How many people benefit from the ＂group purchase＂ of artificial joints
Collecting artificial joints will benefit more people. (Comic Source: vision china)
After coronary stent (heart stent), another high-value medical consumables "group purchase" was successful. Recently, the state organized the centralized procurement of artificial joint products in Tianjin, and the procurement products included the initial total hip replacement and the initial total knee replacement. The procurement period was two years. The results show that the average price of hip joint has dropped from 35,000 yuan to about 7,000 yuan, and the average price of knee joint has dropped from 32,000 yuan to about 5,000 yuan, with an average decrease of 82%.
"It is really a good thing that medical consumables have been greatly reduced, making people feel more at ease and emboldened to see a doctor." During the interview, many readers expressed their jubilant feelings to the reporter. When will the new price of artificial joints land? How much cheaper can the total cost be? What is the clinical situation of the new price of cardiac stent that has been implemented for more than half a year? How will the centralized purchase of high-value medical consumables develop? Guangzhou Daily’s all-media reporter recently conducted an investigation.
Text, map/Guangzhou Daily, all-media reporter Feng Qiuyu
The average price reduction is over 80%
It is expected to land in March-April next year.
It is understood that this procurement of artificial joints has attracted more than 40 enterprises at home and abroad, bidding for more than 800 products, covering artificial hip joints and artificial knee joints. The planned procurement volume is 540,000 sets, accounting for 90% of the demand of the whole medical institution. According to the purchase amount in 2020, the purchase amount of two kinds of joints in public hospitals is 20 billion yuan, accounting for 10% of the high-value medical consumables market. According to the average decline of 82%, it can save more than 16 billion yuan every year.
This artificial joint collection is the first time in the field of orthopedic consumables at the national level. Since 2019, Anhui, Jiangsu, Fujian, Shandong and other provinces have also carried out the collection of artificial joint consumables, with an average decline of 32.12% to 86.26%. After the state organizes the procurement of artificial joints, the related products will be applied to public medical institutions in the alliance area. On October 9, the reporter learned from an interview with the joint procurement office of high-value medical consumables organized by the state that the price and use plan of the selected products in centralized procurement will be implemented from March to April, 2022. "The specific implementation date is determined by the regions of the alliance."
According to the National Procurement Document of Artificial Joints with Concentrated Quantity (GH-HD2021-1), after the implementation, the hospital signed a procurement agreement with the selected enterprises on the national joint procurement platform for medical consumables. Yang Li, a senior researcher at Guangzhou Zhongcheng Medical Machinery Research Institute, said that from the perspective of national and previous provincial-level procurement of artificial joints, the price of the selected artificial joint terminal dropped by about 60%~90%, and patients enjoyed relatively cheap and high-quality medical consumables.
About 2/3 patients were not operated because of the cost.
Centralized purchasing is expected to popularize domestic consumables
Artificial joint replacement is one of the effective methods to treat femoral head necrosis, joint injury, osteoarthritis and other diseases caused by trauma, sports injury, degeneration and aging, which can greatly restore the joint movement function of patients and obviously improve the quality of life.
Zhang Xu, director of the Department of Orthopaedics, Yueyang People’s Hospital, Hunan Province, said that hip fracture in the elderly is often called "the last fracture in life". If you stay in bed for a long time with conservative treatment, it is easy to cause thrombosis and lung infection, which belongs to the "just need" in the operation of replacing artificial joints. Generally, for hip fractures in the elderly over 65 years old, surgical treatment (joint replacement) is the first choice.
"The other part ‘ Not just needed ’ Hip and knee are the main joints. Osteoarthritis and rheumatoid arthritis caused by various reasons, physical deformity affects appearance and walking pain affects daily life. Joint replacement is the best treatment. In the past, due to the high price of replacement joints (joint prosthesis materials) and economic conditions, many patients who needed replacement surgery gave up. " Zhang Xu said that in some second-and third-tier cities and rural areas, there are more cases where treatment is delayed due to high costs. "From the clinical situation, at least two-thirds of patients choose not to have replacement surgery for economic reasons."
Artificial joints belong to high-value medical consumables. In the past, according to the bidding price and different preferential efforts of manufacturers, the pricing of hospital consumables at different levels was not exactly the same. A doctor in a 3A hospital in Shanghai said that the cost of artificial joint replacement in this hospital is between 50,000 and 70,000 yuan, and the medical insurance can be reimbursed about 20,000 yuan. After centralized procurement, the price before medical insurance reimbursement is expected to drop to 20,000 to 30,000 yuan. Zhang Xu introduced that at present, the average cost of knee replacement surgery in Yueyang People’s Hospital is more than 20,000 yuan except joint consumables, and the personal burden is about 50%; The average consumables is more than 20,000 yuan, and the personal burden of medical insurance for employees is about 70%, and the reimbursement is capped at 8,000 yuan. Therefore, after medical insurance reimbursement, individuals need to bear a total of about 24,000 yuan. After the collection, the price of mainstream knee products has dropped to around 5,000 yuan, and with medical insurance reimbursement, ordinary people can spend a lot less, and the average total cost has dropped by more than 40%, which is acceptable to most people.
