▍Source: Deep Blue View
▍Author: Tan Zhuo.
▍Editor: Wang Chen
Normalized nucleic acid detection is a market scale of tens of billions. But under this seemingly arachis duranensis, the third-party nucleic acid detection companies have fallen into the "default door" of payment. In Henan, several well-known large nucleic acid detection enterprises have government guarantees. In order to withstand the pressure of cash flow, some business owners borrowed 40 to 50 million yuan from the bank and put it in it. A third-party testing company participated in the large-scale screening of nucleic acids in Shanghai. "I have been doing it for a month or two, and I haven’t settled the account yet.If it is a large-capacity enterprise, the cost of light reagents a day is several million."A nucleic acid testing company in Shenzhen, the repayment of last year’s nucleic acid screening, has not been received until March this year. A small company in a southern city, which transformed from genetic testing of innovative drugs to nucleic acid testing industry, even regretted entering the company.
"Some payment cycles can be as long as six months to nine months, and once a quarter is very fast. It is normal for this kind of enterprise-side payment to drag on for half a year or a year. "The head of a state-owned nucleic acid testing company in Beijing mentioned that there are hundreds of millions of arrears. These big companies, even if they have a special business team to ask for this sum of accounts receivable, will eventually have to go into battle personally to recover the money. Then the nucleic acid testing enterprises that enter the market are not strong in their own strength, so they have to be carried by the boss himself. But no one can answer how long it can last. Now, the nucleic acid detection enterprises entering the company will inevitably encounter the situation that the price of nucleic acid detection is constantly decreasing, the cost is high, but the profit is getting thinner and thinner."In the future, nucleic acid testing companies are increasingly fighting for scale costs and cash flow."This is almost the consensus of all the testing institutions of nucleic acid enterprises.
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Difficult payment
In the days when there is no payment for two months, what we have to face is the labor cost of a sampler approaching 100 yuan for an hour, the cost of hundreds of thousands of reagents every day, and the cost of laboratory staff of about 2,000 yuan a day, which makes a small third-party testing company in Shanghai fall into the crisis of broken capital flow at any time.
These small and medium-sized enterprises can only keep asking for information from different departments in the city and get a positive reply-The expenses of sampling personnel are paid by the district finance, and medical insurance is not taken.Every time the test samples of residents’ screening are arranged by which department in the city or district, they will be refunded to whom.
Although the departments arranged in each district are different, some district inspections are assigned to enterprises by the Economic and Information Committee, and some district sampling kiosks are coordinated by the National Development and Reform Commission. In the end, the money is paid by the district finance. This can be seen from the people who attended the meeting of the organization enterprises in the city.In the memories of several nucleic acid screening, there are representatives of development and reform, economic and information, health care and medical administration, and few medical insurance departments.
This payment should have been accounted for long ago, but it was stuck for a long time when it came to financial allocation. Until mid-April, the company only got less than one-third of the advance payment.
A nucleic acid testing company in East China, after half a year of completion, the government began negotiations. "The price given by the government is particularly low, and the company said that I will not do it. The government has only let go of a little bit, giving enterprises a little room for meager profits. " The insider said.
Compared with selling test kits, third-party testing is actually a hard job, with high cost of samplers and high cost of bank loans. Low profit, relying on running water to support turnover.
But for large companies, even if the cost of nucleic acid testing is not returned, the impact is not great. In the company where the above-mentioned people are located, nucleic acid testing only accounts for less than 1/5 of the company’s revenue."Such a large-scale company is easy to ask for money, with a dedicated business team and good government relations. If there are some problems, the government will have to go to the bottom and cannot be ruined. "
Small companies are another extreme dilemma. "The running water can run well. If the cost is well controlled, it may be a little profitable, but if the cost is not well controlled, it is a running water with little profit." A practitioner lamented that in good times, although there are hundreds of thousands of running water a day, I really don’t know when this money can be recovered."The smaller the place, the more complex the network, the more difficult it is to collect money, and almost all the leaders go into battle in person. If you can’t get it back, you have to be the boss himself. "
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Game between medical insurance and finance
Who will pay for nucleic acid testing has always been a difficult game. On May 26th, the National Medical Insurance Bureau officially stated that before the cost of normalized nucleic acid testing would be borne by local governments, the buyers in different places were different. In Shanghai, Zhejiang and other places with rich finances, the payment for nucleic acid testing is divided into two parts:If it is a nucleic acid screening organized by the government, it will be covered by the finance; The nucleic acid test in the hospital can be reimbursed by medical insurance.In some places, the cost of nucleic acid testing is jointly paid by medical insurance and finance.
An industry source pointed out that according to the normalization requirement of nucleic acid detection every 48 hours, the medical insurance fund will run out every month in populous provinces like Shandong and Henan.The balance of medical insurance in Shandong Province and Henan Province is 12.8 billion yuan and 11.78 billion yuan respectively, with a population of 102 million and 99 million, which is only enough for 71 days and 68 days of nucleic acid detection.
