Recently, the state issued 1.7 trillion central discount loans, of which 200 billion flowed into the renewal of medical equipment, which sounded the "assembly number" of the new infrastructure of medical equipment. This has also injected a "shot in the arm" into the medical device industry in the deep collection vortex.
After the good news was released, the A-share medical device sector rose sharply in recent days, with UIH Medical (688,271), Kaikai Medical (300,633), Mindray Medical (300,760), Candeley (603,987) and Xinmai Medical (688,016) leading the gains.
Solve the financing problem of hospital equipment procurement
Feng Jian, the head of a private hospital group in Zhejiang, told the First Financial Reporter that a local hospital under the group just happened to purchase medical equipment when the discount loan policy was issued, and soon received a phone call from the local bank and offered discount loans.
"Because it is precisely to purchase these equipment, the benefits of exempting interest are immediate." Feng Jian told the First Financial Reporter, "For private hospitals that are still in a difficult period of operation, purchasing large-scale medical equipment is a big investment in infrastructure costs, and it is still of great significance to get the actual capital cost concessions."
Li Bing, an investor in a private hospital in Shandong, told the First Financial Reporter that the loan interest rate within the support period of refinancing and financial discount policy (3 years) is not higher than 3.2% and not lower than 2.5% (financial discount level). If a hospital buys 20 million yuan of equipment, it will save 500,000 to 700,000 yuan in interest each year and 1 million to 1.5 million yuan in two years.
"The direct benefit of the hospital purchasing equipment is to increase the competitiveness of the hospital. If the loan allows, there are still hospitals willing to purchase equipment, and our hospital will declare it. However, if some hospitals are in poor operating conditions, such as high debt ratio, and banks do not approve them, that is another matter. " Li Bing told the First Financial Reporter.
He also reminded that the original intention of the discount loan policy is good, which can promote hospitals to improve the level of diagnosis and treatment, but for hospitals, they should also do what they can, especially private hospitals. "This policy provides a space for the hospital to operate. After all, it can get actual financial support. As a hospital, it should make full use of this policy. After all, it is necessary to increase investment and debt when purchasing equipment, and the money still needs to be paid back." Li Bing told the First Financial Reporter.
Yi Zhu, executive director of Sullivan’s Greater China Medical Group, told the First Financial Reporter: "2022 is a difficult year for the real economy, and the situation of financing difficulties has intensified. It is urgent to introduce the discount loan policy to alleviate the problem of financing difficulties and expensive financing for enterprises."
Yi Zhu believes that hospitals are an important part of social services and will be one of the beneficiaries of this policy. In addition to private hospitals, public hospitals also benefit obviously, because the funding channels of public hospitals are relatively simple, mainly relying on financial subsidies and loans. This policy can effectively solve the problem of insufficient funds in the development of hospitals, reduce the capital cost of hospitals, and promote the upgrading of hospital equipment to better serve the majority of patients.
"Large-scale tertiary public hospitals are of course strong, and all kinds of medical equipment are complete. Because patients gather in the head hospital, these hospitals always have to purchase equipment regardless of whether they are subsidized or not." A medical system person told the First Financial Reporter, "So this discount loan policy may benefit more grassroots public hospitals with weak medical infrastructure."
The relevant person in charge of a large tertiary hospital in Shanghai told the First Financial Reporter: "As we are the unit responsible for the budget of the Health and Health Commission, in the past, infrastructure construction and equipment investment needed to be purchased by ourselves. If it is really necessary to purchase equipment, we can consider loans. Through this discount loan policy, we can indeed buy some equipment."
The deputy director of the Radiology Department of another large tertiary hospital in Shanghai told the First Financial Reporter: "Many hospitals have applied for procurement, and we are still evaluating it. After all, the cost of purchasing an advanced medical imaging equipment is very high."
Some insiders also said that although some large tertiary hospitals are large in scale, their debts are also very serious, and they are very cautious about the decision to purchase equipment. Take Zhengda First Affiliated Hospital as an example. According to statistics, the balance of the hospital in 2021 was less than 1 billion yuan, accounting for less than 5% of the revenue.
"Our hospital will tend to build joint laboratories with some enterprises, so that the equipment of enterprises can be put into the hospital for free, saving a lot of money." The person in charge of the scientific research department of a hospital in Shanghai told the First Financial Reporter, "For example, we are preparing to cooperate with a domestic medical imaging equipment giant company to build a laboratory."