An orthopedic surgeon in a 3A hospital in Guangzhou said that the price of hip consumables used to be as low as 10,000 to 20,000 yuan domestically, and as high as 100,000 yuan imported. The price of consumables is much higher than that of surgical treatment and medical expenses, which add up to about 15,000 yuan. "After this collection, it is expected to reduce the economic burden of patients. In the past, some patients used to choose imported consumables, and collection is also expected to popularize the use of domestic consumables."
According to statistics, in 2019, the number of artificial hip and knee replacement operations in China has exceeded 900,000, and it has maintained an annual growth rate of about 20%; By the end of 2020, China’s elderly population over 60 years old accounted for 18.70%. Yang Li, a senior researcher at Guangzhou Zhongcheng Medical Machinery Research Institute, believes that for the middle-aged and elderly people who need such products, the national centralized procurement is undoubtedly a major benefit.
Most of the heart stents fell to 700 yuan.
Guangdong’s procurement progress exceeds agreed expectations.
We still need to wait for a short time for the price reduction brought by the centralized procurement of artificial joints, and the price reduction of cardiac stents has already landed in Guangzhou. Yang Li introduced that last year, the price of coronary stents purchased by the state with centralized quantity dropped by more than 94%, and the average price dropped from 13,000 yuan each to around 700 yuan, which was very strong and was implemented on January 1 this year. Liu Zhen, deputy director of the Department of Cardiovascular Medicine of Guangzhou First People’s Hospital, told the Guangzhou Daily all-media reporter: "The price of heart stent collection has been on the ground for some time. This collection is indeed very strong, and other ancillary products have also entered the rhythm of collection."
As a doctor who has been engaged in cardiovascular medicine for more than 20 years, Liu Zhen has to perform hundreds of operations every year, and the heart stent can be said to be his "most familiar old friend". "In previous clinical applications, cardiac stents were made in China and imported. The domestic price was between 8,000 yuan and 11,000 yuan each, the imported price was around 20,000 yuan each, and the employee medical insurance reimbursement was about 70%; At present, the products collected in clinic will be given priority. The price of domestic and imported cardiac stents is mostly more than 700 yuan or even lower, which greatly reduces the burden on patients. "
It is understood that before this, Guangdong Province reported to the National Joint Procurement that the total demand for stent procurement in the coming year was 112,500, accounting for 8.4% of the country, and the usage ranked second in the country. According to the national centralized procurement document of coronary stents, the agreed procurement volume in the first year is 80% of the total procurement demand, that is, the intentional procurement volume in Guangdong Province in the first year is 90,108, which is estimated to save about 1 billion yuan compared with the average online price in Guangdong Province. According to the disclosure of Guangdong Medical Insurance Bureau, by the end of August this year, 132 hospitals in Guangdong Province had purchased a total of 82,427 stents selected in national centralized procurement, and the procurement progress exceeded the agreed expectations.
Expert: Centralized purchasing has become an inevitable trend.
Ordinary people are the biggest beneficiaries.
"The purpose of medical reform is to make the people afford to see the disease, see the disease well, and see the doctor conveniently. Drugs and consumables have been greatly reduced in price round by round. In the future, the collection of high-value medical consumables will further expand the scope of procurement, and all parties concerned will work together to ensure the orderly development of collection and use. " Experts in the industry believe that in the next step, it has become an inevitable trend to quickly start centralized purchasing with products with large clinical dosage and mature use.
"After the collection of coronary stents and artificial joints, the national medical insurance department has a comprehensive understanding of the price formation of the products of the bidding enterprises, which helps to form a scientific and reasonable pricing system. While the price of artificial joint consumables is greatly reduced, how to ensure the quality of products needs to be focused on. " Liang Jialin, secretary-general of the Expert Committee of Value Medical Consultants, believes that the efficacy of drugs in use is mostly short-lived, but implantable consumables (coronary stents, artificial joints and intraocular lenses) are mostly long-term or even accompany patients for life, so we should not only consider the quality of the products themselves, but also continuously track and monitor the medium and long-term efficacy. "In the next stage, the national level can explore the monitoring of the quality and efficacy of the winning products from the national specialized medical association of the National Cardiovascular, Orthopedic and Ophthalmic Medical Center."
Yang Li, a senior researcher at Guangzhou Zhongcheng Medical Machinery Research Institute, believes that, unlike stents (especially traditional metal stents), there is still much room for improvement in the overall permeability of orthopedic track. After purchasing with quantity, it is expected to usher in a significant increase in category usage, and the most important thing is that the majority of patients will benefit. "The overall market concentration and standardization of the industry will be further enhanced. After the price drops sharply, the market demand for products will increase significantly. In the long run, the industry penetration rate and market space will increase. For related manufacturers, especially those with a high proportion of revenue in this business, it is necessary to quickly improve their cost control and operation capabilities to ensure supply after winning the bid. If you fail to win the bid, you should determine the business choice and market expansion measures as soon as possible. "