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处方药的外流、万亿美元的药品市场及其焦虑的人群

    编者按:本文来自“经济观察网”。作者:温淑萍,冯小兵;36氪经授权转载。刘涛的2018年总结报告已经提交,但报告中没有包括一些文字。在他第一次建议董事长放弃药品招标市场两个月后,董事长严厉地斥责了他。因为一个省的中标价格太低,作为销售经理,他决定放弃2000万的市场,保护其他市场的利润。但当时两省的中标价格较低,只能选择放弃。年末,企业销售总额下降20%以上。刘涛迟疑着要尽快与董事长谈谈经销药房的零售环节。毕竟,处方药外流的帷幕已经拉开,中国的药品销售市场最终将从过去的高度控制走向全面市场竞争。根据商务部公布的2017年中国药品销售情况,中国公立医院的总销售额接近110亿元。根据国外药品市场结构分析,如果出现处方药外流的情况,一些学者将把中国近一半的医院药品销售转移到零售药店。放弃是绝望的,选择观望是焦急的。”刘涛说,在近110亿元的市场港口,由于整个销售体系非常成熟,大多数制药公司仍然愿意以微利经营,因此没有一家制药公司愿意离开自己的心。但是,一个有着“万寿百年”理念的企业,必须重视另外5000亿元的市场布局…在控制医疗保险成本、限制医院药品比例和零药品添加后,医院药房已成为成本中心。医院不再热衷于销售药物。中国医药市场的变化已经结束。刘涛说,他们永远不会回到过去。完全市场化的刘涛是山东省一家制药企业的总销售经理。回顾他的职业生涯,他最喜欢的是上世纪90年代,那时没有药物比例,没有药物零加,没有医疗保险控制费,没有“47”,利润率高,销售好,生活和工作轻松美好。随着新医改的开始,随着国家基本药物目录的实施,药品流通中的含水量首次受到抑制,药品平均价格下降了45%左右。然而,刘涛和中国制药公司没有想到的是,降价只是个开始。到2015年,国务院发布《医疗卫生改革试点指导意见》:100个试点城市公立医院药品比例必须降低到30%以下。药品比例的初衷是规范医疗机构和医务人员合理使用药品,处理“扩大处方”等“过度治疗”,即减少医疗费用。自本政策实施以来,在2018年10月13日第二次药品安全合作联席会议上,基金监管部副主任表示,药品比例下降并未导致医疗费用下降。但是根据大数据分析,医院的药物比例从2008年的50%下降到2016年的39%。医疗支出没有下降。医疗保险控制费已成为医疗行业的一个重要命题。事实上,从2009年新医改开始至今,为了减少药品流通中的水分,药品零差价销售在全国范围内得到推广。刘涛认为,这只是15%的水被挤出,而管理层的目标是压缩40%的水空间。到目前为止,“47”采购模式的特点是集中采购和数量采购。1月17日,中国政府网络发布国家组织药品集中采购和使用试点方案。2018年12月,国家医疗保险局首批试点项目“47”药品集中采购一期工程顺利完成。在31种试验性仿制药中,选择25种,成功率81%;22种仿制药,占88%;平均下降率52%;最高下降率96%。刘涛最痛苦的问题就是要和他们一起吃。在全国医保局实施47个采购模式之前,全国各省市已经实施了全国低价联动采购模式。如果某制药公司在北京谈判后对心血管药物的中标价格为65元,甘肃谈判后的中标价格为45元,如果该企业按45元中标价格进入甘肃市场,北京将按45元执行。对于大型品牌企业来说,45元是不够的成本,刘涛算了算。如果中标价格是低利润的,企业将永远不会放弃这个成熟的销售市场。同时,我国医院侧药销售份额最大,可以低利润运行并获得利润。如果你没有足够的成本,你就必须放弃。商务部宣布,2017年,我国三大终端、六大市场(定义范围详见文末“数据说明”)药品销售额16118亿元,比去年同期增长7.6%。从药品销售三大终端销售分布来看,公立医院市场份额最大,2017年占68%,接近1100亿元;零售药店市场份额为22.6%;公立初级医疗终端市场份额近几年有所上升,占2017年为9.4%;如果加上非统计“私立医院、私立诊所、乡村卫生”。全国药品终端销售总额约为1900亿元。尽管刘涛甚至许多制药公司都不愿放弃医院端的成熟市场,但市场的趋势越来越错误。刘涛发现医院不再像以前那样热衷于销售药品。由于医疗改革中的一些政策增加了医药服务成本,医疗保险报销的控制越来越严格,医院的收入结构也不再完全依赖药物。相关政策还表明,医院应通过技术和服务提高收入。一个普遍存在的市场现象是,医疗保险的控制费、药品比例、零差价、招购环节,大部分药品都放弃了医院的销售环节,医院的用药一直受到限制,医生在给病人开药时都要亲手写一份纸质的药品清单,这样病人才能服用。给周边药店送药。在这种情况下,病人只能通过在医院开药来报销,而从社会药店获得的药品不能进入报销系统。因此,事实上,医院已经成为良好药物和真正有效药物的瓶颈。国内新的药品分销平台白洋药业集团董事长傅刚透露,在这种情况下,一些医院开始变相合作药店,也采取了药房托管的形式。在这个过程中,处方已经流向零售药店,现在的规模已经达到1000亿。2018年4月26日,国家卫生委员会召开专题新闻发布会,介绍“互联网健康”和医院互联网医疗服务的发展情况。国家卫生委员会医疗管理局副局长焦亚辉在回答记者提问时表示,很明显,医疗卫生行业将按照“卫生中国2030”的要求,在互联网上开展各种实践,并应用大数据。《规划纲要》和《国务院关于积极推进互联网行动的指导意见》,探索和释放慢性病患者。外部处方和第三方分销。在刘涛等众多制药企业看来,这一政策的试行,是中国近110亿元药品销售格局大幅调整的前奏。药学社会化的过程使药品回归市场竞争状态。刘涛觉得风险在增加,因为他已经放弃了标价较低但尚未进入零售市场的市场。刘涛坚信,药品分拆是为了争取在零售端销售处方药,这才是真正的医疗改革。刘涛表示,过去,药品市场竞争不充分。每个人都忙于非市场因素,因此他们的产品在销售和行政管理方面花费太多。而不是在研发和产品升级上投入更多的能源和资金。因此,我国药品在低水平同质化竞争中不断发展,药品发展的趋势是两极分化。刘涛说,他个人很享受这种变化,中国的药品终于从一个高度控制和非竞争的环境进入了全面市场竞争。由于刘涛认为处方药零售端的风险尚未明确,配套政策也无法预测何时推出,因此他没有建议董事长在政策出台后对零售市场进行布局。刘涛担心,社会药店销售的药品利润可能会相对较高,但十几家制药企业在竞争中的销量必然会大幅下降。即使板蓝根、六味地黄丸是由十几家制药企业生产的,也会出现无序竞争。在处方药外流趋势中,以新药和抗癌药为主的制药公司,包括国外制药公司。近年来,阿斯利康、招商、赛诺菲等跨国企业不仅高度重视零售市场,而且投入大量的人力、物力和财力,形成了零售团队或新的渠道团队。在此之前,武田制药的六种处方产品,包括潘托洛克、达克龙、北信、依克托、比洛斯和普陀平,已授权白洋通过DTP覆盖零售终端。事实上,导致处方药外流快速发展的因素之一很难从“47”中分离出来。一致性评价和“47”招标采购导致仿制药销售价格大幅下降,“魔力药”被淘汰。傅刚认为,中国的药品市场正在“改变鸟笼”。例如,恩替卡韦每年在医院的销售额超过100亿元。现在,“47”实施后,价格下降了95%,规模由150亿变为不足10亿,整个规模大幅缩水。