Recently, the Chinese government network hanged the "Notice of the State Council on the approval of the National Development and Reform Commission's Opinions on Deepening the Economic System Reform in 2016", which is the key work opinion proposed by the National Development and Reform Commission on deepening the economic system reform in 2016 (hereinafter referred to as "Opinions" embodies the characteristics of "four prominent": more prominent supply-side structural reforms, more prominent problem-oriented and goal-oriented, more prominent grassroots practices and innovations, and more emphasis on reform measures.

How to reflect these four highlights in combination with the pharmaceutical industry? Please see the following section on the medical aspects of the "Opinions" section.

[The number of medical reform pilot provinces has been expanded from 4 to 8 to promote the experience of Sanming medical reform, and the number of medical reform pilot cities has increased to 200]

Coordinate the promotion of medical , medical insurance, and pharmaceutical linkage reform. Consolidate and improve the comprehensive reform of county-level public hospitals, increase the number of pilot cities for comprehensive reform of public hospitals to 200, expand the scope of pilot provinces for comprehensive medical reform, and accelerate the establishment of a modern hospital management system. Promote the practice and experience of medical reform in Sanming City, Fujian Province in some pilot provinces for comprehensive medical reform.

Comments: 200 medical reform pilot cities accounted for 60% of the 333 prefecture-level cities and above. The scope of the pilot has doubled from the previous 100, and the scope of the trial has been wide and the increase has been large. From the perspective of drug bidding and procurement, pharmaceutical companies need to cope with 30 provincial-level procurement plans and 200 self-purchasing programs in pilot cities, and it is best to link the two, and the workload is doubled, making it more difficult.

It is not known which Sanming medical reform experience has been promoted in some medical reform pilot provinces. However, Sanming’s medical reform has several characteristics for pharmaceutical companies that need to be clarified again:

1 The first hand is held by the master. This means that the pilot provinces are at least the deputy governor in charge of medical reform to personally coordinate and coordinate the three medical linkages, and the policy communication faced by pharmaceutical companies is more difficult;

2. The medical insurance three guarantees are unified and managed by the financial department. The payment party of drug purchase is integrated by three disparate forms of medical insurance, which means that the negotiating ability of the payer is more aggregated and strong, and the supervision of drug purchase, use and reimbursement will be strengthened;

3. Reducing the expenses of medicines and consumables to increase the medical service fee, which is called “cage change for birds”. This is a structural adjustment. It is inevitable that the quantity and price of medicines and consumables will fall. The resulting series of measures to reduce the price of drugs will be issued frequently, such as the second bargaining normalization, or the more powerful "Sanming +" model (joint limit purchase alliance), or find ways to pay from the medical insurance payment standard. For example, Sanming determines the payment standard for certain expensive drugs at the national minimum price of generic drugs.

4. The implementation of the two-vote system and even the one-vote system. So far, Fujian is the only province in the country that implements the two-vote system, and it is implemented very thoroughly, which is accompanied by an unprecedented increase in the concentration of commercial companies. Currently, only 11 businesses in the province have the right to legally distribute drugs to public hospitals. Small businesses across the province are either transforming, or relying on large companies to become local subsidiaries, or shut down.

Recently, the 570 million yuan vaccine case broke out. Premier Li Keqiang personally instructed to strengthen supervision. The two-vote system is likely to be fully implemented in the pilot provinces. Even a one-step transition to a one-vote system is not impossible. Last year, Zhejiang has involved a one-vote operating mechanism in the reform of innovative medical insurance payment and the improvement of pharmaceutical sunshine procurement. Can the province be implemented immediately after it becomes a newly-added medical reform province? Personally think that there is a great possibility.

[Medical insurance reform] Improve the basic medical insurance system, integrate the basic medical insurance system and management agencies of urban and rural residents, accelerate the reform of medical insurance payment methods, and promote the nationwide network of basic medical insurance and medical treatment in different places. Achieve full coverage of major illness insurance. Study and formulate a pilot program for the integration of medical insurance and maternity insurance.

