As we all know, the three troikas of that drive the economy are investment, consumption, and exports, and their respective sources of funds are fiscal expenditure, residents' income and overseas.
applies the theory to the medical industry, and the same is true in fact. In addition to exports, the main places for investment and consumption are hospitals. Whether it is the expansion of domestic demand for new medical infrastructure or the increase in residents' medical expenditure, it needs to be realized in specific medical institutions scenarios. Therefore, the financial pressure and openness of the hospital play a key role in the prosperity of the overall medical industry.
was stimulated by the equipment renewal loan and interest subsidy policies released by the regulators in mid-September. Before the National Day, the equipment sector led to a rebound in the entire medical sector for several days. Why can cause such a big impact? In addition to the medical sector itself that has undergone long-term adjustments and low valuation, has essentially alleviated the financial pressure in some hospitals to a certain extent, achieving a certain role in investing in driving domestic demand.
It has to be mentioned here that the income structure and financial situation of public hospitals in recent years have changed.
In 2019, the curtain of centralized procurement of pharmaceutical and equipment in my country was opened and the DRG payment reform began to be widely piloted, which profoundly affected the income and expenditure structure of public hospitals. The main core is reflected in the continuous compression of the proportion of drug revenue in total revenue. These two original profit center businesses were quickly converted into cost centers.
According to statistics from the China Merchants Bank special bond department, the annual surplus of public hospitals in my country in 2019 was 146.798 billion yuan, higher than the 73.799 billion yuan in 2018, and the average surplus of tertiary public hospitals was 45.101 million yuan (less than 20% of the tertiary public hospitals suffered losses that year).
situation took a sharp turn for the worse.
July 2022 National Health Commission announced the " National Examination Data". Among the 2,508 third-level public hospitals participating in the evaluation in 2020, 43.5% of the medical surplus was negative.
Since 2020 is the first year of the epidemic, many people blame the problem on COVID-19 . In fact, the more core reason for the loss of public hospitals is that the country puts the reduction of burden on patients' spending first. The original number one profit end of the hospital was cut off. At the same time, a series of policies strictly regulate the charging standards of public hospitals, which caused the hospital's income to decline; at the same time, the "emptying cages and changing birds" of centralized procurement and medical insurance negotiations has not been effectively transferred to medical service income. With the increase of labor costs, the pressure on public hospitals has also increased sharply.
(the main component of public hospital revenue from 2012 to 2020 Source: Health Industry)
The "largest hospital in Asia" that caused heated discussions a while ago Zhengzhou University First Affiliated Hospital announced its 2021 report card as an example, with an average daily revenue of nearly 60 million. Although the number made a group of people sigh, the core of which is that the loss dilemma of public hospitals has emerged.
Data released by Zhengzhou University First Affiliated Hospital shows that the carryover and balance at the end of 2021 was about 1.056 billion, and the data at the beginning of 2021 was about 926 million.
However, careful analysis shows that the total annual revenue of the First Affiliated Hospital of Zhengzhou University is approximately 21.877 billion yuan, of which 18.606 billion is business income (which can be understood as general main business income), and there are also 2.291 billion other income and about 980 million fiscal appropriations.
The total annual expenditure of Zhengzhou University First Affiliated Hospital is 20.834 billion yuan, which means that if there is no government fiscal appropriation, the hospital is barely on the break-even line, and if there is no other income, the "largest hospital in Asia" will fall into a loss.
Although it has been emphasizing that public hospitals have returned to the "public welfare" attribute, if we have the impact of fiscal appropriations on hospital finances, the proportion of fiscal appropriations of the First Affiliated Hospital of Zhengzhou University is only 4.48%, which seems that the impact is not as great as imagined.
Value Medical Advisory Expert Committee Secretary-General Liang Jialin mentioned in "Health National Policy 2050" that after deepening medical reform and abolishing drug bonuses for public hospitals, the losses caused by public hospitals are required to be compensated by six channels, including: The government's focus is on basic construction and large-scale equipment purchase , key discipline development, retired personnel expenses that comply with national regulations, policy losses compensation, and special subsidies for public health service tasks undertaken by public hospitals. For quite some time, many places have not implemented the central deployment.