事实上,还有很多其他的例子。在实施“47”时,基数是年销售额数十亿美元,最终销售额将减少至少一半或更多。然后,这些专利过期药物在医院的原始库存将大幅缩水,“47”模式将逐渐在全国蔓延,或是一个必然的结论。外国制药公司可能会选择快速分销其零售网点。零售药店的另一个部分已经布置好,是制药公司与新的特殊药物。例如,一家国内制药公司开发了一款PD1,成本高达数万元。有些药物还没有进入医疗保险,而且没有保险费,所以这些药物很难进入医院销售。但是医生们仍然需要为病人开处方才能治愈这种疾病,这涉及到所谓的处方流出。刘涛的分析表明,目前医院、药店零售端的药品销售模式为7:3。通过对处方药外流的调整,最终实现传统药物和慢性病药物的社会化。也许医院会留下麻醉剂、有毒麻醉剂或紧急药物和救援药物,所以销售模式可能会逆转。医院7号,药房3号。然而,在海外,前37名中药店占7名,医院占3名。傅刚表示,在中国大政策的趋势下,DRG最终会被采用,即更多的药物会影响医生和医院的收入。病人一种疾病的医疗保险费合计一万元的,医生开9000元的药,医院只收1000元的服务费;只开3000元的药,其余均为服务费。也就是说,医院以后给病人开的药越多,损失就越大。在疾病支付制度下,医疗费用的支付规则将发生重大变化。随着这一模式的实施,当医院和医生注重技术和服务时,中国的医疗服务质量将大大提高。药物成本也将得到完全控制,这是医疗改革中需要解决的最基本的核心问题。傅刚认为,在这样一个全面的市场化阶段,市场将配置资源,价格趋于合理,医院将集中精力看病。新的医疗保障局鼓励DRG为他们的疾病买单。从某种意义上讲,过去的药物是用来补偿医生收入的,并且在调节收入方面起到了作用,实际上是非法的。将来,DRG将根据疾病类型支付。毒品是代价。如果开更多的药,劳动力成本就会降低。一种疾病药品的收费将设定一个配额,所以使用药物是尽可能便宜的。医生可以通过服务费来增加收入。事实上,这对医生来说也是有意义的。这又回到了医疗的本质。医生是医疗服务的提供者。药品的供应是由市场力量完成的。市场力量使性价比达到最优状态。这是医疗改革的理想方向。刘涛决定与董事长谈话,至少希望公司能在这轮结构调整中生存下来,在洗牌中获得更大的生存机会。福冈认为只有洗牌才能成熟。如果一个行业总是有成千上万的生产企业,那么它就是一个高度分散和效率低下的状态。一个产品有100多家厂家,每个工厂都是小而分散的,如何监管?这样的监管成本也太高了。因此,傅刚和刘涛的观点一致,认为中国药品市场将是一个集约整合的过程。目前,中国有4600多家制药企业。多年前,商务部提出建设1000亿级中国医药企业企业集团,增强国际化的集中度和竞争优势。傅刚认为,在限制输液、抗生素和辅助药物的情况下,处方药的药物结构将发生变化,治疗药物的比例将增加,辅助药物的比例将减少,口服药物将取代大部分静脉注射药物。在这种情况下,我国制药企业的组织结构可能会发生巨大变化。过去,一家制药企业的一到两个独家大品种,由于其高毛利,可以养活数千人。现阶段,随着47次采购的实施,价格大幅下降,将不再有利润空间来支撑数千人。刘涛认为,即使有专利制药公司,他们也可能要继续拥有专利药品来支持数千个专业团队,然后做核心工作,大部分事情都要以平台为基础的企业外包,即新的分销平台。这样,整个行业的营销成本将大大降低、优化和标准化。在这一变化过程中,整个医药行业的组织结构、人力结构和分工也将发生巨大变化,以适应先前的两项政策。在处方药流出过程中,有关规定要求药师不得出售处方药。因此,只有与药房携手合作,互联网医疗平台才能走出医院处方药市场。据北京大学医学部的一位人士透露,白洋制药集团旗下的白洋智能科技是中国最早进入医院系统的平台提供商。傅刚回应说,第三方处方共享平台很容易参考,确实与医院HIS系统连接,对接真实处方,并将处方信息、医疗保险结算信息和医疗机构零售信息连接起来,提供完整的数据平台。监管机构的风险管理。大林的一位负责人,刘姓,与易伟合作,在梧州进行了试点。前三个月的数据显示,门店收入增长率为23%,处方药毛利率约为15%。根据通常的销售预测,商店的月销售额约为20万。三个月后,这家商店的销售量约为43万。刘涛也在不断地计算成本。如果药品在药店销售,成本也会大幅下降。一方面,傅刚说,过去,企业的营销成本很高。每一家经营处方药的企业成本率都在40%以上,而且周期很长,因为它有许多政策限制。没有中标人的企业不能进入医院。等待头等舱中标需要一两年时间,中标后进入医院还有很长的过程。因此,在以原医院为主要渠道的药品流通过程中,成本高、周期长是主要问题,企业确实会遇到许多瓶颈。至于处方药的外流,来自天坛医院和朝阳医院的几位专家说,让医生感到骄傲和尊敬的是技术水平的奖励。当医院不使用药物作为主要的收入和生活来源,而是将其转化为服务和技术时,医生将不再开大处方。那么,这将使医疗改革真正逐步取得成功。傅刚认为,处方流出的真正价值和生命力是医院通过第三方处方共享平台提供的便捷服务。该平台与许多合规药店对接,由患者自己选择,允许数据运行更多腿,患者运行更少,并为监管机构提供数据平台。傅刚指出,第三方处方共享平台可以有效地监控医生处方行为,保证医疗保险基金的安全,因为它在医院与医疗保险部门对接的同时,为医疗保险部门打开了数据监管接口。bian zhe an: ben wen lai zi" jing ji guan cha wang". zuo zhe: wen shu ping, feng xiao bing 36 ke jing shou quan zhuan zai. liu tao de 2018 nian zong jie bao gao yi jing ti jiao, dan bao gao zhong mei you bao kuo yi xie wen zi. zai ta di yi ci jian yi dong shi zhang fang qi yao pin zhao biao shi chang liang ge yue hou, dong shi zhang yan li di chi ze le ta. yin wei yi ge sheng de zhong biao jia ge tai di, zuo wei xiao shou jing li, ta jue ding fang qi 2000 wan de shi chang, bao hu qi ta shi chang de li run. dan dang shi liang sheng de zhong biao jia ge jiao di, zhi neng xuan ze fang qi. nian mo, qi ye xiao shou zong e xia jiang 20 yi shang. liu tao chi yi zhe yao jin kuai yu dong shi chang tan tan jing xiao yao fang de ling shou huan jie. bi jing, chu fang yao wai liu de wei mu yi jing la kai, zhong