Comments: The Ministry of Human Resources and Social Security issued a document requesting that all localities plan to integrate urban and rural medical insurance before June this year. After the completion of the integration, the 800 million insured personnel of the new rural cooperative medical insurance will expand their medical treatment (previously limited to the county), and the reimbursement scope will be expanded (increased medical insurance for urban residents). If the national network and settlement facilities are kept up, it will be released. Great medical needs. Pharmaceutical companies should pay close attention to the reimbursement policies of medical insurance and the new rural cooperative medical system to seize opportunities.

[70% of the prefectures and cities carry out pilot grading diagnosis and treatment] Deepen the comprehensive reform of primary health care institutions, accelerate the construction of grading diagnosis and treatment systems, and conduct pilot projects in about 70% of the cities.

Comments: Graded diagnosis and treatment is an important policy to optimize the allocation of medical resources and carry out orderly and reasonable medical treatment, which will bring about structural changes in the medical and pharmaceutical markets. If it can be implemented smoothly, outpatients and drugs in large hospitals will be diverted to the grassroots, especially the sinking of chronic diseases such as diabetes and high blood pressure, and the grassroots market will usher in a positive. Pharmaceutical enterprises should promptly lay out the layout of “stratified promotion” and “grading sales” according to product characteristics.

[Drug supply and circulation reform] Improve the drug supply security mechanism, promote drug circulation reform, and reduce the virtual high price of drugs.

Comments: While reducing the price of drugs, it should also ensure the normal use of drugs. The shortage of some commonly used drugs in recent years has caused social concern. However, in some provinces, the low price theory has suppressed the price of drugs, which also makes the drugs face the risk of poor supply and declining quality of treatment, which should be paid attention to by relevant departments.

[Revision of supply side approval for drugs and devices] Comprehensively promote the reform of the drug and medical device review and approval system, establish a review system based on clinical efficacy, promote the evaluation of the quality and efficacy of generic drugs, and carry out the drug listing permit holder system. Pilot.

Comments: How to deal with the backlog of 21,000 drug application approvals? How to carry out the evaluation of generic drug consistency, can more than 5,000 pharmaceutical companies across the country survive the crisis? This is the “de-stocking” and “de-capacity” of the drug supply side reform.

The pilot implementation of the listing licensor system has decoupled drug approvals from production companies and released productivity, but the supporting policies have not yet been introduced. For example, natural persons hold approvals, but there are adverse drug reactions or quality accidents. The individual's ability to resist risks is limited. How to bear the corresponding risks? Some people in the industry have proposed to rely on industrial funds and commercial insurance mechanisms to prevent them, and how to proceed, it remains to be seen.

[Medical staff salary reform] Promote the reform of the salary system for medical staff in public hospitals, and establish a new mechanism for maintaining public welfare, mobilizing enthusiasm, and ensuring sustainable operation.

Comments: If the medical reform does not respect the demands of medical personnel, it will be difficult to touch the pain points of the system. The purpose of medical reform is to achieve Pareto optimality for stakeholders such as patients, medical workers, pharmaceutical companies, and governments. By suppressing or sacrificing one party to achieve other aspects of the benefits, I am afraid it will not last.

[Social management, optimizing the medical supply side] Implementing a number of policy measures to accelerate the development of social medical treatment.

Comments: According to the official data released by the National Health and Family Planning Commission, as of the end of September 2015, there were 13,304 public hospitals nationwide and 13,600 private hospitals. Compared with the end of September 2014, there were 37 public hospitals and 1637 private hospitals.

Although the number of non-public hospitals has continued to rise in recent years, even exceeding the number of public hospitals, public hospitals have absorbed most of the patient resources. At the same time, public hospitals themselves are overwhelmed, in addition to grading medical treatment and diversion patients, encouragement Social management, increasing the resources of non-public hospitals is actually the "supply side" of optimizing medical care.

[The supporting policy of the two-child policy should be kept up] to guide the local governments to formulate supporting policies for adjusting and improving the birth policy.

Comment: The full arrival of an aging society, the society needs younger people to optimize the population structure, which is also the “supply side” reform of the population. The implementation of the two-child policy has promoted the development of related industries, and various entrepreneurial projects related to this have emerged in the society.

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