The awakening moment of the siege of medical equipment: from "a hero in troubled times" to "the one who remains is king"

We now see that the medical device industry is actually very hot. Whether it is investment or entrepreneurship, there are also various cross-border robberies who want to get a share.

But is the industry under siege?

Is it really possible to pick up money when you come in?

In a prosperous scene, what risks exist in the development of enterprises?

What are the distinct implications for various types of businesses?

These are some topics worth discussing.

Our "Medical Learning" has been focusing on training and consulting in the medical device industry since 2017. After providing counseling and services to more than 100 listed and leading companies, as a third-party perspective, we follow our observations and feelings with Everyone share.

First of all, the medical device industry is greatly affected by policies, which is a consensus. However, the impact of this policy may be more far-reaching than we imagined, because it may directly affect or even directly create many listed companies of private enterprises.

If you enter this industry now, is it possible to simply copy a listed company? In fact, we cannot "only see thieves eating meat, but not seeing thieves being beaten." We cannot look at this issue apart from the historical environment and external environment in which these enterprises were located at that time.

1. Five stages

Zhang Bo from Zhengzhou, Henan Province-Mr. Zhang, a good teacher and helpful friend of mine, is an expert in the field of orthopedics. He has worked in the medical device industry for 40 years and has experienced almost the entire history of the development of the industry. He told me 5 very important things about the development of medical device companies. The important stages are very helpful for us to see the development process of the enterprise from the perspective of God, and can discover many truths and realities. In these five stages, different enterprises have different fates.

First of all, let's look at the first stage, that is, the planned economy stage.

Planned Economy (1949-1979)

Older people in the industry experience this special 30 years.

From 1949 to 1979, it was the era of the national planned economy. Many industries, including the medical equipment industry, belonged to a planned and nationwide supply system.

The same is true for the medical device industry, which has very typical characteristics of a planned economy. During this period, there were four major medical device procurement and supply stations in the country, referred to as device stations. They are in 4 cities "North, Shanghai, Guangzhou and Shenyang", that is, Beijing, Shanghai, Guangzhou, and Shenyang. Under the system at that time, stations were divided into second-tier and third-tier stations according to provinces and cities. For example, there is a medical device procurement and supply station in Henan Province, which is considered a second-level station. Below the second-level station is a third-level station in various cities. It is through this third-level circulation that it flows to hospitals. This is the stage of the planned economy before 1979. .

To establish such a medical device procurement and supply system, the planned production of medical devices will all be sold to these four major medical device procurement and supply stations. Manufacturers will not sell products to hospitals, and there are no distributors in the circulation field. The website is actually the dealer.

Of the four equipment stations, the one in Shenyang was the first to close down, while the ones in Guangzhou and Shanghai are still there. Therefore, in this period, the simple summary is that the market is blank, there are no manufacturers, no distributors, nothing.

Coexistence of Planning and Market Economy (1979-1989)

The 10 years of the second stage, we call it the era of the coexistence of planned economy and market economy, this era is from 1979 to 1989.

In 1978, the second generation of central leaders with Deng Xiaoping at the core established a turning point policy of "focusing on economic construction". Until 30 years later, we can still feel the profound impact of these policies on China's reform.

At that time, the historical background of China as a whole was to vigorously develop the economy, and the whole country was introducing foreign technology and capital, such as the introduction of automobile production lines, the introduction of Coca-Cola, the introduction of home appliances, especially the product lines of refrigerators, air conditioners, and washing machines, all over the country. .

The overall historical environment is that China absorbs technology, attracts capital, etc. by encouraging foreign-funded enterprises to invest in China and to establish joint ventures with China. During this period, some signs of Chinese enterprises began to emerge, because the whole country took economic development as its main purpose and introduced many foreign technologies, investments, and enterprises.

