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| Pharmacy trusteeship: is it a monopoly market, or is medicine separate? |
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| Author：中國銘鉉 企劃部 Release Time：2017-8-17 14:49:17 Number Browse：922 |
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Medical network - on August 17, recently, the national development and reform commission of guangdong province is the pharmacy trusteeship antitrust enforcement behavior guide for advice, specify the public hospitals, pharmaceutical companies could face of monopoly behavior in the pharmacy trusteeship, this will undoubtedly become a pharmacy trusteeship challenges of public hospital reform stage.
And promulgated by the state council in February "on further reform and improve the use policy for producing and distributing medicines of several opinions, clearly put forward the strategies of the separated medicine is" qualified can explore the outpatient pharmacy from medical institutions. Explore the prescription information of medical institutions, the information of medical insurance settlement information and drug retail consumption information connectivity and real-time sharing. The regulations provide a basis for the legality of pharmacy trusteeship.
So, is pharmacy custody a monopoly, or is it a medical separation? This is a more complex problem, and it means that the process of implementing the pharmacy will not be easy. This paper will analyze the problem.
The pharmacy trust market is potentially dangerous
Public hospitals and medical revenue sharing agreement signed between enterprises suspected of vertical monopoly, while medicine division sales agreement signed between enterprises has a horizontal monopoly
Pharmacies are hosted by government-controlled pharmacies, and there are voluntary pharmacies between public hospitals and pharmaceutical companies. Is typical of the former in November 2014, hubei province development planning commission joint industrial and commercial bureau, price bureau, food drug administration departments jointly issued "on the strengthening of the public hospital pharmacy trusteeship management work in guidance (trial)" file, by pharmaceutical companies to question is the administrative monopoly, government support local 89 pharmaceutical enterprises in hubei province joint opposition. So, later the pharmacy trusteeship is mainly spontaneous behavior between public hospitals and pharmaceutical companies, generally have agreement, clear public hospital and pharmaceutical enterprise revenue sharing, consign hospital outpatient pharmacy, pharmaceutical enterprises, ownership, personnel, facilities and equipment hosting of pharmaceutical enterprises.
According to the research of the monopoly of economics, the real monopoly is the administrative monopoly, because under the administrative intervention, potential competitors have always exit the market, the existing operators have no competitive threat. This means the government should not intervene in the pharmacy. Article 8 of the anti-monopoly law also stipulates that "administrative organs and organizations authorized by law and regulations shall not abuse the administrative power to exclude or restrict competition".
So, is there a monopoly in the voluntary pharmacy between public hospitals and medical enterprises? According to the definition of "anti-monopoly law" article 3 monopoly, pharmacy trusteeship almost met all defined requirements: (1) public hospitals are generally will be commissioned a medicine outpatient pharmacy enterprise management, and have the agreement signed, this constitutes "operator monopoly agreement", also "has or may have effect of eliminate or restrict competition concentration". Public hospitals are in an absolute monopoly in the pharmaceutical market and have the power to "give who can give them to the outpatient pharmacy", which constitutes "operator abuse of market dominance".
Further into the process of pharmacy trusteeship, public hospitals and medical revenue sharing agreement signed between enterprises suspected of vertical monopoly, while medicine division sales agreement signed between enterprises has a horizontal monopoly. The legal basis that the pharmacy can find is that the concentration of operators in article 15 of the anti-monopoly law for the purpose of "specialization of division of labor" does not constitute a vertical monopoly and a horizontal monopoly.
Logically, the pharmacy is beneficial to hospital pharmacists to transform the work from selling drugs to clinical pharmacy professionalization service, which is beneficial to the specialized division of labor within the hospital. Pharmacy trusteeship, however, also affects the medical market bargaining power, all managed pharmacy pharmaceutical enterprise bargaining strength obvious enhancement, public hospital medical market formed with the core of public hospital bargaining power, it will be harmful to the pharmaceutical industry division of labor, is not conducive to new drug research and development, more conducive to rent-seeking behavior.