The director of the Radiology Department of a large tertiary hospital in Shanghai told the First Financial Reporter: "The key problem lies in the demand. The equipment is purchased according to the demand, and it is bought when there is demand, not because there is a discount policy, and there is no need to borrow money to buy it. It is unnecessary."
Imaging equipment manufacturers benefit first.
In Li Bing’s view, the most direct and first beneficiaries of the discount loan policy should be medical device manufacturers and distributors, not hospitals. "This means that the market of manufacturers has room for substantial growth." He told the first financial reporter.
Other investors also believe that the medical device industry, which has been silent for a while, may be reborn because the new infrastructure of medical devices has been put on the agenda. "In the past, the market did not attract enough attention to the new infrastructure of medical devices." A medical device investor told the First Financial Reporter, "Now the discount loan policy has shaken this undercurrent market."
Yi Zhu told the First Financial Reporter: "The policy limits the use direction of this loan to the purchase of medical equipment such as diagnosis and treatment, clinical examination, severe illness, rehabilitation and scientific research transformation. Correspondingly, it will mainly benefit the fields of imaging, IVD, monitoring and rehabilitation equipment."
Multinational giants first "liked" the discount loan policy. GE Medical told the First Financial Reporter: "Recently, we are concerned about the decision of the Standing Committee of the People’s Republic of China to determine special refinancing and financial interest subsidies to support the upgrading of equipment in some areas, expand market demand and increase development potential, and the Health and Health Commission took the lead in issuing a notice to confirm the use of financial interest subsidies to upgrade and transform medical equipment. This has undoubtedly injected a shot in the arm into the medical and health field, which is good for the overall domestic medical equipment industry. "
GE medical said that the implementation of a series of discount and loan combination boxing will be beneficial to the development of medical equipment manufacturing industry and accelerate the innovation iteration of enterprise equipment and products; On the other hand, it is also conducive to the overall development of medical equipment manufacturing industry, encouraging enterprises to expand production scale and improve production capacity and efficiency, which has a great impetus to the road of high-quality development of medical equipment in China.
At present, GE Medical has developed, produced and put more than 100 products into the market in China, covering a series of innovative products such as 256-slice CT, 3.0T magnetic resonance, obstetrics and gynecology, heart, whole-body ultrasound and ventilator, anesthesia, monitoring and ECG.
Some multinational medical device manufacturers also said that the favorable policies should be viewed more rationally. "It is still difficult to assess how much this policy will benefit our business, and we will have to wait until the final result comes out." The president of a European multinational medical imaging equipment company in China told the First Financial Reporter.
"The overall policy of discount loans is favorable. After all, in the short term, it will help to promote hospitals in need to buy or replace equipment as soon as possible." A senior official in China, a large German intensive care equipment manufacturer, told the First Financial Reporter, "But we should also see clearly that these demands are only released in advance. After all, equipment is not a high-frequency procurement commodity, unlike consumables. Now I buy more, and I may buy less in the future."
However, according to an internal document circulating in the industry, it seems unnecessary to worry about future demand reduction. "Some equipment may be purchased in advance, but with the increase in personnel and manpower investment in hospital equipment procurement, the ability to receive medical treatment will gradually increase, bringing new medical needs, which in turn will promote the hospital’s investment in new infrastructure." A summary of internal interviews with relevant departments wrote.
"I think as a hospital, they are more inclined to purchase some medical instruments and imaging equipment with shorter return period, such as CT, MRI, color Doppler ultrasound, IVD, and monitors, because there are a large number of patients’ needs, and for equipment such as surgical robots and gene sequencers that are expensive and difficult to return to their original cost, the demand of hospitals may not be so urgent." Seimi Zhang, a senior person in the medical device industry, told the First Financial Reporter.
Gu Xin, an executive of a multinational gene sequencing equipment manufacturer in China, told the First Financial Reporter that the types of equipment purchased by hospitals are closely related to clinical cognition. "At least at the present stage, the demand for using gene sequencing in clinical diagnosis is relatively small. This is because gene diagnosis is a relatively new discipline, and not many clinicians know this new technology. On the other hand, it is also related to cost. If gene diagnosis can be included in medical insurance in the future, the demand will increase significantly." Gu Xin told the First Financial Reporter.
Demand for innovative technology and equipment to be released
The first financial reporter learned that although some large tertiary hospitals are actively promoting the construction of research hospitals and strengthening their scientific research capabilities, the medical talent pool in emerging frontier technologies such as gene therapy is still in the early stage.