In the past 10 years, many major events have occurred in the country:

The national college entrance examination was resumed in 1978;

Hong Kong businessman Huo Yingdong built China's first Sino-foreign joint venture hotel in Guangzhou, and also the first five-star hotel - White Swan Hotel;

The first private enterprise in China - "Shanghai Industrial and Commercial Office Patriotic Construction Company" was established in Shanghai;

Yuan Geng, who was once the head of the artillery regiment in 1949, put up a sign at the gate of the Management Committee of Shenzhen Shekou Industrial Zone, which read "Time is money, efficiency is life", and started the reform of the experimental zone in Shekou, Shenzhen;

The 83-year-old Konosuke Matsushita flew to China as the first international entrepreneur to visit New China. In the following 10 years, Japanese companies became the first batch of foreign pioneers in the Chinese market.

Under such a large macro background and environment, the entire medical industry began to experience some small waves.

Let's look at the production enterprises first. Anke, a representative enterprise in the medical device industry, has appeared.

Anke was established in 1984. At that time, the entire medical device industry in China was almost a blank sheet of paper. There was no accumulation of technology and no production enterprises. All medical diagnosis and treatment equipment had to be imported from abroad. MRI, as the world's leading Medical equipment, which has only been on the market for a year, is very expensive. After missing the good time for the development of X-ray machines and CT machines in the 1970s, the State Science and Technology Commission and the State Planning Commission gave the Chinese Academy of Sciences a death order: develop MRI.

In this context, the Chinese Academy of Sciences and the US listed company Analogic jointly established Anke. Analogic is favored for its production of core components of multiple medical device products such as MRI. Anke has become the first joint venture in the field of medical devices in China.

The establishment of Anke has a very close relationship with the overall background at that time, and it also had a very critical impact on the development of the entire medical device industry. This is a story that everyone in the industry knows.

Looking at the distribution field again, since 1979, some small distributors have appeared in the circulation field, but hospitals are still unable to place orders from manufacturers at this time, and the trading of medical devices is still mainly circulated within the system, but people outside the system began to Infiltrating into the system, some initial dealers began to appear, and many of them were not inside the system, but those who dared to venture outside the system and dared to find their own way out, and some were unemployed, returned City personnel, low-education people and so on.

These people started to sell medical products in the name of "self-employed" . Little secret envy of "free body" .

To briefly summarize, this decade is a state of coexistence of planned economy and market economy. Manufacturers and dealers have begun to appear sporadically, and the market is slowly awakening.

Complete Market Economy (1989-1999)

This 10-year period is particularly interesting. The 10-year period from 1989 to 1999 played a crucial role in the entire medical device industry. In this 10 years, it can be said to be the golden 10 years for the development of the medical device industry .

The state of an industry at that time was that the planned and unplanned dual-track systems coexisted, and the system was rapidly diverging, and the entire market was in a very hazy state. On the one hand, we need to engage in economics. On the other hand, we are faced with the long-term influence of ideology in the past. For purely market-oriented behaviors, we are still struggling with the issue of "surname capital" or "surname society". In fact, most people have no bottom in their hearts.

In many other industries, when the country has no clear policies and regulations, sometimes it is even in a gray area. Some courageous people start to do business and start businesses, and two typical companies have emerged. Forms, one is a township enterprise, and the other is a private private enterprise.

Private enterprises began to appear in China in 1984, which is the first year of Chinese private enterprises. However, the emergence of these enterprises is not as vigorous and strategic as imagined. On the contrary, many people have no choice but to solve the problem of livelihood because they cannot enter the state-owned enterprises and cannot return to the countryside to farm. Individual industrial and commercial households, or in other words, are a way to make a living out of the private soil in the form of enterprises.

Therefore, looking at the entire industry, many times the bosses of companies that seem to be very successful and listed companies have never thought about how big the company was at first. Just survive. Therefore, the development of many enterprises, especially Chinese enterprises, has a lot of mud-legged origins, and they have gradually walked this road step by step. There are many last resorts and forced, as well as various chances and coincidences.

In the medical device industry, since 1989, the policy has changed, manufacturers can sell products directly to hospitals, and there is no need to circulate them through medical device procurement and supply stations.

But at that time, there was a characteristic that the manufacturer directly contacted the hospital, and there was no communication between the manufacturer and the manufacturer at the beginning.