Again, the pharmacy trusteeship (including pharmaceutical supply chain extension, pharmaceutical supply chain outsourcing, cancel outpatient pharmacy) also try to vertical integration and information integration in the design of the system, reducing the transaction cost under the background of current policy. Such as the guangzhou women and children health care center of the pearl river new city park cancelled the outpatient pharmacy, by popular medicine fu center store the exercise of the functions, and the pharmacy service for the hospital patients, pharmacy and hospital information interconnection, patients in the hospital pay cost, enjoy treatment of medical treatment insurance. This pattern is "door inn", but because realize information interconnection, as well as the further realization of other social pharmacy share with the information Internet, communication, public hospital laid the foundation, is a kind of beneficial attempt.
Pharmacy trusteeship is a transitional measure of medical separation
Even under the drug control policy, the drug revenue at outpatient pharmacy in the hospital is very significant. It is only in the pharmacy management policy that the public hospital has the time to adjust the income structure, and it is possible that it will voluntarily abandon the hospital outpatient pharmacy in the future
Although the pharmacy trusteeship suspected monopoly, but due to the reform of public hospitals in pharmaceutical drug income losses arising from zero bonus policy gap is too big, and public hospital income structure has not been adjusted to compensate for drug loss of income level, hospital outpatient pharmacy drug income is of great significance for public hospitals still. Therefore, after the reform of public hospitals, it has been proved that the problematic pharmacy trusteeship is still the preferred coping strategy of public hospitals.
However, due to the pharmacy trusteeship is essentially legalise drugs addition income through the benefit sharing agreement, and not completely cut off in public hospitals, doctors, pharmaceutical enterprise between the interests of the chain, may strengthen the interests the chain instead. In addition, the final mark of medical separation should be that hospital pharmacists specialize in clinical pharmacy services without pharmaceutical sales. And the pharmacy trusteeship is a powerful way to strengthen sales of drugs, which means that it is a stretch to take "pharmacy" as a form of "medicine separation".
So, does this mean that the pharmacy can be abandoned and the hospital pharmacy removed from the public hospital? The question concerns whether medicine is divided by gradual reform or radical reform. Throughout the world no one country the radical reform success is used for medicine, separately or as in the United States, Canada and so on are natural evolution in medicine, or divide the medicine like Japan of reforming social governance. So inevitably there will be a separate "medicine" transition stage, and at this stage, Japan has a "door inn", these pharmacies and hospitals in related party transactions, weaken the prescription of separate flow and pharmaceutical policy, but also really start medicine separate policies laid the foundation for the next step.
At the present stage, pharmacy trusteeship is the transitional stage of "medical separation". It is only through this stage that it is possible to realize the dissection of outpatient pharmacy in the hospital. Because even in medicine accounted for under the policy, remaining in the hospital drugs accounted for 30%, hospital outpatient pharmacy drug absolute quantity for public hospitals is still very considerable income, in the short term is unlikely to abandon the interests of public hospital. Only in the case of pharmacy custodian policy, can the public hospital have the time to adjust the income structure, and in the future, they may voluntarily abandon the outpatient pharmacy in the hospital. But there is also a danger that pharmacies will lead to new interest groups that will be harder to reform in the future.
Conclusion > > >
What should I do in the future? This requires a trade-off between medicine and medicine. Pharmacy trusteeship suspected monopoly, has negative effect for the pharmaceutical industry structure adjustment, but for hospital pharmacists in clinical pharmaceutical care professional has positive effect, for the time is right for stripping laying a foundation for hospital pharmacy. Of course, it is also important to monitor the influence of the monopolistic behaviors generated by the custodian in the pharmaceutical market to prevent the emergence of new interest groups. Like in guangdong province is put forward for the pharmacy trusteeship constraint mechanism, enhance competition and pharmaceutical innovation, form a benign medicine industry structure. (the writer is an associate professor of medicine and health management, shandong university)
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