guo de yao pin xiao shou shi chang zui zhong jiang cong guo qu de gao du kong zhi zou xiang quan mian shi chang jing zheng. gen ju shang wu bu gong bu de 2017 nian zhong guo yao pin xiao shou qing kuang, zhong guo gong li yi yuan de zong xiao shou e jie jin 110 yi yuan. gen ju guo wai yao pin shi chang jie gou fen xi, ru guo chu xian chu fang yao wai liu de qing kuang, yi xie xue zhe jiang ba zhong guo jin yi ban de yi yuan yao pin xiao shou zhuan yi dao ling shou yao dian. fang qi shi jue wang de, xuan ze guan wang shi jiao ji de." liu tao shuo, zai jin 110 yi yuan de shi chang gang kou, you yu zheng ge xiao shou ti xi fei chang cheng shu, da duo shu zhi yao gong si reng ran yuan yi yi wei li jing ying, yin ci mei you yi jia zhi yao gong si yuan yi li kai zi ji de xin. dan shi, yi ge you zhe" wan shou bai nian" li nian de qi ye, bi xu zhong shi ling wai 5000 yi yuan de shi chang bu ju zai kong zhi yi liao bao xian cheng ben xian zhi yi yuan yao pin bi li he ling yao pin tian jia hou, yi yuan yao fang yi cheng wei cheng ben zhong xin. yi yuan bu zai re zhong yu xiao shou yao wu. zhong guo yi yao shi chang de bian hua yi jing jie shu. liu tao shuo, ta men yong yuan bu hui hui dao guo qu. wan quan shi chang hua de liu tao shi shan dong sheng yi jia zhi yao qi ye de zong xiao shou jing li. hui gu ta de zhi ye sheng ya, ta zui xi huan de shi shang shi ji 90 nian dai, na shi mei you yao wu bi li, mei you yao wu ling jia, mei you yi liao bao xian kong zhi fei, mei you" 47", li run lv gao, xiao shou hao, sheng huo he gong zuo qing song mei hao. sui zhe xin yi gai de kai shi, sui zhe guo jia ji ben yao wu mu lu de shi shi, yao pin liu tong zhong de han shui liang shou ci shou dao yi zhi, yao pin ping jun jia ge xia jiang le 45 zuo you. ran er, liu tao he zhong guo zhi yao gong si mei you xiang dao de shi, jiang jia zhi shi ge kai shi. dao 2015 nian, guo wu yuan fa bu yi liao wei sheng gai ge shi dian zhi dao yi jian: 100 ge shi dian cheng shi gong li yi yuan yao pin bi li bi xu jiang di dao 30 yi xia. yao pin bi li de chu zhong shi gui fan yi liao ji gou he yi wu ren yuan he li shi yong yao pin, chu li" kuo da chu fang" deng" guo du zhi liao", ji jian shao yi liao fei yong. zi ben zheng ce shi shi yi lai, zai 2018 nian 10 yue 13 ri di er ci yao pin an quan he zuo lian xi hui yi shang, ji jin jian guan bu fu zhu ren biao shi, yao pin bi li xia jiang bing wei dao zhi yi liao fei yong xia jiang. dan shi gen ju da shu ju fen xi, yi yuan de yao wu bi li cong 2008 nian de 50 xia jiang dao 2016 nian de 39. yi liao zhi chu mo you xia jiang. yi liao bao xian kong zhi fei yi cheng wei yi liao hang ye de yi ge zhong yao ming ti. shi shi shang, cong 2009 nian xin yi gai kai shi zhi jin, wei le jian shao yao pin liu tong zhong de shui fen, yao pin ling cha jia xiao shou zai quan guo fan wei nei de dao tui guang. liu tao ren wei, zhe zhi shi 15 de shui bei ji chu, er guan li ceng de mu biao shi ya suo 40 de shui kong jian. dao mu qian wei zhi," 47" cai gou mo shi de te dian shi ji zhong cai gou he shu