"The success of medical reform will come when graded diagnosis and treatment is realized." Some time ago, the relevant person in charge of the National Health and Family Planning Commission said. In September last year, The State Council issued the "Guiding Opinions on promoting the construction of hierarchical diagnosis and treatment system" (No. 70) clearly put forward the goals of hierarchical diagnosis and treatment, "two years of gradual improvement, initial results; Five years of comprehensive promotion, mature and stereotyped ". At present, nearly 20 provinces and cities in the country have introduced graded diagnosis and treatment policies, and various forms of medical union, "three-division co-management" and "1+1+1 voluntary signing" have been wonderful. The pilot diseases include hypertension, diabetes, cardiovascular and cerebrovascular diseases and tumors, covering the most concentrated spectrum of diseases.

What impact will supply-side reform have on the market pattern? How are companies responding?

Affect the future market pattern

1. Changes in market structure;

A number of professional organizations at home and abroad have jointly conducted a comprehensive assessment of the disease in China. Studies have shown that urbanization, rising incomes and ageing have led to a surge in non-communicable diseases. In 1990, China was very similar to other developing countries in that the main diseases causing health damage to residents were chronic obstructive pulmonary disease, lower respiratory tract infections, and stroke. Twenty years later, the main diseases that damage health are malignant tumors, heart disease, cerebrovascular disease. The assessment also shows that dietary factors, high blood pressure and tobacco are the main risk factors affecting the life expectancy of Chinese residents.

Changes in the structure of diseases determine the structural changes in the drug market, and the market shares of the major categories closely related to the top four diseases, anti-tumor, cardiovascular, central nervous system, and digestive tract, continue to rise. The combined market share of these four major classes of drugs is expected to be more than half, reaching 51.8% in 2019. Among the 11 chronic diseases studied in IMS, hypertension, dyslipidemia and diabetes were the three diseases with the largest drug use scale. The category structure of the grass-roots market will undergo major changes, and hypertension, diabetes, cardiovascular and cerebrovascular diseases, respiratory diseases, advanced tumors, and chronic kidney disease related to chronic diseases will become the main players, and the market size and market proportion will both increase.

In the end-market structure, public hospitals still dominate the market, reaching 69% in 2014. The share of primary medical institutions increased from 8% to 9%, while the share of retail terminals decreased from 26% to 23%. With the comprehensive and in-depth promotion of hierarchical diagnosis and treatment, the proportion of drug use in large urban public hospitals is expected to decline, and the grassroots market is rising rapidly. With the support of relevant policies such as e-commerce and medical insurance, retail has ushered in a new development inflection point. E-commerce could become an important terminal channel. The diversified and balanced development of terminal markets such as large hospitals, grassroots markets, retail, and e-commerce has better adapted to the new changes in medical services and drug demand.

2. Changes in consumption behavior;

The number of deaths caused by chronic diseases in China accounts for 85% of the total number of deaths in the country, and the burden of medical expenses accounts for 70% of the national disease burden. Due to the weak capacity at the grass-roots level, fewer types of drugs and other reasons, a large number of chronic patients are used to flock to large hospitals. According to the survey, 83-85% of the outpatient patients in large hospitals are chronic patients, among which hypertension and diabetes occupy the majority of chronic diseases, and they only prescribe drugs to contribute 30% of the outpatient volume in tertiary hospitals.

The graded diagnosis and treatment practice of Xiamen City shows that from January to July 2015, the number of general outpatient consultations in the city\'s tertiary hospitals decreased by 15.5% compared with the same period last year, while the number of grassroots community diagnosis and treatment services increased by 36.3% compared with the same period last year. Xiamen\'s reform goal is to reduce the number of outpatient visits in tertiary hospitals by more than 35 percent year-on-year by the end of 2015, and increase them by more than 35 percent in primary hospitals.

Hierarchical diagnosis and treatment brings great adjustment to the distribution structure of terminal consumption. Within two years, 90% of patients will stay in the county for treatment, and more than 70% of residents will choose primary medical institutions for illness within two weeks, which means that within two years, about 1/5-1/3 of the outpatient volume of tertiary hospitals will be diverted to the grassroots, and the drug needs of patients who are falling may be met in multiple channels, including community health, social pharmacies, DTP pharmacies, e-commerce and other channels.

Adjust business strategies in response to changes

"Strengthening the grassroots and building the mechanism" is the basic direction of medical reform. With the deepening of the integrated reform, the service capacity of community health institutions will be improved, and part of the outpatient volume of tertiary hospitals will be transferred to the grass-roots level. Other end markets such as community health, social pharmacy, and pharmaceutical e-commerce may generate more incremental opportunities. The basic level is strong, the mechanism is alive, the patient is sinking, and the terminal differentiation is an irresistible trend.

