Regarding the scope of the special rectification of "secondary bargaining" defined in the notice, the author consulted the relevant responsible personnel of the Finance Department of the Hunan Provincial Health Commission, and received the reply: This "secondary bargaining" rectification focuses on the behavior of public hospitals not settling according to the agreed purchase and sale prices in order to obtain irregular rebates. At present, most hospitals in Hunan Province are involved in "secondary bargaining" rebates to varying degrees and in different forms, such as bearing the cost of drug consumption fund recovery and deducting penalties for excessive drug use as the name and method of rebates.

The rebate income from "secondary bargaining" is used by hospitals to supplement related operating costs. This time, the Hunan Provincial Health and Health System carried out a special rectification work on "secondary bargaining" of drug consumption, requiring it to be completed in October. In terms of action, the "secondary bargaining" behavior was immediately stopped and the rebate funds already obtained were cleared. Its blade is pointed inward, which can be described as "fast", "accurate" and "ruthless".

The rectification of "secondary bargaining" is essentially a supplementary measure to the zero-margin policy for drug consumption. By rectifying the "secondary bargaining" and cutting off the profit chain of using drugs to support doctors, it is a necessary means to further promote the reform of the three medical linkages and the coordinated development of the three medical systems.

Coincidentally, on August 19, the Hunan Provincial Medical Insurance Bureau issued the "Notice on Further Strengthening the Management of Sunshine Centralized Procurement of Drugs and Medical Consumables in Public Medical Institutions". The notice requires: For products outside the selected catalog of centralized volume procurement, medical institutions should conduct online bargaining with manufacturers, and the negotiated price shall not be higher than the online price. Bargaining between medical institutions and manufacturers should be conducted on the "Autonomous Bargaining System" of the Medical Insurance Procurement Management System, and procurement should be carried out at the price agreed by both parties, and the effective transaction price should be fully presented in the "Procurement Transaction Information" of the Medical Insurance Procurement Management System. At the same time, any disguised rebate, rebate, kickback and other illegal behaviors such as low-price purchase and high-price sale and explicit discounts and hidden deductions during settlement are strictly prohibited. Strictly implement the selected price of centralized volume procurement, and medical institutions shall not conduct "secondary bargaining" for the selected products of centralized volume procurement.

Implementing the volume-based procurement principles of the medical insurance department of "unified procurement" and "quantity for price" and not engaging in "secondary bargaining" in the use link is a manifestation of the government's credibility and contractual spirit. Does online bargaining between medical institutions and manufacturers belong to "secondary bargaining"? The relevant person in charge of the Finance Department of the Hunan Provincial Health Commission replied to the author: Online bargaining does not belong to "secondary bargaining" and does not contradict the notice of the Hunan Provincial Medical Insurance Bureau. There is no agreement requirement for unified quantity and price for products outside the selected catalog of centralized volume-based procurement, and because online bargaining can be checked and controlled, hospitals can only sell at zero margin and do not have the conditions to make profits from drugs. Therefore, the medical insurance department encourages hospitals to bargain online in accordance with relevant requirements and business logic.

Faced with increasingly stringent medical insurance payment requirements, the operating pressure of hospitals has become increasingly severe, and cost reduction and efficiency improvement have become the core content of hospital lean management and sustainable development. The income from "secondary bargaining" has been cut off, and the operating difficulties of hospitals may be further aggravated. So, what other impacts will "secondary bargaining" bring?

It is easy to stop but difficult to clear. The digital invoices that the country is vigorously promoting, the rebate red-letter electronic invoices correspond to the actual settlement unit price of the "secondary bargaining" drugs, and the hidden rebate will be controlled by the tax system. Pharmaceutical companies will find it difficult to continue to cooperate with price cuts and profit sharing due to the influence of the price system, and hospitals will also lose the motivation for "secondary bargaining" due to the exposure of actual settlement prices and the requirement of zero difference. Obviously, digital invoice management has become a technical means to cut off drug rebates. Stopping "secondary bargaining" is a management means to break the drug-supported medical system.

Two-pronged approach will surely end the stubborn disease of "secondary bargaining". The government has the responsibility to invest in public hospitals, which is determined by the public welfare of public hospitals. In recent years, the investment gap has become the main contradiction affecting the operation of public hospitals. It is not difficult to foresee that to clear the funds obtained from "secondary bargaining", relying solely on the current financial investment of the government, it will face the possibility of implementation difficulties.

Delaying the repayment may become the priority of hospitals. It has become a common phenomenon that the repayment cycle of hospitals has been continuously extended. The "secondary bargaining" rebates of some hospitals are implemented in the name of alleviating funding costs. The income from "secondary bargaining" is unsustainable, which will objectively put pressure on the hospital's capital payment. Delayed payment of the third-party service of the pharmaceutical supply chain has become an important way for hospitals to transfer the cost of drug consumption management in hospitals. The way some pharmaceutical companies obtain business shares through the construction of projects such as smart pharmacies has become difficult to solve the fundamental problems of hospitals. The huge costs of personnel, logistics, etc. have become operational problems that hospitals cannot overcome.

The third-party service of the pharmaceutical supply chain, which mainly uses drug consumption SPD, has become an advanced tool for hospital drug consumption management with its increasingly mature operating model. By charging service fees instead of exchanging business shares, the third-party service of the pharmaceutical supply chain has become a more compliant solution for drug consumption management in hospitals. Breaking the core requirement of the reform of the three medical linkages is to break the medical support of drugs, and any profit-making behavior of drugs will be strictly controlled. Improving the professional ability and value of medical care, realizing the cage-changing of medical income, and pursuing the positioning of health management organization centered on health are the correct paths to promote the high-quality development of hospitals.

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