supplied medicines to this hospital. Now, the government proposes to select the best enterprise for custody, which means that the remaining 49 enterprises will be driven out. Verbally speaking, it is to choose the best, but in fact it is to choose the most willing to pay. " Mingde Yu said, "In order not to lose ground, enterprises can only bite the bullet and throw money. Therefore, for enterprises, knowing that pharmacy custody is a cup of poison, they have to drink it in order to survive. "

"As for the southern enterprises, why did they run to the north to chase the land? In the final analysis, it depends on the relationship with the government. The hospital itself has no right to choose who to cooperate with. The hospital is like a child bride of the government, and whoever the government sells it to is who it is. " Mingde Yu said.

The reporter noted that Kangmei Pharmaceutical said in the announcement issued on February 11th that Kangmei Pharmaceutical signed an agreement with Tonghua Municipal Government, and Tonghua Municipal Government handed over 45 public hospital pharmacies in its jurisdiction to the company for exclusive custody in two batches. "This kind of behavior of the government actually violates the autonomy of the hospital. The hospital should decide who to entrust the pharmacy to and who to cooperate with according to its own needs, but now it has become the government ‘ Lalangpei ’ Behavior. " Mingde Yu said.

Liao Xinbo said that the government’s behavior is undermining fair competition in the market. "Euphemistically called ‘ Separation of medicine ’ Instead of cutting off the interest chain, it has formed a stronger monopoly supported by the government. "

It won’t be cheaper to see a doctor.

"In fact, the people don’t care who the hospital entrusted the pharmacy to, and they don’t care ‘ Taking medicine to support doctors ’ Whether the problem has been fundamentally solved, the most important thing is whether it is cheap for me to see a doctor and buy medicine. " Liu Yun (pseudonym), a licensed pharmacist in a top-three hospital in Beijing, said, "Most hospitals that implement pharmacy custody now have cancelled drug addition and implemented zero-difference rate. Before cooperating with the hospital, the custody enterprise made a price reduction commitment to the government, so after the custody, the drug price will definitely decrease slightly. However, since the drug addition of these hospitals has been cancelled, the custody enterprise will make money. The decline in drug prices will not be too great. "

"Pharmacy trusteeship will not have much impact on patients’ access to medical treatment and medicine, but because the hospital has entrusted the pharmacy, it may dilute the management of drug safety and drug quality." Liu Yun said that the custodian will only consider the interests, so there may be excessive choice of low-priced and high-profit drugs.

"After the pharmacy is hosted, my work looks a lot simpler, but in fact, the pressure is even greater." Qiangzi (a pseudonym), a medical representative of a pharmaceutical company, said, "Before the pharmacy is entrusted, we need to go from the director of the department and the director of the pharmaceutical machinery department to the pharmaceutical affairs committee and pharmacy procurement ‘ Public relations ’ Now I just need to win the custodian. But in fact, in order to strive for higher profits, the custodian will not only meet the profit-seeking needs of the hospital and itself, but also realize the promise of price reduction, and will lower the purchase price of drugs, and all our profits have been taken ‘ Public relations ’ Well, there is still room for further price reduction! " "Moreover, the prescription right is still in the hands of doctors. In order for doctors to finally prescribe our medicines to patients, the red envelopes for doctors have not been reduced at all." In Hadron’s view, pharmacy trusteeship can neither solve the problem of "taking medicine to support doctors" nor let ordinary people spend less money on medical treatment.

"The number of custody fees charged by hospitals to pharmaceutical companies is calculated based on the income of pharmacies in the previous year, and this ratio usually increases by 5% every year. The enterprise itself will not print money, and in the end, it is still the people who pay for medical treatment and medicine. " Mingde Yu said that medical institutions only hand over the power to supply goods to enterprises, and they have to charge enterprises 40% or even higher custody fees, which is a typical profiteering behavior. "The hospital is actually forcing suppliers to increase the price of drugs, continue to exploit consumers, and make it more expensive for ordinary people to see a doctor!"