Here comes the wolf! After the dental implant collection, is the doctor still motivated?

The “Central Collection of Dental Implants”, which has been subject to many disputes over its feasibility, has finally come to an end.

On the evening of August 18th, the National Medical Insurance Bureau issued the “Notice on Carrying out Special Treatment of Oral Implant Medical Service Fees and Consumables Prices (Draft for Comment)” (hereinafter referred to as “Draft for Comment”) , it is clear that it will organize the special management of dental implant medical service charges and consumables prices to standardize dental medical services and consumables charges.

The “Draft for Comments” has a total of 12 articles, focusing on standardizing the charging method of oral implants, regulating the price of the whole process of dental implants, and implementing the centralized procurement of implants.

It is worth noting that the Ningbo Municipal Medical Insurance Bureau and the Sichuan Provincial Medical Insurance Bureau have respectively explored the payment of dental implant medical insurance and the centralized procurement of consumables.

Among them, the Ningbo Municipal Medical Insurance Bureau adopted the measure of “the overall price limit of dental implant consumables and medical service costs”, and specified that each domestic brand is 3,000 yuan, and each imported brand is 3,500 yuan. The price consists of two parts: consumables and service fees, including 1,000 yuan for domestic consumables, 1,500 yuan for imported consumables, and 2,000 yuan for medical services.

Sichuan Provincial Medical Insurance Bureau took the lead in organizing the “Inter-Provincial Alliance Oral Implant System Centralized and Quantitative Procurement”, and took the lead in launching information on products such as oral implants, prosthetic abutments, and implant prosthetic accessories. Fill out the work.

At the beginning of 2022, Chen Jinfu, deputy director of the National Medical Insurance Bureau, revealed at the regular briefing of the State Council that dental implant consumables are one of the high-value medical consumables that will be focused on in 2022. It is also clarified that the centralized procurement of dental implant consumables by the provincial alliance organized by the Sichuan Medical Insurance Bureau is a centralized procurement method under the leadership of the state, focusing on the exploration of dental implants. And mentioned the plan of “strive to launch in the first half of 2022”.

However, the middle of the year has passed, and there has been no sound in the collection of dental implant consumables by the Sichuan Provincial Alliance.

Some industry insiders said it was “very stressful.” This is mainly due to the unique clinical and commercial environment of dental implants:

First, there is not much room for gold sales in the cost of dental implant materials, and the doctor’s income mainly comes from medical service fees.

Second, dental implants belong to the field of consumer medical care. For the medical solutions for “missing teeth”, there are cheaper “fixed dentures” and “movable dentures”, etc., the Medical Insurance Bureau Although it is based on the starting point of serving people’s livelihood, its interference with market behavior is limited;

Thirdly, the number of public hospitals and private institutions in the medical institutions that carry out dental implants is “28”. If private medical care is not motivated, it will be difficult to increase the amount of centralized procurement ;

Fourth, there is still a gap between domestic implant technology and overseas developed countries, and the supply of high-quality implants is insufficient, which also makes centralized procurement face a qualitative test;

This “Draft for Comments” addresses the above issues in a targeted manner.

However, it is worth discussing that dental implants are one of the few clinical areas where “doctors’ medical services are not low-paid”. Under the “double price limit” of consumables and medical service costs, can dentists still be motivated? While the centralized procurement of dental consumables benefits patients, what new variables will it bring to the dental medical industry?

How to reduce the cost of 3000 implants and 7000 dental implants?

2999 and 1999 are the “affordable prices” given by many dental clinics. However, after the actual dental implantation, consumers discovered that the actual dental implantation cost ranges from about 6,000 yuan to 7,000 yuan. The difference in the middle mainly includes other consumables fees, doctor service fees, etc.

Unlike other medical services, dental implants are expensive, and not just because of high-value consumables.

According to the research conducted by the Pacific Research Institute, after the price of dental implants is split, its proportion is implants(50%)< strong>, operation fee + anesthesia fee(25%), repair material(10%), implant base (5%), crown fee(5%).

Therefore, if you want to reduce the price of dental implants, the centralized procurement of consumables is not enough.

Previously, the “double price limit” method of consumables + medical services developed in Ningbo, Zhejiang Province has been used in this national recruitment.

According to the “Draft for Comments”, the charging methods for dental implant medical services and consumables will be standardized. This specifically includes:

(1) Promoting the “separation of technology and consumption” in dental implant medical services in an orderly manner.

The charging method of “service items + special consumables” is adopted separately. Implant consumables such as implants, crowns, bone powder and their corresponding medical services are priced separately.

