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    Home > Chemial News > Policies > New medical insurance documents: these actions will be severely beaten

    New medical insurance documents: these actions will be severely beaten

    Echemi 2020-05-12

    Recently, a draft document entitled "Guiding Opinions on the Establishment of Drug Price and Recruitment Credit Evaluation System" was circulated online.
    The core of the document is to establish the price and marketing behavior of pharmaceutical enterprises, take six measures of trustworthy commitment, proactive declaration, information verification, credit evaluation, graded disciplinary, and credit repair to create a combination of prevention, monitoring, disciplinary, and repair functions. Closed-loop optimized drug price and recruitment credit evaluation system.
    If the document is successfully issued, it will form a targeted blow to the long-standing commercial bribery in the pharmaceutical field, and it will have a disruptive impact on the sales model of drugs with gold. It is another important reform measure after the National Medical Insurance Agency promotes the centralized purchase of drugs. .
    Commercial bribery, market manipulation and other untrustworthy behaviors in the pharmaceutical field frequently occur, which seriously affect the industry's circulation order and trading environment.
    On the one hand, these behaviors have resulted in falsely high drug prices and the loss of medical insurance funds, which has increased the burden on patients to use drugs. On the other hand, it affects medical service control and safety management, such as causing drug abuse and over-medicine, jeopardizing the safety of patients' medication.
    In addition, it is also an important reason for weakening the innovation power of the pharmaceutical industry and the deepening reform of the pharmaceutical system. Pharmaceutical companies have formed a path dependence on the "sales with gold" model, lost innovation and reform momentum, and hindered the standardized development of the pharmaceutical industry.
    Taking commercial bribery as an example, the search results of China Judgment Documents Network show that 68 of the top 100 Chinese pharmaceutical industry companies involved 696 bribery or bribery cases, with an average of 10.23 cases per company, involving multiple types of drugs. It has serious adverse effects on the market-led drug price formation, patient safety, and efficient and reasonable use of medical funds.
    Jianzhi Pharmaceutical Industrial Enterprise
    Existing means of governance for untrustworthy behavior have certain limitations. Although law enforcement agencies maintain a high pressure on untrustworthy behaviors such as commercial bribery in the pharmaceutical field, a system of comprehensive governance and source governance has not yet been formed.
    First, the current method of supervision resolves discovered and verified cases of commercial bribery through post-punishment. The parties involved have been fined and sentenced, but this is only a small horn exposed above the iceberg and below the sea. The main part of sex and scale is basically unaffected, and it is still floating on the main channel of the healthy development of the pharmaceutical industry.
    Secondly, no disciplinary action has been taken against the two parties who have committed bribery. Taking commercial bribery as an example, it is mainly the hospital doctors who receive the bribes, and the bribery party is less blamed. It should be admitted that some doctors and hospital administrators have lost their basic ethics and have taken the initiative. But all the blame is on the party receiving the bribe, which is obviously not true.
    As far as this epidemic is concerned, tens of thousands of medical staff volunteered to take the initiative, irrespective of remuneration, irrespective of life and death, and rushed to the frontline of the Hubei epidemic prevention, indicating that the doctor's perseverance and ethics are the mainstream. It is hard to imagine that the phenomenon of drug rebates will be the result of unilateral requests from hospital doctors and forced helplessness by pharmaceutical companies.
    Third, it mainly pursues accountability for entities directly involved in dishonesty, and has not yet touched the companies behind those directly involved. After a breach of trust is discovered or verified, the pharmaceutical company can “abandon the car to keep the car handsome,” with little impact on interests and deterrence.
    In addition, there is currently a lack of targeted measures to manage dishonesty. Recent pilots and explorations that use centralized drug procurement and use as breakthroughs have restricted certain degree of untrustworthy behaviors such as the “gold sales” model of enterprises, but the range of products covered is still limited, and targeted system construction is urgently needed.
    Pharmaceutical companies have to regulate their own behavior
    The establishment of the credit evaluation and disciplinary punishment system is timely, and it is of great significance to deal with commercial bribery and other untrustworthy behaviors from the source, and to improve the limitations of existing governance methods.
    First of all, it is conducive to promoting enterprises to actively regulate their own behavior. The main sales channel for drugs is in public hospitals. The system of keeping promises, declaring and verifying will link the results of the pharmaceutical enterprise ’s credit evaluation with the bidding and reimbursement qualifications for the enterprise to enter the public hospital market, which will greatly increase the cost of the enterprise ’s untrustworthiness.
    Secondly, it is conducive to efficiently handling the systemic problems exposed by isolated cases. Credit evaluation and graded disciplinary establishment of a relatively comprehensive and complete information disclosure and sharing mechanism for major stakeholders.
    The dynamic collection and management of systemic commercial bribery and other violations of laws and regulations through coordination and linkage is equivalent to correlating individual behaviors and individual cases of pharmaceutical commercial bribery to the main responsibility of pharmaceutical enterprises, and is equivalent to transferring pharmaceutical enterprises through entrusted agents Legal responsibility is regrouped into the pharmaceutical companies themselves, blocking the “back door” of the pharmaceutical companies ’mechanism of separating commercial interests from illegal risks.
    "Trustworthy and prosperous business", the establishment of a credit evaluation system provides a guarantee for a fair and standardized and orderly circulation order and trading environment in the public procurement market for medicines, which helps to promote the integrity of pharmaceutical companies, reduce patient burden, and effectively protect patients Benefits and the safety of the medical insurance fund, thereby enhancing the people's sense of gain, happiness, and security.
    To promote the healthy development of China's medical and health undertakings, we must promote the credit evaluation system. The credit evaluation and disciplinary punishment system will be an important management tool to manage the excessively high drug prices and regulate the drug price behavior under market conditions.
    With regard to the content disclosed in the "Exposure Draft", we can already see the vague appearance of this system. It should be said that this system is based on deepening the reform of the medical security system, which is the refinement and derivation of policies; adopting contracts and commitments is an important feature of the market mechanism.
    To provide strong support for improving the efficiency of medical resource allocation, reducing the burden of the masses, and effectively guaranteeing the interests of the masses and the safety of the medical insurance fund; laying a solid foundation for the construction of a unified and open national pharmaceutical production and distribution market structure.

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