Medical network May 24 - a few days ago, the state council reform office issued the deepening the reform of medical health system 2017 key tasks, the outflow of prescription was mentioned this issue again. This year's prescription outflow will focus on retail pharmacies, on the basis of last year's "hospital unrestricted prescription outflow". 

 

Health reform is put forward, the ministry of commerce, people club department, planning department, the food such as drug safety pharmaceutical regulatory coordination, across the country to explore retail pharmacies classification management, encourage the development of chain pharmacies, explore the prescribing information of medical institutions, health care billing info and drug retail spending connectivity, real-time information sharing. 

 

This means that the prescription outflow not previously existing healthcare docking, settlement and retail pharmacies is unable to undertake the outflow of prescription importance is given to the market situation, prescription lobbyists flow problem will become this year "reform" to promote the focus of the work. As a result, the arterial network (WeChat: vcbeat) has initially proposed a report on the trend of prescription outflow, and a brief discussion of the outside of the prescription hospital. 

 

One, the outside prescription flow is inevitable trend 

 

Medicine is a separate story 

 

Since the launch of health reform, "medical separation" has been the focus. The reasons behind the public medical institutions and personnel in our country is a large share of revenue from medicines, in medicine, medical compensation, uneven distribution of sources is opaque, transparent, regulation is not in place, easy to breed medical bribery, prescription is overweight, high medical costs. 

 

The purpose of "medical" separately, is to put the medicine out of income from the income of medical institutions, to cut off the drug bidding, medical institutions and medical workers with direct interests relationship between drug companies and drug dealers, to establish diagnosis and drug use separate operation systems and mechanisms. 

 

Policy, can be traced back to 2000, the state council reform office of the "instructional advice on the reform of medical health system in the town, according to the opinion for the first time, the medicine should be" separate accounting, management, unified due, reasonable return ", meaning is in the hospital within two books, drug income according to the new accounting system accounted independently, and at the same time, the drug income and expenses balances turned over to the administrative department of health, unified capture puts fiscal social security fund only door, after assessment of the overall arrangement, reasonable again returned to medical institutions. 

 

But separate "medicine" in the actual operation process, also has many problems, the most intuitive is the drug income from medical institutions, medical staff get benefit and labor pay do not match, a lack of interest compensation mechanism. In this case, the "medical" separately, and improve staff treatment problems, explore to improve gradually fee, the setting up of auxiliary means such as service charge of pharmaceutical affairs. 

 

The "Beijing health reform", which began in April, is a more comprehensive attempt at a separate implementation of medicine. Comprehensive reform of medicine "by the Beijing issued separate implementation plan", its main goal is by eliminating drug addition, set up the medical service, to achieve transformation of the operation mechanism of public medical institutions, to standardize medical behaviors. 

 

The specific way of implementing health reform in Beijing is to reduce the price and cost of the equipment, such as the purchase of the medical products and the cost of health insurance. And, Beijing health dynamic adjustment mechanism is set up on the price mechanism, through the regulation of public medical institutions running cost and income structure changes dynamically adjust YaoXie consumable price and medical service price, not only ensure patients go to a doctor to buy medicine has improved overall cost not, at the same time, clear medical staff labor value. 

 

Overall, "medical" separately with the public medical institutions control medicine proportion, cancel the drug addition, health care cost synergies, such as the drug during the process of public medical institutions run by the revenue into cost, reversed transmission public medical institutions for medical reform separately. 

 

Prescription outflow policy 

 

In implementing the "medicine to separate" the process of comprehensive reform, the outflow of prescription or outside the hospital prescription circulation is one of the key content, meaning that previously borne by hospital pharmacy drug supplies, pharmaceutical services should be gradually released into the other drug circulation channel is given priority to with retail pharmacies, ensuring patients buy medicine demand. 

 

On the policy side, the regulatory response to the prescription outflow is becoming clearer. From exploration in 2014 patients with "on prescription to the medical institutions or new mode" independent retail pharmacy to buy medicine for the patient's encouragement, in 2015 to "no limit prescription drain" hospital to hospital, in the latest 2017 years "reform" task "to explore the prescribing information of medical institutions and health care billing info and drug retail spending connectivity, real-time information sharing" to focus on cleaning the courtyard outside the prescription flow of systemic disorders. 