(2) Guide the formation of a reasonable price for dental implant crowns.

Online purchase of dental implant crowns is implemented, and public medical institutions independently choose according to clinical needs, and sell them at “zero mark-up” of the actual purchase price.

(3) Standardize and integrate the price items of oral implants.

Distinguish the technical difficulty and output of multiple stages of dental implants, conventional first-stage implantation surgery (implant placement), second-stage surgery (placement of healing abutments), crowns Placement services, etc. are explicitly included.

Complex implant surgeries such as complex full-arch restoration implants and maxillary sinus bone grafting can clearly reflect differences in the price of medical services.

Under the “double price limit”, what should I do if the hospital lacks power?

“Double price caps” on consumables and medical services may make medical institutions less motivated.

Dental implants are one of the few clinical areas where physicians are “well paid for medical services.” An industry insider pointed out to the health community that in the past, doctors in private hospitals earned about 3,000 yuan per tooth. After the double price limit, doctors’ income will be cut in half, which will inevitably affect their enthusiasm.

In the past, stomatologists from public hospitals also told the health community that the performance of stomatologists is measured by the volume of business. For that kind of money, it’s really better to grind some porcelain, pull some wisdom teeth, fill some resin, do some veneers, and even take out some root canals.

Although the “Draft for Comments” has not announced the specific price limit, according to the Ningbo Municipal Medical Insurance Bureau every domestic brand is 3,000 yuan and imported brand is 3,500 yuan. Judging from the payment standard of a 60% decrease, it is not a small pressure for dental medical institutions.

The above-mentioned industry insiders told the health industry: “3980 yuan is the bottom line for dental implants, and medical institutions cannot make money below this price.”

According to previous media reports, due to the high operating costs of public hospitals and “many logistical and administrative staff, which will be borne by the cost,” the pressure on public medical institutions is bound to be bigger.

The “Draft for Comments” mentions that “there will be ups and downs, and the price parity relationship of related medical services will be straightened out”, which may relieve the pressure for reform to a certain extent.

“Technically difficult and high-risk items such as zygomatic surgery, complex bone grafting, etc. are allowed to open an appropriate price gap with conventional dental implant surgery. Tooth extraction, periodontal scaling, tooth filling For projects mainly based on technical labor services, if the historical price is low, the price can be appropriately increased.”

Previously, some dental experts questioned the media“If the cost of dental implants is cheaper than root canal treatment, patients may request to extract natural teeth and replace them with dental implants under price induction. This is neither medically consistent nor can it adversely affect the patient’s health”.

According to the “Draft for Comments”, the price of medical services for the restoration of missing teeth such as fixed dentures and removable dentures should maintain a reasonable price ratio with oral implants, and medical institutions are encouraged to give priority to providing patients with suitable missing teeth. Tooth Restoration Services.

In other words, the decline in the price of dental implants may have a “chain reaction” on other dental restoration methods, and the prices of fixed dentures and removable dentures may be further reduced.

Special treatment for dental implants benefits small private dental clinics

According to the “Draft for Comments”, in principle, the number of medical institutions (including private ones) participating in this centralized procurement in each overall planning area should account for more than 40% of the medical institutions providing dental implant services. Or the total reported demand in the region accounts for more than 50% of the total actual use in the previous year.

According to the proportion of about 80% of domestic private dental medical institutions, at least all public hospitals and more than 20% of private dental medical institutions should start reporting.

Industry people generally believe that the impact of this special governance on public medical institutions is far greater than that on private institutions.

The “Draft for Comments” emphasizes that for public medical institutions that refuse to report or insufficiently report, the differentiated price policy will be tried, and the actual charging standard shall not exceed the government-guided price/autonomous price 80% of the pricing average.

Combined with the impact of the above-mentioned “double price caps” on doctors’ income, this may lead to “doctors from public dental institutions leave” or “public dental institutions give up dental implant business” .

Individuals in the industry believe that after the general reduction in the price of dental implants, it will also deal a blow to large chain dental medical institutions. On the contrary, it will benefit small dental clinics.

“In the past, large dental chain institutions had large marketing expenses, and small clinics could not compete at all. Now, the price has dropped, and everyone has no money for marketing, so they can only compete for services .For small dental clinics serving the surrounding communities, if they do a good job, they will have the opportunity to overtake.” The person said.

In addition, the director of a private dental hospital believes that centralized procurement reduces the circulation link, thereby reducing the price of dental implants. The high-end technology and implants demanded by “consumer medical care” will gradually be tilted towards private or large chain institutions.

Source | Health Community

Editor | Alaska Treasure