Under the new situation, enterprises should take precautions, change due to the situation, adjust business strategies, and seriously think about where customers are going. How has customer behavior changed? Who else can we serve? Are existing products and services adapted to new changes? What does the mission of the company require in the new stage... Let\'s wait.

1, different measures, pay attention to health needs;

Hierarchical diagnosis and treatment not only changes the patient\'s medical behavior, but also promotes the change of health concept. Under the guidance and intervention of medical staff such as general practitioners, patients\' medical behavior and lifestyle will change. Subdivided groups of patients with different chronic diseases such as hypertension, diabetes, and stroke, their product demand is no longer limited to drugs, but has expanded to related household medical devices, nutrition products, health products and other related products. There will also be a lot of information consultation, healthy life and other service needs.

Accordingly, enterprises should pay attention to the changes in the needs of target groups, conduct in-depth research on the needs of products and services, and optimize the product and service portfolio of enterprises on this basis to achieve transformation and development.

2. Service extension to expand medical and health boundaries;

Promoting hierarchical diagnosis and treatment is a systematic project, and the health system is the first to face many challenges and pressures. For example, how to increase the number of general practitioners and enhance their capacity training? How to effectively control the cost of pharmacies? After a large number of chronic patients sink, how to meet the multi-level drug demand? How to improve informatization, effectively support management and services? How to establish a broad and effective disease management system...... Customer difficulties are new market opportunities. These challenges and pressures put forward new issues for enterprises, can expand the boundaries of medical and pharmaceutical services, extend into the medical system, help customers solve key problems, so as to achieve new development?

Commercial enterprises specializing in logistics services and supply chain management can explore cooperation in logistics service extension, pharmacy trusteeship, prescription dispensing and other ways, and can also help community health service institutions in variety supply assurance, information technology and disease management. For example, Shanghai\'s community comprehensive reform has explored the way of prescription dispensing in designated pharmacies, and drug manufacturing enterprises also have room to expand, and there are opportunities to expand service boundaries in terms of general practitioner training, disease management, and medication compliance.

3. Service outsourcing, deepening industrial and commercial cooperation;

For pharmaceutical manufacturing enterprises, especially brand high-end pharmaceutical enterprises, the city hospital market has always been the core, with the largest investment in operating resources and the largest contribution to sales. The grass-roots market is called the non-target market, or the broad market, there is no professional marketing team, and the customer management is relatively extensive. Now the pattern of the market has quietly changed, the target population is no longer concentrated in large hospitals, how do pharmaceutical companies adjust their business strategies? How to optimize organization and resource allocation? How to serve flat markets more efficiently and cost-effectively?

The dilemmas facing industrial companies need not be confined to the search for internal solutions. The transformation and upgrading of commercial enterprises progress rapidly, the national network, deep distribution, modern logistics, medical e-commerce, prescription dispensing, etc., extremely rich distribution service functions can undertake customer management and market services of industrial enterprises in the grass-roots market. Outsourcing part of the business of pharmaceutical companies to distribution companies is one of the basic trends in the future. Earlier this year, Bayer joined hands with Shangyao Holdings. In the next five years, Shanghai Pharmaceutical Holdings will "integrate total" Bayer\'s "white and black" and other five brand drugs in the Chinese market commercial operations. Similar service outsourcing cases will be performed among more pharmaceutical business enterprises.

4, innovation-driven, embrace the "Internet +";

The intervention of the Internet provides an efficient and feasible path for graded diagnosis and treatment. "Internet + medical" brings big data advantages, experts and grassroots doctors online communication, discuss cases, remote consultation, improve the efficiency of high-quality medical resources. At the end of last year, Wuzhen Internet Hospital was officially launched and tried online diagnosis and treatment, electronic medical record sharing, electronic prescription and other services for the first time. The Internet hospital connects big hospitals and big doctors upward, grassroots hospitals and grassroots doctors downward, and connects medical, insurance and medicine in the middle, which is essentially a big platform for graded diagnosis and treatment on the Internet.

Decentralization and flattening are important features of the future of the pharmaceutical market, showing a common trend in the Internet era. Medicine should also "+ Internet", e-commerce is more suitable for customers scattered, a small single point of the grass-roots market, "connect everything" and "always online" advantages, it is easier for enterprises to communicate with customers efficiently. Production enterprises to expand the Internet thinking, user experience, simple, extreme, iterative...... Product innovation has more sources. Distribution enterprises to expand the Internet thinking, user experience, socialization, big data, platform, cross-border, service expansion has unlimited space. These are not the worst of times. They may be better times.

Information source Medical Economic News