医保巨变,药企营销被彻底颠覆!

2018-03-23 遥望 赛柏蓝

超级医保局来了,有行业专家断言,药企回扣营销,2年之内,就会走到死路。随着国务院机构改革逐步落实,组建国家医疗保障局。有医药行业专家向赛柏蓝表示,集医疗服务与药品(含器械耗材)定价、购买支付、监督于一身的“超级医保局”即将挂牌。全面推行以按病种付费为重点的多元复合式医保支付方式改革也将全面提速,这有可能彻底改变医生诊疗行为、医院用药结构,而医药供应商的市场竞争规则也将被彻底颠覆。企业靠回扣致

超级医保局来了,有行业专家断言,药企回扣营销,2年之内,就会走到死路。

随着国务院机构改革逐步落实,组建国家医疗保障局。有医药行业专家向赛柏蓝表示,集医疗服务与药品(含器械耗材)定价、购买支付、监督于一身的“超级医保局”即将挂牌。

全面推行以按病种付费为重点的多元复合式医保支付方式改革也将全面提速,这有可能彻底改变医生诊疗行为、医院用药结构,而医药供应商的市场竞争规则也将被彻底颠覆。

企业靠回扣致胜的传统营销模式,日子不多了!药企再沉醉于用钱袋子驱动医生的处方笔,那真就是“祝自己继续困惑,继续不知死之将至。”

▍医保支付方式巨变彻底管住医生

3月20日,国家卫计委官网刊出《关于巩固破除以药补医成果持续深化公立医院综合改革的通知》(国卫体改发〔2018〕4号)(以下简称《通知》)。有专家透露这可能是以国家卫计委(医改办)名义最后一个医改文件了,其重要性不言而喻。

《通知》再次强调,扎实推进医保支付方式改革。贯彻落实《国务院办公厅关于进一步深化基本医疗保险支付方式改革的指导意见》(国办发〔2017〕55号),全面推行以按病种付费为重点的多元复合式医保支付方式,2018年国家统一确定100个以上的病种,指导各地推进实施。推进按疾病诊断相关分组(DRG)付费试点,完善按人头、按床日等多种付费方式。

其实,为控制医疗费用,推进医保支付方式改革等,国家卫生计生委、国家中医药管理局于2017年8月30日印发了《医疗机构临床路径管理指导原则》。

截止文件印发时,临床路径累计印发数量达到1212个,涵盖30余个临床专业,基本实现临床常见、多发疾病全覆盖,基本满足临床诊疗需要。

更有专家向赛柏蓝表示,随着明确临床路径的疾病越来越多,纳入按病种付费的病种也必将越来越多,未来,预计95%的药品都将被覆盖在按病种付费为主的多元付费方式之下。

相比于过去长期以来实行的医保按服务项目付费,按病种付费将极大改变医生的诊疗行为。

关于过去长期以来医保按服务项目付费,中国医药企业管理协会常务副会长牛正乾曾撰文分析,在现有按项目的医保付费机制下,某种程度上虽然能够调动医疗服务提供者的工作积极性,但很容易发生医生诱导需求和促使医疗机构提供过度医疗的现象。

在按项目付费机制下,只要医院针对医保患者使用医保目录内的品种,理论上就可以纳入医保支付(报销)范围。

又由于过去医院有15%的药品加成收益(2015年之前)或私下议价返利,销售药品就成为了医院的利润来源。

再加上存在给予医生回扣等违规行为,自然,医生在诊疗过程中,倾向于多用药、用贵药。

而在按项目付费的机制下,医生收受回扣行为和医院的利益并不矛盾,相反,医生回扣行为某种程度上还可以增加医院的收益(回扣多、药价贵,药价贵医院加成收益也就多),所以难以产生医院约束医生回扣行为的内生动力。

约束及稽查医生回扣行为似乎成了纠风办、纪委、卫计委等主管部门的事情,医院的实际动力并不大,睁一只眼闭一只眼的现象广泛存在。也就造成了药企靠回扣营销制胜的乱象。

而按病种付费是一种包干制,医院给医保患者在诊疗过程中使用的药品成为了医院的费用成本,销售药品不再是医院的利润来源。

按照社科院公共政策研究中心主任朱恒鹏的说法,在按病种付费之下,医生享有剩余索取权和剩余控制权。也就是“结余留用、超支分担”的原则。

也就是说,在按病种付费下,每个病种被预先设置一定的报销金额,节省下来的是医院自己的,医院花超了则要自行负担部分。显然,医院不会做赔本的生意。

这样一来,医生考虑的就不是以往的通过多检查、多开药等创收,而是节省诊疗费用。毕竟在按病种付费下,医生在诊疗过程中省钱反而是在为自己和医院赚钱了。

在这种付费机制下,当病种费用包干以后,医生如果继续有回扣行为,就会直接损害医院的收益,若回扣多必然导致药价高,从而使在打包费用之内,减少了医院的收益,医生的回扣行为和医院利益成了矛盾的、对立。

那么,过去医院对医生回扣行为“睁一只眼闭一只眼”的做法就会发生改变。

在包干制新的医保付费机制下,医院就有了约束医生回扣行为的内生动力,必然会改变对科室(医生)的考核规则,在医院新的考核规则下,医生的回扣行为的约束很可能由过去的“纠风办”变成了“临床科主任”,纠风办等管医生回扣行为难度很大,但科主任管医生不拿回扣应该难度不大。

有人会提出疑问,医生不拿回扣了,行吗?医生的收入太低,有的医生甚至灰色收入占了其收入的较大比例。实际上,医生不拿回扣可能收入更高。

▍医生不拿回扣赚的更多

除医保支付方式改革外,《通知》还提出,扩大公立医院薪酬制度改革试点。

《通知》要求积极做好试点工作,为探索建立适应我国医疗行业特点、体现以知识价值为导向的公立医院薪酬制度,调动医务人员的积极性、主动性、创造性,推动公立医院事业发展奠定基础。