liang cai gou. 1 yue 17 ri, zhong guo zheng fu wang luo fa bu guo jia zu zhi yao pin ji zhong cai gou he shi yong shi dian fang an. 2018 nian 12 yue, guo jia yi liao bao xian ju shou pi shi dian xiang mu" 47" yao pin ji zhong cai gou yi qi gong cheng shun li wan cheng. zai 31 zhong shi yan xing fang zhi yao zhong, xuan ze 25 zhong, cheng gong lv 81 22 zhong fang zhi yao, zhan 88 ping jun xia jiang lv 52 zui gao xia jiang lv 96. liu tao zui tong ku de wen ti jiu shi yao he ta men yi qi chi. zai quan guo yi bao ju shi shi 47 ge cai gou mo shi zhi qian, quan guo ge sheng shi yi jing shi shi le quan guo di jia lian dong cai gou mo shi. ru guo mou zhi yao gong si zai bei jing tan pan hou dui xin xue guan yao wu de zhong biao jia ge wei 65 yuan, gan su tan pan hou de zhong biao jia ge wei 45 yuan, ru guo gai qi ye an 45 yuan zhong biao jia ge jin ru gan su shi chang, bei jing jiang an 45 yuan zhi xing. dui yu da xing pin pai qi ye lai shuo, 45 yuan shi bu gou de cheng ben, liu tao suan le suan. ru guo zhong biao jia ge shi di li run de, qi ye jiang yong yuan bu hui fang qi zhe ge cheng shu de xiao shou shi chang. tong shi, wo guo yi yuan ce yao xiao shou fen e zui da, ke yi di li run yun xing bing huo de li run. ru guo ni mei you zu gou de cheng ben, ni jiu bi xu fang qi. shang wu bu xuan bu, 2017 nian, wo guo san da zhong duan liu da shi chang ding yi fan wei xiang jian wen mo" shu ju shuo ming" yao pin xiao shou e 16118 yi yuan, bi qu nian tong qi zeng zhang 7. 6. cong yao pin xiao shou san da zhong duan xiao shou fen bu lai kan, gong li yi yuan shi chang fen e zui da, 2017 nian zhan 68, jie jin 1100 yi yuan ling shou yao dian shi chang fen e wei 22. 6 gong li chu ji yi liao zhong duan shi chang fen e jin ji nian you suo shang sheng, zhan 2017 nian wei 9. 4 ru guo jia shang fei tong ji" si li yi yuan si li zhen suo xiang cun wei sheng". quan guo yao pin zhong duan xiao shou zong e yue wei 1900 yi yuan. jin guan liu tao shen zhi xu duo zhi yao gong si dou bu yuan fang qi yi yuan duan di cheng shu shi chang, dan shi chang de qu shi yue lai yue cuo wu. liu tao fa xian yi yuan bu zai xiang yi qian na yang re zhong yu xiao shou yao pin. you yu yi liao gai ge zhong de yi xie zheng ce zeng jia le yi yao fu wu cheng ben, yi liao bao xian bao xiao de kong zhi yue lai yue yan ge, yi yuan de shou ru jie gou ye bu zai wan quan yi lai yao wu. xiang guan zheng ce hai biao ming, yi yuan ying tong guo ji shu he fu wu ti gao shou ru. yi ge pu bian cun zai de shi chang xian xiang shi, yi liao bao xian de kong zhi fei yao pin bi li ling cha jia zhao gou huan jie, da bu fen yao pin dou fang qi le yi yuan de xiao shou huan jie, yi yuan de yong yao yi zhi shou dao xian zhi, yi sheng zai gei bing ren kai yao shi dou yao qin shou xie yi fen zhi zhi di yao pin qing dan, zhe yang bing ren cai neng fu yong. gei zhou bian yao dian song yao. zai zhe zhong qing kuang xia, bing ren zhi neng tong guo zai yi yuan kai yao lai bao xiao, er cong she hui yao dian huo de de yao pin bu neng jin ru bao xiao xi tong. yin