For example, from 1989 to 1999, the employees of the production company traveled all over the country to sell products by themselves, so the model at that time was actually a one-vote system.

1989年，前文提到的张总到东莞人民医院去推广他们公司的产品，东莞人民医院订完他们的产品说：你能不能帮我，我需要很多很多的骨科的器械、内植物。 张总说：对不起，我是生产厂家，我不是经营企业，我不能帮你去定这个东西。 但是因为广东改革开放比较早， 医院说，你们可以帮我订，订完以后我仍然买你的，我不管是谁的。

所以，其实那个时候整个医械市场是处于一种朦胧的状态，各个厂家的产品都自己一票制的对于终端，但是医院有多种需求，一个厂家没办法满足，于是经营型企业，也就是经销商，慢慢的出现了存在的必要性。

到了1999年，这个市场已经完全市场化了，比如说大家已经都相互的可以去采购、订购了。

需要注意的是，国家当时相应的也没有太多的监管。比如在2000年以前，医疗器械经营是不要许可证的，你想卖什么东西都可以，开个店，可以卖几千万的核磁，也可以卖一个棉签，都是一样的。所以我们把那个阶段，定义为完全的市场经济阶段。

所以在第三个阶段，也就是完全市场经济阶段，全国的医疗器械呈现了大繁荣的景象，中国的医疗器械进入了发展的快车道，出现了大批的医疗器械的生产厂家。

所以在完全市场经济的这种历史背景下，也就1989年到1999年，这个是医疗器械行业，尤其是民营企业它发展最好的黄金10年。我们也留意了一下，目前医疗器械上市公司市值排名前十的上市公司，他们创立的时间也大多都在这10年里面。

比如迈瑞是1991年成立的，万泰是1991年成立，万孚是1992年成立，包括新华医疗、新产业生物、东软、乐普和先健等等。你会看到这10家公司它成立的时间段就刚好落在了1989年到1999年。

这10年百废待兴，市场需求巨大，而这些公司的创始人敢干、敢闯，所以他们就进入到了这么一个相对空白的领域。

我跟有一位行业内干了20年的朋友聊，他就跟我去讲了一个观点，说我们去分析医疗器械企业的经营、管理和企业发展的历史，其实前面20年的发展都没有太多的意义，他们之所以能够发展起来原因非常简单，就是做得早。那个时候没有企业，市场上没有产品，那你最早做，自然就有非常明显的先发优势。

换句话说，假设我们把这些公司的创始人、老板请出来，在现在的环境下，让他们再去创办一家企业，很可能做得没有以前好，因为企业的成长的路径和现在面临的挑战是完全不一样的，外部环境已经发生了翻天覆地的变化。

当然这种假设和观点，并不是否认这些公司的眼光、格局、技术和胆识，只是我们从另外的视角来看，更侧重于外部环境的分析，其价值在于给现在的企业不同的视角和启发。

国际接轨（1999年—2017年）

从1999年开始，进口的医械品牌开始规模化进入中国，给中国医械行业带来了很多有价值的东西。

比如，他们带来了一个对流通领域非常重要的东西-代理制，经销商和终端不在厂家的代理范围内，厂家是不会把产品卖给你的。这个时候，国内的厂家才开始知道了方法和规则，只有拥有了这种代理制，也就是医疗器械经销商，你这个产品才有一个明确的销售方向。

同时，进口品牌的产品进入中国，还带来了更重要的东西，直接催生了医械行业的繁荣，就是他们带来了先进的治疗手段、先进的理念，使中国的医生开始接触到先进的技术。

做骨科的张总给我举过一个例子，他是干骨科产品的高质耗材，做人工关节替换的。他在2000年只有70台进口关节，而在2017年，光河南的销售就有2000多台，几乎是30倍的增长。但是为什么2000年只有70台呢？2000年中国人就不看病了吗？中国人就穷？其实是因为中国的医生不会做关节置换手术，他就更不懂得关节置换这个理念。这个是因为国外的产品进入中国，带来了先进的治疗手段，还有先进的理念，使中国的医生开始接触到这种先进的技术。

