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| Three "abnormal phenomena" are analyzed |
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| Author：中國銘鉉 企劃部 Release Time：2017-8-15 11:18:04 Number Browse：682 |
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On August 15, in the context of overcapacity, the medical network chose a number of drug manufacturers to produce the shortage of medicines that are easy to handle, cheap and urgently needed. As long as the price is appropriate, there must be a company actively participating. Medicine is to the doctor what rice is to the cooking. The emergence of a shortage of drugs is a reminder that millions of people can't get medical treatment without medicine.
On Monday morning, August 14, the national development and reform commission hanging network operators the shortage of drugs and drug ingredients of price behavior guide (draft) drew close "watch" industry (are available for advice before September 13, 2017). Contact recently, national health development planning commission issued "on reform and improve the shortage of drug supply security mechanism of the implementation opinions" (countries who medicine ZhengFa [2017] no. 37), from a combination of ministries and commissions, as you can see drug shortage situation is still to be reckoned with.
Especially the "implementation opinion" clear, "requirements by the end of 2017, set up the mechanism of drug shortage of information collection and summary analysis, to refine the list of shortages drug monitoring and early warning and management system, set up national drug supply security based on big data applications integrated management platform and a shortage of drug monitoring and early warning information system, perfect department in consultation with the linkage mechanism, a preliminary establish national, provincial, city and county level monitoring and early warning mechanism and the national and provincial levels coping mechanism." "By 2020, realize the shortage of drug supply security comprehensive management and monitoring early warning and the sharing of information resources sharing, establish a mature and stable drug shortage of real-time monitoring and warning and grading system, build the shortage of pharmaceutical information collection, summary analysis, department coordination, graded response, industry leading" five one "work pattern, forming a shortage of drug supply security system with Chinese characteristics." In recent years, according to the various measures introduced by the competent authorities and the market reaction, the shortage of medicines should cause the industry to continue to pay attention.
Generally speaking, the supply shortage of products is always coexisting with insufficient capacity, and the oversupply of products always coexists with excess capacity. However, in the field of medicine, influenced by various factors, quite a part of the product presents excess capacity and the contradiction of supply shortage coexist, the marketable products and the enterprise is the contradiction between production outages. Among these influencing factors, the only low price of bidding is the "second price", which is the most important aspect of the bid price.
The most pressing problem
In my opinion, although the current drug shortage is not the most basic and long-term problem in the medical field, it is already the most urgent and important question.
In general, China's current drug production capacity is still surplus. Over the years, local governments have attached great importance to the development of the pharmaceutical industry, and most have listed it as a pillar industry, innovation and entrepreneurship, and advantageous industries. According to the annual report on food and drug administration of 2016, by the end of November 2016, there were 4,176 original pharmaceutical and pharmaceutical production enterprises. Pharmaceutical production enterprise number and the quantity of drug substances and drug products enterprises are less and less than one year, this is because the production enterprise licence renewal period, some enterprises due to not through the GMP certification, temporarily not suspended due to the lack of conditions for renewal of the replacement.
According to the author, many pharmaceutical factories are still in the position of production capacity and sales difficulties, and the shortage of medicines is a frequent phenomenon.
In recent years, the heart surgery with medicine "protamine injection", heart CuiXie rescue medication "west orchid injection", the "actinomycin D" to treat tumor in children, treatment of infant spasm corticotrophin, emergency surgery for glaucoma medication mitomycin, prevention of thromboembolic disease "dipyridamole" and so on the many kinds of cheap drugs, there is shortage of the country or even out of stock.
End of 2015, the authoritative media reported: 12 large and medium cities of the country more than 40 3 armour hospital clinical drug use, sampling survey was released national and local supplement of 512 kinds of medicine, about 340 kinds of different degree of short supply, many of them are cheap life-saving medicine. As a result of the shortage of medicine, the price of the shortage of medicine has been fired, and some of them have gone up by dozens or even hundreds of times.
