A state initiative to reduce intermediaries in China’s pharmaceutical¹ market is expected to more than halve² the number of companies in the sector³, but experts say the government will struggle to achieve its aim of cutting drug prices and tackling bribery⁴ in distribution chains.

中国政府一项缩减医药市场中间环节的计划，有望使该领域的企业数量减少一半以上，但专家们表示，政府将很难实现其压低药价、清除分销链条中贿赂行为的目标。

The vast majority of China’s $110bn annual pharmaceutical sales are to state-run hospitals, which depend on drug and medical equipment sales for most of their revenue. Drug sales are conducted through a byzantine network of some 13,500 distributors, with kickbacks⁵ to doctors rife⁶.

中国医药行业每年销售1100亿美元产品，其中绝大部分流向公立医院，这些医院的收入主要靠卖药和卖医疗器材。药品销售通过一个复杂的网络进行，这个网络由大约1.35万家分销商组成，给医生回扣的现象相当普遍。

Regulations limiting the number of invoices⁸ between drugmakers and hospitals to a maximum of two will be rolled out nationwide by next year, the State Council said last month. The number of drug distributors is expected to plummet⁹ as a result.

中国国务院上月表示，将不晚于明年在全国推开“两票制”（指药品从生产企业到流通企业开一次发票，流通企业到医疗机构开一次发票）。预计这将导致药品分销商数量大幅减少。

“Reducing the number from more than 10,000 to 2,000-3,000, that is what I have heard from officials,” said Xie Qilin, deputy secretary-general of the Chinese Medical Doctor Association.

中国医师协会(Chinese Medical Doctor Association)副秘书长谢启麟表示：“把数量从1万多家减至2000到3000家，这是我从官员那里听到的。”

The “two invoice⁷ reform” as it is known is already being tested in 11 provinces, with Fujian in the east reporting a halving¹⁰ of distributors since its adoption¹¹ in 2012. “The market is not concentrated enough,” Wu Zhen, vice-minister of China’s food and drug administration, said last year, explaining the rational for the policy.

名为“两票制”的改革已在11个省份试行，福建省报告称，自2012年执行规定以来，药品分销商已减少了一半。中国国家食品药品监督管理总局副局长吴浈去年在解释出台该政策的理由时表示：“（市场）集中度不够。”

“The agencies will have to enlarge or die,” said an employee at an overseas medical device manufacturer who asked not to be identified. The sector employs more than 3m people, many of whom will be forced to switch to larger companies or change professions, the Economic Observer newspaper reported.

某海外医疗器械制造商的一名要求不具名的员工表示：“代理商要么必须扩张，要么就得关门。”《经济观察报》(Economic Observer)报道称，该行业员工数量超过300万，其中很多人将被迫转投较大的公司或改行。

Eric Carlson, a partner at law firm Covington & Burlin, said in a recent report that the crackdown on small distributors would accelerate sector consolidation¹², “centralising distribution in a handful of pharmaceutical distributors, many of which are state-owned or state-controlled”.

科文顿?柏灵律师事务所(Covington & Burling)合伙人埃里克?卡尔森(Eric Carlson)在最近一份报告中表示，对小型分销商的打压将加快行业整合，“将分销集中到少数药品分销商手中，其中很多是国有或国有控股企业”。

Beneficiaries would include companies such as Sinopharm Group, in which the Chinese government has a majority stake, with Fosun Pharma as a partner.

受益者将包括国药控股(Sinopharm Group)等公司，中国政府持有国药控股多数股份，复星医药(Fosun Pharma)也是股东之一。

The reform is likely to be more of a challenge for Chinese drugmakers that typically distribute their products indirectly¹³, through local intermediaries. If applied¹⁴ to the medical device market it could benefit overseas companies by reducing the need for complicated supply chains.

对中国药企来说，此次改革很可能更多是一次挑战。中国药企一般通过地方中间商间接分销其产品。如果这一改革应用于医疗器械市场，可能会使海外药企受益，因为它们不再有那么大的必要去建立复杂的供应链。

Ireland-based Medtronic, for instance, was fined $17m by Chinese anti-monopoly authorities last year for price fixing in its multi-layered local distribution system.

例如，总部位于爱尔兰的美敦力(Medtronic)去年被中国反垄断部门罚款1700万美元，原因是该公司在其多层级的地方分销体系中进行限价。

Other large multinationals¹⁵ tend to have their own sales teams, which employed some 20,000 staff as of 2011, according to Rachel Lee, an industry observer.

其他大型跨国药企在华往往都拥有自己的销售团队，根据行业观察人士Rachel Lee的数据，自2011年起，这些销售团队共雇用了约2万名员工。

But use of direct sales staff has not prevented bribery. GlaxoSmithKline paid a record ￡297m fine in 2014 after its sales staff were found guilty of corruption¹⁶, while Bristol-Myers Squibb faced $14m in US penalties over alleged¹⁷ bribery of Chinese hospital officials. Novartis agreed pay $25m last year over similar charges.

但使用直销人员并没有防止贿赂行为的发生。2014年，葛兰素史克(GlaxoSmithKline)在其销售人员被判犯有行贿罪后支付了创纪录的2.97亿英镑罚款。而百时美施贵宝(Bristol-Myers Squibb)因涉嫌贿赂中国医院官员在美国被罚了1400万美元。去年，诺华(Novartis)同意就类似的指控支付2500万美元。

State officials have said the reform is aimed at reducing drug prices. The current drug distribution system is “very inefficient¹⁸ and very costly¹⁹, and the cost in the end is borne by the patient”, said Franck Le Deu of McKinsey’s healthcare practice. “Provinces and even cities can have a vested interest in having homegrown distributors in their backyard.”

政府官员已表示，此次改革的目的在于降低药品价格。当前的药品分销体系“非常低效、成本很高，这些成本最终都由患者承担”，麦肯锡(McKinsey)医疗行业实践部门的乐诚铎(Franck Le Deu)说，“说到在自己的后院保有本地的分销商，各省、甚至市可能都在这方面存在既得利益。”

But according to Liu Tingfang, a hospital reform researcher at Tsinghua University, the squeeze on distributors will benefit pharmaceutical companies — which will save on distribution costs — more than patients.

但清华大学研究医改的刘庭芳研究员表示，压缩分销商给药企带来的好处（药企将可节省分销成本）要多于给患者带来的好处。

“Prices will not see much impact. Kickbacks will still exist,” he said, with low-paid medical staff at hospitals still expecting a share of sales. “It is necessary to reform doctors’ salaries.”

“药价不会受到太大影响。回扣将依然存在，”他说，因为医院收入不高的医务人员仍指望从药品销售中分一杯羹。“有必要对医生的工资进行改革。”