"Some hospitals pay more attention to scientific research, and the dean himself is an academician. They will be more active in the early layout of these new technologies, but the awareness of more hospital leaders is still lacking. Coupled with the current economic challenges, the investment in non-essential equipment will be less active." Gu Xin told the First Financial Reporter.
A deputy chief physician of the Department of Cardiology, a large tertiary hospital in Shanghai, told the First Financial Reporter that some genetic diagnosis techniques may be used in the field of structural heart disease, especially congenital heart disease, but they are rarely used as a whole, and their usefulness has not been fully revealed.
However, the situation is also changing. With more and more scientific research proving the influence of genes on diseases, precise treatment driven by gene diagnosis will surely receive more attention in the future. "For example, structural heart disease, current research has found that the incidence of a considerable number of patients is related to heredity. With the promotion of related research, precise treatment will definitely become the future trend." Gu Xin said.
In the eyes of the industry, this discount loan can not only release part of the clinical equipment demand, but also help accelerate the development of domestic medical equipment.
"At present, it is in the historical opportunity period when the country vigorously supports domestic innovative medical device products. I think hospitals may get greater support and encouragement when purchasing domestic devices and equipment." Seimi Zhang, an insider, told the First Financial Reporter.
UIH recently publicly responded to the new infrastructure of medical equipment on its WeChat WeChat official account. "We provide customized services for diversified scenarios for medical institutions at all levels for discount applications with tight time and difficult planning." UIH wrote. Since UIH went public at the end of August this year, its share price has risen steadily, and its current market value exceeds 160 billion yuan.
In addition, with more and more domestic surgical robots approved for listing by NMPA in China, the market believes that the discount loan policy will also stimulate the demand for technical equipment in this emerging field. For example, Tumai, the first domestic four-arm laparoscopic surgery robot independently developed by minimally invasive medical care, was approved by NMPA not long ago.
A domestic head surgery robot manufacturer has told the First Financial Reporter that since the release of the discount loan policy, the enthusiasm of hospitals for purchasing surgical robots is higher than in the past.
Jiang Tengfei, senior consulting director of Sullivan’s medical team in Greater China, believes that in terms of surgical robots, China enterprises can combine the advantages of the local market and exert their innovative ability in integrating AI intelligence. "In recent years, in terms of professional surgical instruments, a number of domestic brands with independent intellectual property rights have emerged in the China market, such as endoscopic/orthopedic surgical robots. How these enterprises develop in the future is worthy of attention." Jiang Tengfei told the First Financial Reporter.
"Now it seems that China’s centralized procurement policy will continue for a long time, which requires medical device companies to develop more innovative and core technologies that can be independently controlled, and serve the clinical unmet needs at a more competitive price." Seimi Zhang told the First Financial Reporter.
In recent years, the state has also issued a series of policies to encourage domestic medical device enterprises to accelerate innovation and become bigger and stronger. Last month, the National Medical Insurance Bureau clearly stated in the Reply of the National Medical Insurance Bureau to Recommendation No.4955 of the Fifth Session of the 13th National People’s Congress that "innovative medical devices will not be included in centralized procurement for the time being", and a certain market should be set aside outside centralized procurement to provide space for innovative products to open up markets.
However, in the field of domestic medical devices, there are still some problems in the industrial chain, such as duplication of low-end production capacity and waste of production resources, and there is still an objective gap with the world advanced level. Many products still need to be tested by the market. Enterprises need to further increase investment in R&D, achieve technological breakthroughs, gradually break through the core technical barriers of high-end equipment, and improve the localization rate of high-end medical device products. Take the high-end medical imaging products as an example. At present, the localization rate is less than 10%.
Cui Xiaobo, medical managing director of Ipsos medical industry, a consulting company, told the First Financial Reporter: "At first, domestic factories were engaged in the production of some relatively low-end medical device products. In the past few years, with the independent innovation and research and development advocated by the state, some manufacturers also began to develop high-end medical device products, but the core components still rely on imported supply chains, such as tubes and detectors of CT equipment. The problem caused by this is that the procurement cost is high. When it does not reach a certain amount, the enterprise has no bargaining power, so it loses money year after year. "
Cui Xiaobo said that although some local manufacturers of head medical devices are doing some independent research and development for some core components and referring to foreign enterprises, it is one thing to assemble medical devices, and it is another to use them well in clinical application. "Especially for the setting of some parameters, because international brands have a lot of overseas research and development or experience in other markets and then get it to the China market, I think there is still a certain gap in this part." He told the first financial reporter.
(Feng Jian, Li Bing, Seimi Zhang and Gu Xin in the text are all pseudonyms)