In March 2016, the national health development planning commission issued the national health and family planning commission drug administration department about plans to implement fixed-point production drug varieties of public comment ", made plans to implement fixed-point production of 16 kinds of drugs variety listing, faces the society for public opinion. In May 2016, the guangdong pharmaceutical trading center made a list of 806 companies not listed in accordance with the contract. Since 2017, Shanghai has issued a total of 17 clinical emergency medicine notices. At the end of march, the NHFPC also issued a special notice, with 57 drugs in the province of liaoning province, including some emergency rescue products.
The author also noted that in March, a number of media reported that more than 1,000 professional ophthalmologists in guangzhou had signed a call for the injection of mitomycin for only 11.5 yuan, which was broken and there was no substitute. There are more than 10,000 cases in the country's three major eye centers that must use the drug a year, and the risk of blindness could result in tens of thousands of patients... In combination with the situation, the author believes that some shortages of drugs are not normal and should not be, which are highlighted in the following aspects.
1. There is a shortage of products under overcapacity.
China's pharmaceutical industry, like most industries, has seen a glut of uninnovative generic production capacity after decades of development. If there is still shortage of the original research drug, the production line design capacity of generic drugs is much higher than that of production. Current our country is pushing supply side reforms, companies go capacity, inventories, deleveraging, cost reduction, repair, in this case, there are companies ignore the demand, emptying capacity, stop production, so that if a product shortage happened, is not a normal phenomenon.
2. A few, short - term shortages have a trend towards most, long-term shortages.
There is a shortage of medicines in the pharmaceutical market, but shortages are often caused by special causes. For example, sudden mass epidemic disease, seasonal change of drug reserves can not keep up with demand, distribution scheduling is not timely and so on. These shortages can usually be quickly dispatched to restore supply. But if there is a general, diversity, and long-term shortage, it is not normal.
3. Low price, good curative effect and large sales of lifesaving medicine are the easiest to be short of.
The disappearance of market products is essentially a "market elimination". China's drug market has tens of thousands of drug production approval Numbers, eliminating some of the production of "zombie" products, which is good. Such selection should be enterprise competition and market selection, survival of the fittest, superior bad discard, but now a shortage of drugs mostly have production for many years, the craft is mature, obvious curative effect, the price is not high, clinical must product, the market exit mechanism, it is not optimal, largely bidding and bargain "secondary" varieties of non exclusive monopoly bargain, is the "adverse selection". The more the market needs and the bigger the sales, the easier it will be to be undercut, and the easier it will be to be eliminated.
In general, the substitution of drugs is strong, so the shortage is not easy to happen, and now it happens. Specific analysis: either narrow spectrum curative effect, alternative weak demand medicine shortage, or alternative medicine shortage. At the same time, it is not clear that some shortages have been covered by alternative medicines, and the severity of the shortage has not been sufficiently exposed.
These shortages, most of which are directly attributable to the fact that companies are unable to sustain production due to higher costs than prices, are economic shortfalls rather than technical shortages.
Economic shortage
According to the author's research, the current shortages of drug economy can be divided into three categories.
1. A shortage of price
Price is a condensation product value and use value, is the comprehensive result of cost and the supply and demand, and production, circulation, consumption is the most important economic factors, it through the market equilibrium on its own. As long as it is not mandated by the government, the actual price is naturally formed by the market.
Drugs ex-factory price now, and we have the administrative power, the influence of a provincial scale effect of centralized purchasing price, there are medical irrespective of form monopoly "secondary bargaining", combined with the practice of the national minimum price linkage, in addition to sole medicine, patent medicine, imported drugs for most of the drugs, ex-factory price is only retreat, once dropped below the cost line, the enterprise is unable to maintain a simple reproduction, could easily lead to outages, suspend production.
2. Shortage of liquidity
In the final sales of drugs, the price of sales is often several times that of a pharmaceutical factory, but more than half of the final sales price is a rigid "promotion fee", which also includes the grey part. The cost of liquidity, which is normally required, is also as low as productive costs, and it is difficult to maintain the normal operation of the enterprise.