所以，第四个阶段-国际接轨，进口品牌带来了代理制，带来了先进的治疗手段和理念，这就使我们医疗器械的厂家和经销商大量出现了，也带来了医疗行业的一个新的发展，一个学术的繁荣盛况。

在这个时间段，我们也可以看到一些比较有代表性的公司，他们成立的这个时间刚好在这个时间段内，但是他们跟和最早一批公司不太一样的就是他们相对年轻。我们可以从他们创立的时间上可以看得出来，比方说联影是2010年创立，联影属于中国医疗器械企业里面也是非常的具有特色的一家企业。它的成功的历程、它的背景，包括它发展路径可能跟很多企业都不太一样。

除了联影之外，还有中元和硕世，他们的成立时间都是2008年。他们比之前在1999年之前成立那些公司相比，大概晚了10年，但是晚了10年并不代表着他们在发展的历程上会比之前那些公司更慢，反而因为有了在前面第一个吃螃蟹的人，所以后来的企业可以充分地借鉴发展的过程中所总结的经验，踩过的坑，以及吸纳外溢出来的人才。所以后来者可以站在巨人肩膀上看得更远、跑得更快。从这些企业成立的时间到他们上市或者拟上市的时间看，它的时间周期比第一批公司要快很多，所以这也是比较有代表性的一些企业。

两票制等医改时代（2018年开始）

到了现在，我们发现整个国家的政策又发生了很大的变化，虽然让很多企业叫苦连天，但是从逻辑上看，又有必然性。

国家早期通过一个比较自由，甚至比较混乱的阶段性发展策略，让所有的企业都能够各自野蛮发展，达到百花齐放的结果。但是到了后期，大部分产品已经到了一种严重过剩的状态，这个行业里面企业太多了。

我们简单统计了一下，在这个行业里面的生产型的企业至少有1.8万家，但是药品行业整个厂家只有8000家。所以我们所听到的一个声音是什么？在整个国家的医改政策的大背景下，其实要做行业整顿，要做一个腾笼换鸟的动作。笼子还是这个笼子，但是里面的鸟不一样了，它会选择什么样的鸟留下来？就是选择那些优秀的鸟留下来，最后只会留下综合竞争力非常强的少数厂家。

大多数企业在挤压，规范性调整、医保控费的环境下面临非常大的挑战。很有可能1.8万家生产型企业最终可能会只会剩下8000家，也就是有1万家企业可能会在整个医改政策的调整下会死掉，对于流通领域这个情况可能会更加的惨烈。

我们必须要意识到的，整个行业的环境跟20年前已经很不一样了，之前是乱世出枭雄，现在是“剩者为王”。

2.四条外因

在整个中国医疗器械企业的发展史，其实是3股力量「国营企业-民营企业-外资企业」相互博弈、此消彼长的过程。而现在的环境，对于外企是很艰难的。国家鼓励国产替代就是釜底抽薪的一击，比如外企的产品要进医院，需要过论证会，就是要论证为什么要去用进口的，而不是用国产的？是不是有哪些产品的特性、优势是国产是没有办法去满足的？只有在充分论证的情况下才可以去使用进口。所以整个外部的环境对外企确实会存在非常大的挑战，这是不容置疑的一个事实。

但是，从逻辑上看，这又是必然。医械行业前期通过外资的引进，引进技术、产品、理念等促进了行业的发展，到了一定程度，我们一定会是希望我们的国产产业能够崛起。所以在全国医疗体系一盘棋的情况下，它的采购的模式能明显地看到国产替代的不可逆趋势。这和我们现在全球的这种国家主义的竞争态势下，中国要考虑经济脱钩、去依附有关，这是不可逆的趋势。