ci, shi shi shang, yi yuan yi jing cheng wei liang hao yao wu he zhen zheng you xiao yao wu de ping jing. guo nei xin de yao pin fen xiao ping tai bai yang yao ye ji tuan dong shi zhang fu gang tou lu, zai zhe zhong qing kuang xia, yi xie yi yuan kai shi bian xiang he zuo yao dian, ye cai qu le yao fang tuo guan de xing shi. zai zhe ge guo cheng zhong, chu fang yi jing liu xiang ling shou yao dian, xian zai de gui mo yi jing da dao 1000 yi. 2018 nian 4 yue 26 ri, guo jia wei sheng wei yuan hui zhao kai zhuan ti xin wen fa bu hui, jie shao" hu lian wang jian kang" he yi yuan hu lian wang yi liao fu wu de fa zhan qing kuang. guo jia wei sheng wei yuan hui yi liao guan li ju fu ju zhang jiao ya hui zai hui da ji zhe ti wen shi biao shi, hen ming xian, yi liao wei sheng hang ye jiang an zhao" wei sheng zhong guo 2030" de yao qiu, zai hu lian wang shang kai zhan ge zhong shi jian, bing ying yong da shu ju. gui hua gang yao he guo wu yuan guan yu ji ji tui jin hu lian wang xing dong de zhi dao yi jian, tan suo he shi fang man xing bing huan zhe. wai bu chu fang he di san fang fen xiao. zai liu tao deng zhong duo zhi yao qi ye kan lai, zhe yi zheng ce de shi xing, shi zhong guo jin 110 yi yuan yao pin xiao shou ge ju da fu tiao zheng de qian zou. yao xue she hui hua de guo cheng shi yao pin hui gui shi chang jing zheng zhuang tai. liu tao jue de feng xian zai zeng jia, yin wei ta yi jing fang qi le biao jia jiao di dan shang wei jin ru ling shou shi chang de shi chang. liu tao jian xin, yao pin fen chai shi wei le zheng qu zai ling shou duan xiao shou chu fang yao, zhe cai shi zhen zheng de yi liao gai ge. liu tao biao shi, guo qu, yao pin shi chang jing zheng bu chong fen. mei ge ren dou mang yu fei shi chang yin su, yin ci ta men de chan pin zai xiao shou he xing zheng guan li fang mian hua fei tai duo. er bu shi zai yan fa he chan pin sheng ji shang tou ru geng duo de neng yuan he zi jin. yin ci, wo guo yao pin zai di shui ping tong zhi hua jing zheng zhong bu duan fa zhan, yao pin fa zhan de qu shi shi liang ji fen hua. liu tao shuo, ta ge ren hen xiang shou zhe zhong bian hua, zhong guo de yao pin zhong yu cong yi ge gao du kong zhi he fei jing zheng de huan jing jin ru le quan mian shi chang jing zheng. you yu liu tao ren wei chu fang yao ling shou duan di feng xian shang wei ming que, pei tao zheng ce ye wu fa yu ce he shi tui chu, yin ci ta mei you jian yi dong shi zhang zai zheng ce chu tai hou dui ling shou shi chang jin xing bu ju. liu tao dan xin, she hui yao dian xiao shou de yao pin li run ke neng hui xiang dui jiao gao, dan shi ji jia zhi yao qi ye zai jing zheng zhong de xiao liang bi ran hui da fu xia jiang. ji shi ban lan gen liu wei di huang wan shi you shi ji jia zhi yao qi ye sheng chan de, ye hui chu xian wu xu jing zheng. zai chu fang yao wai liu qu shi zhong, yi xin yao he kang ai yao wei zhu de zhi yao gong si, bao kuo guo wai zhi yao gong si. jin nian lai, a si li kang zhao shang sai nuo fei deng kua guo qi ye bu jin gao du zhong shi ling shou shi chang, er qie