In some economically fragile areas, medical insurance funds have reached a bottleneck, and the time for paying premiums has been delayed again and again. In order to help enterprises tide over the difficulties, some areas have reduced the medical insurance rate, and the current fund income has been affected.
In a southern province, 70% of the personal medical insurance account and 30% of the financial account are for employees’ medical insurance. If it is residents’ medical insurance, the outpatient department will co-ordinate 70% and the financial department will pay 30%. This guidance was extremely difficult when it landed in a city under the province. The director of the city’s medical insurance bureau said frankly,"The medical insurance funds have been very tight, and the outpatient department co-ordinates this part. We are responsible for the hospital. If we have to give the people free nucleic acid within the scope of the contract, the hospital is under great pressure."
He reported this situation to the mayor in charge, and the pressure on the medical insurance fund was relatively high. The mayor in charge of medical insurance also recognized this suggestion and adjusted the policy appropriately. All the nucleic acid expenses of inpatients and those who should be examined should be paid by the finance.
The municipal finance promised at that time not to use the medical insurance fund for these expenses. But a month ago, the city’s finances could not support this expense.
“People in the financial department told us that finance is very difficult now and there is no money. I hope to implement the original policies of the province in a unified way. "After the National Medical Insurance Bureau officially stated that the cost of normalized nucleic acid testing will be borne by local governments, this burden has been put on finance again.
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Local financial dilemma
There are too many loopholes to be filled by local finance. A third-class and second-class regional medical center in Shanghai earned 120 million yuan every month in the past. Starting from March, the monthly revenue will not exceed 10 million.The hospital will allocate funds for killing this part of the anti-epidemic materials, and the financial resources will also make up for the sharp drop in revenue.It seems to be a drop in the bucket, but as far as the financial department is concerned, it is already exhausted. A district government official in Shanghai said,"Finance is now going to protect the cost of nucleic acid, but also to protect people’s livelihood, daily government supplies, all of which are free. There is only such a piece of income, but the expenditure is constantly increasing. "
In Shanghai in 2021, it is impossible to predict that there will be such frequent screening this year, and write this public health expenditure into the government budget. The data is even more shocking. According to data from the Ministry of Finance,In April 2022, the national fiscal revenue, that is, the general public budget revenue, was about 1.2 trillion yuan, a sharp drop of 41.3% compared with the same period of last year.In 2021, the fiscal revenue of 31 provinces, municipalities and autonomous regions (excluding Hong Kong, Macao and Taiwan) totaled 11,124.8 billion yuan, the fiscal expenditure was 20,986.2 billion yuan, and the new fiscal deficit was 9,861.4 billion yuan. Only eight provinces and cities have positive financial contributions, while the rest of the provinces have to rely on these eight provinces and cities and the central transfer payment to support them. Among them, Jiangsu, Zhejiang and Shanghai account for half of the national net tax paid to the central government.
–04–
The price goes down again and again.
Between the departmental game and the dilemma, the price of nucleic acid testing has been lowered again and again, which seems to be a buffer zone, giving the finance a certain breathing space. The latest notice of the National Medical Insurance Bureau requires all localities to reduce the single-person detection of new coronavirus nucleic acid to no more than 16 yuan per person and the multi-person mixed detection to no more than 5 yuan per person before June 10th. For large-scale screening and normalization testing organized by the government, the testing institutions are required to provide services according to the 3.5 yuan of not more than one person for multi-person mixed inspection.
This is the fifth price adjustment in China. In January, 2021, the price of nucleic acid testing dropped from 120 yuan to 80 yuan. Five months later, 20 yuan was downgraded. From November, 2021, the national price of nucleic acid testing dropped below that of 40 yuan. By April this year, the price of single inspection was not higher than that of 28 yuan, and the price of multi-person mixed inspection was not higher than that of 8 yuan. The person in charge of the relevant departments of the National Medical Insurance Bureau stressed that the National Medical Insurance Bureau has fulfilled the function of managing the price of medical consumables, deployed medical insurance departments at all levels to adopt measures such as centralized procurement by inter-provincial alliances, competitive bidding and regional price linkage, and continuously introduced the prices of tested products into a lower range.
However, for the third-party testing enterprises, it is a confused account how much to settle.
A company in Zhengzhou once received tasks from other cities. A staff member recalled that in an emergency, how much money to settle and how much sample size will not be explained in advance. There are only a few words on the other end of the phone."You are ready, and the samples will be delivered tomorrow."
After that, it is a long payment period.
A person in charge of an enterprise that has been in arrears for one year mentioned his concern, "When undertaking the task of nucleic acid detection last year, the unit price was in 60 yuan/time, and now it has dropped by two-thirds. If these outstanding payments are calculated at the new price, it is difficult for enterprises to survive. "
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