 

 

"Prescription outflow" policy review 

 

From a policy of progressive relationship can also see that regulators hope that through the implementation of prescription outflow to achieve the purpose of medicine apart, the first is to mobilize the enthusiasm of patients, clear prescription outflow obstacles, let patients can decide where to buy medicine. Followed by health care docking, prescribing information connectivity and improve patients in community pharmacies or other ways to buy medicine experience, on hospital pharmacy essentially "diversion". 

 

Second, the effect of prescription outflow on the industry 

 

Changes in the circulation of drugs 

 

Prescription outflow, the most visible change is the change of drug retail channels, mainly in the channel before drug retail will gradually to the social pharmacy, online pharmacies, such as channel flow, here we can see two groups of related data. 

 

First is the size of the whole medicine retail market, according to Chinese commerce industry research institute, the scale of domestic pharmaceutical terminal sales for 1.38 trillion, 2015, from the point of the three terminals, the terminal public hospitals accounted for 69%, the second terminal retail pharmacies terminal accounted for 22%, the third terminal public primary care terminal accounted for 9%, the proportion of the whole was 7:2:1. 

 

 

Drug retail market data 

 

In terms of the market for prescription drugs, data from IMS shows that China's prescription drug market was about 990 billion in 2015, accounting for about 70% of the total. In terms of concrete channel, because the prescription drugs sales must rely on doctors prescribe the and the doctor's advice, compared with the overall drug market, prescription drugs in the hospital sales proportion is higher. The three channels (hospitals, retail pharmacies, and third terminals) for the 2015 prescription market, which IMS offers, are 77%, 10% and 13% respectively. 

 

By industry in the process of separated medicine to flow to the outside of the court of the prescriptions of forecast, roughly judgment is the prescription for the next five years outflow about 1/5 of the total prescriptions of left and right sides, and presents the fast growth. Combined with the growth of the overall pharmaceutical retail market, the prescription outflow is expected to generate over $250 billion in retail pharmacies by 2018. By 2020, the prescription drug will reach a third of the total, and the market is nearly 800 billion. 

 

 

The market for prescription outflows is expected 

 

The effect of the prescription outflow on the downstream of the industrial chain 

 

It should be noted that the change in market size caused by prescription outflows is not an "incremental", but a reinvention of the original pharmaceutical distribution. Now that involve reshaping, then it will lead to redistribution industry related party interests, from the Angle of the terminal patients, will force the shift diagnosis and buy medicine program. 

 

We analyzed the chain from the top down. For pharmaceutical industry enterprises, due to long-term in sales and marketing channels for hospital, formed the academic promotion, marketing system of medical representatives, if change sales channels, its must be outside channels to promote hospital in time to make corresponding adjustment. In addition to meet the need of outside sources of hospital marketing costs, it involves the interests distribution marketing team have been established, and probably because of the internal interest distribution mechanism caused by not timely response to market changes, eventually lost part of the courtyard outside the market share. 

 

For medicine circulation enterprises, the distribution mode of enterprise aside, most of the enterprises on the market or the way such as pure pin, once the prescription outflows, means its handling of the market share will be shrunk dramatically. This will also cause some small, pure marketing companies to face operational difficulties or seek consolidation. Under pure pin pathways to play an important role in medicine and natural persons, are perhaps more fatal blow, the reason is that the existence of the business logic of the fracture, the market has no longer need it as a business link point exists, the master of medical resources cannot be converted to more medicines in circulation. 

 

For medical institutions, the top involving consideration is the opaque drug extra benefits cut off, but it is difficult to in the short term after the cut off the other in the form of administrative measures to improve the treatment, even by setting up medical service fee, compensation fee and so on way, but the original drug income, there will be shrunk dramatically. At the same time, the medical auxiliary policies such as the control medicine accounted for separately, zero price difference, measures such as two votes would lose gray behavior more survival soil, further compressed profit space. 

 

For patients, the one-stop process of a doctor's purchase is broken down to the ends, which can easily break the experience. In response, patients may be more likely to consider the formal safety of the drug when they are taking drugs outside the hospital, and who will be responsible for the accident if there is an accident. There is also a shortage of professional services compared to the hospital. These are the resistance of patients to buy drugs outside the hospital, and they will be there for a long time. 

 

How to accept the prescription outflow 

 

How do retail pharmacies take on prescription outflows 

 

Can be seen from the relevant planning under the state council also, retail pharmacies will become prescription outflow to undertake the main body, if undertake goes well, a few years, scale of retail pharmacies will multiply, this is great news for the retail pharmacies. 