tou ru da liang de ren li wu li he cai li, xing cheng le ling shou tuan dui huo xin de qu dao tuan dui. zai ci zhi qian, wu tian zhi yao de liu zhong chu fang chan pin, bao kuo pan tuo luo ke da ke long bei xin yi ke tuo bi luo si he pu tuo ping, yi shou quan bai yang tong guo DTP fu gai ling shou zhong duan. shi shi shang, dao zhi chu fang yao wai liu kuai su fa zhan de yin su zhi yi hen nan cong" 47" zhong fen li chu lai. yi zhi xing ping jia he" 47" zhao biao cai gou dao zhi fang zhi yao xiao shou jia ge da fu xia jiang," mo li yao" bei tao tai. fu gang ren wei, zhong guo de yao pin shi chang zheng zai" gai bian niao long". li ru, en ti ka wei mei nian zai yi yuan de xiao shou e chao guo 100 yi yuan. xian zai," 47" shi shi hou, jia ge xia jiang le 95, gui mo you 150 yi bian wei bu zu 10 yi, zheng ge gui mo da fu suo shui. shi shi shang, hai you hen duo qi ta de li zi. zai shi shi" 47" shi, ji shu shi nian xiao shou e shu shi yi mei yuan, zui zhong xiao shou e jiang jian shao zhi shao yi ban huo geng duo. ran hou, zhei xie zhuan li guo qi yao wu zai yi yuan de yuan shi ku cun jiang da fu suo shui," 47" mo shi jiang zhu jian zai quan guo man yan, huo shi yi ge bi ran de jie lun. wai guo zhi yao gong si ke neng hui xuan ze kuai su fen xiao qi ling shou wang dian. ling shou yao dian de ling yi ge bu fen yi jing bu zhi hao, shi zhi yao gong si yu xin de te shu yao wu. li ru, yi jia guo nei zhi yao gong si kai fa le yi kuan PD1, cheng ben gao da shu wan yuan. you xie yao wu hai mei you jin ru yi liao bao xian, er qie mei you bao xian fei, suo yi zhei xie yao wu hen nan jin ru yi yuan xiao shou. dan shi yi sheng men reng ran xu yao wei bing ren kai chu fang cai neng zhi yu zhe zhong ji bing, zhe she ji dao suo wei de chu fang liu chu. liu tao de fen xi biao ming, mu qian yi yuan yao dian ling shou duan di yao pin xiao shou mo shi wei 7: 3. tong guo dui chu fang yao wai liu de tiao zheng, zui zhong shi xian chuan tong yao wu he man xing bing yao wu de she hui hua. ye xu yi yuan hui liu xia ma zui ji you du ma zui ji huo jin ji yao wu he jiu yuan yao wu, suo yi xiao shou mo shi ke neng hui ni zhuan. yi yuan 7 hao, yao fang 3 hao. ran er, zai hai wai, qian 37 ming zhong yao dian zhan 7 ming, yi yuan zhan 3 ming. fu gang biao shi, zai zhong guo da zheng ce de qu shi xia, DRG zui zhong hui bei cai yong, ji geng duo de yao wu hui ying xiang yi sheng he yi yuan de shou ru. bing ren yi zhong ji bing de yi liao bao xian fei he ji yi wan yuan de, yi sheng kai 9000 yuan de yao, yi yuan zhi shou 1000 yuan de fu wu fei zhi kai 3000 yuan de yao, qi yu jun wei fu wu fei. ye jiu shi shuo, yi yuan yi hou gei bing ren kai de yao yue duo, sun shi jiu yue da. zai ji bing zhi fu zhi du xia, yi liao fei yong de zhi fu gui ze jiang fa sheng zhong da bian hua. sui zhe zhe yi mo shi de shi shi, dang yi yuan he yi sheng zhu zhong ji shu he fu wu shi, zhong guo de yi liao fu wu zhi liang jiang da da ti gao. yao wu cheng ben ye jiang de dao wan quan kong zhi, zhe shi yi liao gai ge zhong xu yao jie jue de zui ji