除此次《通知》提及公立医院薪酬制度改革外,一年多以来,相关部门多次出台文件,推进公立医院薪酬制度改革试点。

随后,在2017年1月,国家人社部、财政部、卫计委、中医药管理局印发《人力资源社会保障部财政部国家卫生计生委国家中医药管理局关于开展公立医院薪酬制度改革试点工作的指导意见》,正式掀起公立医院薪酬制度改革试点的大潮。

同年10月9日,国务院常务会议指出要改善公立医院薪酬制度,要求人力资源社会保障部门牵头制定方案扩大公立医院薪酬制度改革试点,推动建立多劳多得、优绩优酬的激励机制。

在2017年12月12日,人社部、财政部等四部委再次印发《关于扩大公立医院薪酬制度改革试点的通知 》

2018年2月,在全国卫生计生工作会议上,薪酬制度改革被列为2018年十大卫生计生重点工作之一。

两会期间,总理在政府工作报告中更是强调要深化公立医院综合改革,协调推进医疗价格、人事薪酬、医保支付改革,提高医疗卫生服务质量,下大力气解决群众看病就医难题。

医生的合法收入究竟能不能提高?能不能提高到比灰色收入还高的水平?

有医药行业资深人士分析,如果医生拿药品回扣,假设药品的回扣比例是药品价格的25%。那么,医生每多拿100元的回扣,可能造成医疗费用支出增加400元,也就是,如果医生少拿100元回扣,就可以节省400元,假设医保付费机构把节省下来的400元,拿出200元作为激励,合法奖励给医生,这样医保费用还可以节省200元。

也就是,只要医生的薪酬激励机制设计合理,完全可以做到不拿回扣,合法收入比灰色收入更高,医保还可以大大节省费用。

医药企业,注意了,针对医生的薪酬激励机制,正在改变。

▍回扣营销走向死路

医生的诊疗行为,是医院用药结构形成的直接动因。长期以来,在药品高回扣的刺激下,医疗机构的用药仍然是价格虚高的药品占据绝对的主导地位,而中标价格较低的药品却很难给患者使用。

据赛柏蓝了解,多年前,中国医药企业管理协会常务副会长牛正乾直指这一现象的背后原因正是,不合理的医保付费机制没有发挥约束激励作用和药品加成管制政策的助推,造成了医院用药价格虚高,购销使用等环节的“回扣贿赂”现象。

在按项目付费的医保付费机制和药品价格加成管制政策下,药品正常的价格竞争机制失灵,谁的回扣多谁的销量就大,这倒逼药品生产经营企业建立“高定价、暗回扣”的营销体系,开展以回扣为主要手段的隐性畸形交易竞争。

同时,在过去医疗服务低价管制和药品加成管制这两大游戏规则的制约下,医院大多并不满足于15%的药品加成收益,而会通过形形色色的手段,让医药企业为自己提供各种各样的“服务”或“返点”,放任医生及其他相关人员向医药企业收取现金回扣。

然而,当按病种为主的多元医保付费机制改革实施后,药品在医院中由利润中心改变为费用成本,医疗机构的药品使用结构将发生根本变化。

在医院迫于医保付费改革的约束下,改变对科室(医生)的考核规则,医生在诊疗开具处方时,将由过去追求回扣,改变为追求药品的性价比,廉价的好药,将得到青睐。

目前虚高价格的药品将会被廉价药品、性价比高的药品所替代。

在按病种等包干制下,医生为医院节省的成本越多,很可能获得的奖励越多,而当合法奖励如果大于等于或者略少于回扣时,也就没有动力去拿回扣,况且还会迫于医院、科室给予的真正监督。

药品生产经营企业在营销过程中没有必要再采用“高定价、暗回扣”的非法营销模式。药品生产经营秩序将恢复正常,彼此之间的竞争不再是商业贿赂的竞争,而是质量、价格、服务、效率、管理的竞争,这种竞争环境下,医药企业的竞争规则将发生根本改变。

随着国家医疗保障局的成立,医保改革的加速,医生薪酬激励机制的逐步建立,药企传统的竞争规则将彻底颠覆。

请注意:“国办发〔2017〕55号”文件提出的改革目标是:全面推行以按病种付费为主的多元复合式医保支付方式。各地要选择一定数量的病种实施按病种付费,国家选择部分地区开展按疾病诊断相关分组(DRGs)付费试点,鼓励各地完善按人头、按床日等多种付费方式。

到2020年,医保支付方式改革覆盖所有医疗机构及医疗服务,全国范围内普遍实施适应不同疾病、不同服务特点的多元复合式医保支付方式,按项目付费占比明显下降。

记住:到2020年,医保支付方式改革覆盖所有医疗机构及医疗服务。时间紧迫,必须转型,过去靠回扣致胜的营销模式,真的日子不多了。

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    2018-03-24 patch_yyy

    学习了

    0

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    2018-03-24 小新伊森

    学习了

    0

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    2018-03-23 龙胆草

    学习谢谢分享

    0

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    2018-03-23 flysky120

    希望改革是好事

    0

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    2018-03-23 轩辕狼

    学习了

    0

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    2018-03-23 戒馋,懒,贪

    谢谢分享学习了

    0

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    2018-03-23 1ddf0692m34(暂无匿称)

    学习了.谢谢分享

    0

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    2018-03-23 1e160a78m83(暂无匿称)

    医院取消门诊药局是好事还是坏事

    0

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    2018-03-23 121e6640m66暂无昵称

    学习

    0

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    2018-03-23 131****1460

    学习了受益匪浅

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