The "two-ticket" system implemented by the state is normal and reasonable for most drugs, and is the rational choice for the lowest cost. But in rural and remote mountainous area, traffic inconvenience, even distribution in place, is also the cost is very high, so we can see several provinces in advancing the implementation of the policy in the region at the base to take some of the transition. Without the provisions of the provincial local government adjust measures to local conditions, drug firms will have to give up those high circulation cost of rural and remote areas, traffic inconvenience, mountains it's enterprise but is in line with the market economy rule of rational choice. In view of this, some provinces have already listed a number of regions based on the situation in this province, implementing easing policies and requiring drug companies to ensure that supply is in place. The scientific practice of seeking truth from facts and specific circumstances should be affirmed and promoted.
3. A shortage of quantity
A shortage of quantity is also a kind of price shortage, because eventually it can be traced back to price. However, due to its formation, formation process and direct pricing unreasonable price sex shortages have differences, so in this single column analysis.
Quantity and price have a natural connection. In the cost and scope of supply and demand determine the price of roughly common changes, because the cost of products with different composition, variable cost and fixed cost, according to the sales amount allocation of fixed costs, will be diluted by larger sales. Therefore, the normal product sales law is a large quantity and low price.
In many places, the centralized procurement of medicines is the practice of "price fixing and price change", which is why the economics of "centralized" procurement of drugs should be concentrated. But in some places, they only apply the word "price of price" and "change the price", and reject the substance of "the low price of quantity". And use the hospital monopoly advantage, in the purchase quantity is smaller than the provincial centralized purchasing, to bargain "secondary" mandatory at a low price, thus appeared less "low price" instead.
Without the scientific law of "low volume price" or "small amount of high price", it makes no sense to "value the price and change the price in quantity". So, just from the "secondary bargaining" in the province of purchasing amount will be lower than the entire province centralized purchasing purchasing quantity that say, "secondary bargaining" requirements on the basis of winning bids to reduce the price is not reasonable.
In addition, there is a problem with the quantity shortage, since it is the price of the quantity and the price is fixed, so the purchase quantity should be ensured. In fact, the amount of purchase comes from the doctor's prescription, which is difficult to be consistent with the purchase amount of the theoretical purchase in advance. More equitable and reasonable measures are needed.
Above three kinds of drug shortage phenomenon reflects the characteristic of three different kinds of drug shortage highlight reflect, if the product factory price is compressed into its profits only maintain simple reproduction, it will not be able to expand production of new product development. If the price of a product is compressed to a cost, its profit is zero or negative, and it can only stop production, a new shortage of drugs comes out.
At present, China's pharmaceutical industry the original medicine is very few, are generally considered to be technical reasons, but cannot be ruled out due to drug low-margin r&d spending less than a factor, it is logical and reasonable deduction. Now some places are coming out of the well-meaning of changing the status quo of the "doctor", arguing that the method of using administrative pressure will soon be effective, and the lowering of drug price is the main measure. In the short term, drug prices do drop, but there is a shortage of medicines. We must look at the matter in a matter-of-fact manner.
"We will deepen reform of the medical and health system in 2017 national key task" has been clear: the national guard planning department is responsible for the shortage of reform to perfect the drug supply security mechanism of the implementation opinions, is responsible for establishing and perfecting the shortage of drug monitoring and warning and classification system; The ministry of industry and information technology (miit) is responsible for expanding the production range of the shortage of medicines. So the drug shortage is expected to be resolved gradually.
The state has made it clear that the solution to the shortage of medicines is fixed-point production. It is reported that the provinces have taken the first step and hope to see the initial results of the experience.
In the context of excess capacity, it should not be a problem to select a number of drug manufacturers to produce those shortages of medicines that are easy to handle, cheap and urgently needed. As long as the price is appropriate, there must be a company actively participating. Medicine is to the doctor what rice is to the cooking. The emergence of a shortage of drugs is a reminder that millions of people can't be treated without medical care.
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