Here, it actually explains the doubts about the great influence of policy mentioned above.
According to statistics from Yang Song's team of Tianfeng Pharmaceuticals, as of October 7, hospitals in more than 12 provinces have received medical equipment interest subsidy loans, with a total amount of nearly 2 billion yuan.
This time the implementation speed exceeded market expectations.
Since the State Council decided on September 13 that the special re-loan and financial interest subsidies support the equipment update and transformation in some fields, it has only been half a month since the medical institutions in Yangjiang, Guangdong that received the fastest loan to be issued.
Of course, in addition to meeting the requirements put forward in government documents, the hospital updates and purchases may be more of the profit center equipment, including imaging equipment, inspection equipment, and surgical equipment.
1) Imaging equipment
Among the 21 landing projects issued by Tianfeng Pharmaceutical statistics, 4 mentioned the words "MRI" or "" medical imaging device.
In fact, the performance of the medical imaging equipment industry has accelerated in the past two years and is very dependent on the advancement of new medical infrastructure. Experts pointed out that a large part of the increase in equipment procurement in 2022 is supported by new infrastructure, otherwise the industry's capacity may decline more.
As we all know, medical equipment has strong periodicity, and a considerable number of equipment will be replaced in about 7 years. After this peak has passed, it will take a long time to wait for the opportunity to come again. Another opportunity for
imaging equipment lies in consumables. After enough equipment is laid, the core consumables (bulb tubes) will be replaced once every 1-2 years of CT and nuclear magnetic field in major hospitals. For example, the 256-row CT tube costs 1.5-2 million yuan.
At present, the leader in domestic mid-to-high-end imaging equipment is United Imaging Medical.
2) Clinical testing instrument
Laboratory department is currently one of the important profit centers of hospitals, so improving overall testing capabilities and testing efficiency may also be one of the purposes of some hospitals applying for loans.
Among the many inspection instruments, the chemiluminescence assembly line is one of the core equipment with high value and high output value. At present, the performance of related products such as Mindray Medical , New Industry, Antu Bio , Yahuilong, Mike Bio and other products has gradually approached the import manufacturer. Under the advocacy of domestic procurement policies, domestic IVD companies are expected to gain more market share of tertiary hospital .
3) Surgery & Operating Room Equipment
Endoscope is the strongest segment in this round of market trends. The existence of means reasonable . Its internal logic recognized by the market includes three aspects:
● Follow the big policy direction: Endoscope equipment and consumables can be used for diagnosis and treatment, widely used in various departments, and used in various minimally invasive surgeries, which has accelerated the hospital's bed turnover to a certain extent and conformed to the general direction of the implementation of the DRG policy;
● Strong performance certainty: Taking Soft Mirror Company as an example, Kaili Medical's net profit after deducting non-recurring items in the first half of the year was 148 million to 188 million, a year-on-year increase of 62.38% to 106.26%.Another company, Aohua Endoscopy, is a new product series that is about to be launched, with strong expectations of increasing volume;
● The domestic substitution rate is low: According to Oriental Securities statistics, endoscopy in domestic medical equipment was early restricted by factors such as equipment performance, doctor habits, market education, etc., and the domesticization rate was low. This wave of the government encouraging domestic substitution and new medical infrastructure to help the domestic endoscopy industry develop rapidly;
In addition to endoscopy, surgical & operating room equipment includes blood gas analyzer , anesthetics, Crane tower , surgical robot, dynamic air disinfection machine and other large number of equipment, summarized from the areas of expertise of each company: Huakang Medical is better at the hospital sensor control equipment level (crane tower, disinfection machine ), Libang Instrument has certain characteristics in blood gas analyzers, surgical robots are more invasive, and the "No. 1" Mindray can provide a considerable number of equipment solutions (anthocyanates, monitors, etc.).
Conclusion: The most pessimistic moment for the medical industry may have passed. Perhaps national fiscal support is just a starting signal. With the relaxation of future policies, at least two of the three horses will become an important driving force for industry companies to counterattack.
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