ben de he xin wen ti. fu gang ren wei, zai zhe yang yi ge quan mian di shi chang hua jie duan, shi chang jiang pei zhi zi yuan, jia ge qu yu he li, yi yuan jiang ji zhong jing li kan bing. xin de yi liao bao zhang ju gu li DRG wei ta men de ji bing mai dan. cong mou zhong yi yi shang jiang, guo qu de yao wu shi yong lai bu chang yi sheng shou ru de, bing qie zai tiao jie shou ru fang mian qi dao le zuo yong, shi ji shang shi fei fa de. jiang lai, DRG jiang gen ju ji bing lei xing zhi fu. du pin shi dai jia. ru guo kai geng duo de yao, lao dong li cheng ben jiu hui jiang di. yi zhong ji bing yao pin de shou fei jiang she ding yi ge pei e, suo yi shi yong yao wu shi jin ke neng pian yi de. yi sheng ke yi tong guo fu wu fei lai zeng jia shou ru. shi shi shang, zhe dui yi sheng lai shuo ye shi you yi yi de. zhe you hui dao le yi liao de ben zhi. yi sheng shi yi liao fu wu de ti gong zhe. yao pin de gong ying shi you shi chang li liang wan cheng de. shi chang li liang shi xing jia bi da dao zui you zhuang tai. zhe shi yi liao gai ge de li xiang fang xiang. liu tao jue ding yu dong shi chang tan hua, zhi shao xi wang gong si neng zai zhe lun jie gou tiao zheng zhong sheng cun xia lai, zai xi pai zhong huo de geng da de sheng cun ji hui. fu gang ren wei zhi you xi pai cai neng cheng shu. ru guo yi ge hang ye zong shi you cheng qian shang wan de sheng chan qi ye, na me ta jiu shi yi ge gao du fen san he xiao lv di xia de zhuang tai. yi ge chan pin you 100 duo jia chang jia, mei ge gong chang dou shi xiao er fen san de, ru he jian guan? zhe yang de jian guan cheng ben ye tai gao le. yin ci, fu gang he liu tao de guan dian yi zhi, ren wei zhong guo yao pin shi chang jiang shi yi ge ji yue zheng he de guo cheng. mu qian, zhong guo you 4600 duo jia zhi yao qi ye. duo nian qian, shang wu bu ti chu jian she 1000 yi ji zhong guo yi yao qi ye qi ye ji tuan, zeng qiang guo ji hua de ji zhong du he jing zheng you shi. fu gang ren wei, zai xian zhi shu ye kang sheng su he fu zhu yao wu de qing kuang xia, chu fang yao de yao wu jie gou jiang fa sheng bian hua, zhi liao yao wu de bi li jiang zeng jia, fu zhu yao wu de bi li jiang jian shao, kou fu yao wu jiang qu dai da bu fen jing mai zhu she yao wu. zai zhe zhong qing kuang xia, wo guo zhi yao qi ye de zu zhi jie gou ke neng hui fa sheng ju da bian hua. guo qu, yi jia zhi yao qi ye de yi dao liang ge du jia da pin zhong, you yu qi gao mao li, ke yi yang huo shu qian ren. xian jie duan, sui zhe 47 ci cai gou de shi shi, jia ge da fu xia jiang, jiang bu zai you li run kong jian lai zhi cheng shu qian ren. liu tao ren wei, ji shi you zhuan li zhi yao gong si, ta men ye ke neng yao ji xu yong you zhuan li yao pin lai zhi chi shu qian ge zhuan ye tuan dui, ran hou zuo he xin gong zuo, da bu fen shi qing dou yao yi ping tai wei ji chu de qi ye wai bao, ji xin de fen xiao ping tai. zhe yang, zheng ge hang ye de ying xiao cheng ben jiang da da jiang di you hua he biao zhun hua. zai zhe yi bian hua guo cheng zhong, zheng ge yi yao hang ye de zu zhi jie gou