 

 

The scale and growth of retail pharmacies in our country (data source: institute of Chinese studies) 

 

From the scale of retail pharmacies data also shows that in the past five years while the market continues to grow in size, but you have a sharp drop in growth has a peak, retail pharmacies urgently needs to find a new growth point in response to the weakness of growth. 

 

From the development of retail pharmacies in our country, there are several problems. Chain, one is the market rate is low, the national food administration of drug safety, according to statistics, 2015 by the end of 4981 the national pharmaceutical retail chain enterprises, retail chain stores in 20.4, the number of monomer drugstores is 24.3 m, the chain rate was 45.5%. Low linkage rates mean there is no scale to operate, and there is no scale effect on cost control and overall quality. 

 

The second is the low concentration of markets and the lack of national champions. Data show that in 2015 China's top ten chain stores sales total accounted for only 17.04% in the retail industry, horizontal contrast, medicine circulation industry before the big three of the size of the market is almost one-third of the total market size. 

 

The third is the lack of specialized services, the most intuitive of which is the gap in the number of pharmacists. According to the national food drug administration center of attestation of qualification of licensed pharmacists, data released as of December 31, 2016, the number of the registration of licensed pharmacist was 342109, registered in community pharmacies and medical institutions of licensed pharmacists, 303329, the average population of just 2.2 people. In terms of the 44 m pharmacy, the average per pharmacy has less than 1, the number of licensed pharmacists means that patients can't enjoy in pharmacy professional pharmacy practice. 

 

For patients worry about the problem of drug is not normal, not safe, retail pharmacies should also in the supply chain security, brand construction, in order to meet the service requirements of patients. 

 

In addition, DTP pharmacies, as an innovative model for retail, have a certain advantage in the process of prescribing an outflow. But in input costs, qualification requirements, professional services also relatively general pharmacy has a higher demand, retail pharmacies choice by the DTP incoming pharmacy prescription outflows, should be comprehensive measure between the input and output. 

 

In general, the prescription outflow will lead to huge opportunities for the retail pharmacies, but retail pharmacies should continuously optimize itself, ensure that both hard and soft strength, specific category, drug use is a good Angle, chronic diseases, common diseases. 

 

How does the Internet medical treatment carry out the prescription outflow 

 

In addition to offline retail pharmacies, Internet medical will also benefit in the process of prescription outflow, such as medicine, electricity, medicine, O2O, Internet hospital related industries. 

 

The judge set up front is "telemedicine" and "electronic prescription" rapid promotion and popularization, this two kinds of transformation to solve the Internet medical enterprises lack of medical resources and the problem of unable to get the prescription, through the access path of telemedicine, connected to the doctors can easily return visit, follow-up, rehabilitation for patients with medical services, such as electronic prescriptions issued at the same time, the separated medicine interaction from new together, go to a doctor to buy medicine experience on continuous. 

 

From the point of the case of has been implemented, both the government leading and electronic prescription pilot, classification of diagnosis and treatment also have Internet medical treatment, medicine, electricity companies seeking to build "closed loop". We have collected several cases for you to analyze the specific modes of operation. 

 

In the above case, of course, there are many problems, such as remote diagnosis and treatment can't accurate judgment of the patient's condition, on the prescriptions of bad control, doctor, the curative effects are probably more prescriptions, under heavy drugs, prescription of excess, in addition, in this the directivity of cooperation, also may be associated with interests, encourage similar to medical bribery grey behavior. 

 

Prescription outflow for medical treatment, medicine, electricity, medicine, O2O Internet companies influence is not consistent, Internet medical need for the platform of doctor-patient communication and electronic prescription, offline pharmacy, medicine, electricity, O2O is the final medical provider. In the process of Internet medical hospital (the Internet) to provide the benefits of doctor-patient communication platform, offline pharmacy, medicine, electricity, medicine, O2O is drug sales revenues, although some companies now have "medicine closed-loop" trend, but should be clarified a few of the interests of the different sources, roll out because of a wide range of online diagnosis and treatment + drug purchase behavior, not a single enterprise can be completely covered. 

 

Taken together, the prescription drug circulation structure under the outside circulation policy to promote a major shift, involved in all aspects of drug circulation, is a matter of industry related party interests, should be early layout to cope with change.