ren li jie gou he fen gong ye jiang fa sheng ju da bian hua, yi shi ying xian qian de liang xiang zheng ce. zai chu fang yao liu chu guo cheng zhong, you guan gui ding yao qiu yao shi bu de chu shou chu fang yao. yin ci, zhi you yu yao fang xie shou he zuo, hu lian wang yi liao ping tai cai neng zou chu yi yuan chu fang yao shi chang. ju bei jing da xue yi xue bu de yi wei ren shi tou lu, bai yang zhi yao ji tuan qi xia de bai yang zhi neng ke ji shi zhong guo zui zao jin ru yi yuan xi tong de ping tai ti gong shang. fu gang hui ying shuo, di san fang chu fang gong xiang ping tai hen rong yi can kao, que shi yu yi yuan HIS xi tong lian jie, dui jie zhen shi chu fang, bing jiang chu fang xin xi yi liao bao xian jie suan xin xi he yi liao ji gou ling shou xin xi lian jie qi lai, ti gong wan zheng de shu ju ping tai. jian guan ji gou de feng xian guan li. da lin de yi wei fu ze ren, liu xing, yu yi wei he zuo, zai wu zhou jin xing le shi dian. qian san ge yue de shu ju xian shi, men dian shou ru zeng zhang lv wei 23, chu fang yao mao li lv yue wei 15. gen ju tong chang de xiao shou yu ce, shang dian de yue xiao shou e yue wei 20 wan. san ge yue hou, zhe jia shang dian de xiao shou liang yue wei 43 wan. liu tao ye zai bu duan di ji suan cheng ben. ru guo yao pin zai yao dian xiao shou, cheng ben ye hui da fu xia jiang. yi fang mian, fu gang shuo, guo qu, qi ye de ying xiao cheng ben hen gao. mei yi jia jing ying chu fang yao de qi ye cheng ben lv dou zai 40 yi shang, er qie zhou qi hen zhang, yin wei ta you xu duo zheng ce xian zhi. mei you zhong biao ren de qi ye bu neng jin ru yi yuan. deng dai tou deng cang zhong biao xu yao yi liang nian shi jian, zhong biao hou jin ru yi yuan hai you hen zhang de guo cheng. yin ci, zai yi yuan yi yuan wei zhu yao qu dao de yao pin liu tong guo cheng zhong, cheng ben gao zhou qi zhang shi zhu yao wen ti, qi ye que shi hui yu dao xu duo ping jing. zhi yu chu fang yao de wai liu, lai zi tian tan yi yuan he zhao yang yi yuan de ji wei zhuan jia shuo, rang yi sheng gan dao jiao ao he zun jing de shi ji shu shui ping de jiang li. dang yi yuan bu shi yong yao wu zuo wei zhu yao de shou ru he sheng huo lai yuan, er shi jiang qi zhuan hua wei fu wu he ji shu shi, yi sheng jiang bu zai kai da chu fang. na me, zhe jiang shi yi liao gai ge zhen zheng zhu bu qu de cheng gong. fu gang ren wei, chu fang liu chu di zhen zheng jia zhi he sheng ming li shi yi yuan tong guo di san fang chu fang gong xiang ping tai ti gong de bian jie fu wu. gai ping tai yu xu duo he gui yao dian dui jie, you huan zhe zi ji xuan ze, yun xu shu ju yun xing geng duo tui, huan zhe yun xing geng shao, bing wei jian guan ji gou ti gong shu ju ping tai. fu gang zhi chu, di san fang chu fang gong xiang ping tai ke yi you xiao di jian kong yi sheng chu fang xing wei, bao zheng yi liao bao xian ji jin de an quan, yin wei ta zai yi yuan yu yi liao bao xian bu men dui jie de tong shi, wei yi liao bao xian bu men da kai le shu ju jian guan jie 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