这是我们所看到的中国医疗器械崛起的过程。如果说我们来总结一下，为什么中国的企业能够崛起，我们觉得有这么几个核心的方面：

外部原因

1989年到1999年的黄金十年，整个医疗器械一片空白，国家以经济建设为中心，大力改革，鼓励引进技术、人才、资金、产品，于是最早一批吃螃蟹的人在整个发展的过程中就有非常明显的先发优势。医疗器械市值排名前十企业，他们创立时间大概都在黄金十年里。

敢闯敢干

中国民营企业的崛起或者早期发具有非常明显的中国特色，出身与背景决定了这些企业有天然的草莽性和灰色性，就像某位中国早期的官员说的一句话：“改革与创新，往往是从违规开始的”。尽管国家政策是以发展经济为重心，但是因为没有经验，所以就必然出现了一些裂缝，放眼中国所有的民营企业，这些裂缝就被很多的中国的泥腿子出身的企业家所抓住了。

比如1984年的王石，在深圳成立“深圳现代科教仪器展销中心”（万科的前身）时，最开始倒卖玉米，后来发现换汇倒卖比倒卖玉米赚钱快很多，于是王石的展销中心其实本质上扮演的是终端洗钱的角色，只是在当时的历史背景下，法律选择了视而不见，留下了极大的斡旋和模糊的空间。

民营企业家是敢闯、敢干，敢为天下先，甚至是从走私、倒爷等等方向开始，游离在法律的边缘，再通过其他的方式慢慢正规化过渡或升级。这是特定历史背景下的产物，是非功过，不能一概而论。

行业红利

行业的红利我们不得不提，在归因一家企业成功要素的时候，我们不能只把它归结为企业内部，还要关注企业外部、包括外部环境、包行业的发展红利期。这是很多企业时候不想承认，但是作为真正的企业家必须要客观、清醒认识到的。

而这种行业红利，现在还有没有？值得我们去思考。

资本红利

中国发展经济，除了实业，金融工具也发挥了巨大的作用。

所以最早一批做起来的企业，最后借助资本的力量取得了非常好的回报和收益。同时也会在一段时间内让所有人都进入了一种近似疯狂的漩涡，动辄谈及的都是哪家公司又上市了，哪个高管又卖了多少股票，又挣了多少钱。

但是，我们可能需要意识到，这是在资本红利下的造富神话，很有可能是一个阶段性的神话。我们如果说把过多的这种想法、希望放到了资本上去，很有可能让我们脱离了产品、脱离了商业、脱离了生意本身。

在行业充满金融泡沫的环境下，我们可能要回归一种理性的思考。这种理性的思考可能是看一家公司的产品到底有没有市场？他到底有没有在创造社会价值？到底有没有去踏踏实实做事儿，而不是去2VC。对于最健康的公司而言，上市不是终点，它只是中间的一个工具和一个里程碑式的事件，长久来讲，这个公司它本身它的一个所属的赛道、它的模式、它能够提供的社会价值和经济价值，这个才是我们最终要考虑的东西。

3.三大挑战

最后，谈一下我们培训过100多家上市或龙头公司，总结出来的医械企业面临的普遍挑战。

说普遍，是因为这不是一家企业所暴露出来 的，而是很多企业的共性，我们总结为3点：

路径依赖，缺乏适应当下阶段的系统方法

企业发展过程中，是一个不断地打怪升级的过程，不管是研发、生产，还是营销都在摸索中前进。在早期，企业在刚开始可以不讲套路，不按常理出牌，不管黑猫、白猫，抓住老鼠就是好猫，这和当时的历史环境密不可分，那个时候不需要专业的方法，谁做谁挣钱，谁做谁成功。

但是这只是完成了资本的原始积累，这种方法的使命是有阶段性的，完成了原始积累，到了后期，如果你依然按照这种方式去做，就会形成路径依赖，就会发现有问题，因为整个外部环境已经发生了很大的变化。

所以当时张瑞敏在做海尔冰箱的时候，在公司的规定里面，第一条规定是“不允许随地大小便”，这是那个时候公司所面临的情况不得已去做的规定。但是现在公司有这样的规定，那一定是疯了。

这就要求我们相应的要去变化，不管是对于市场、销售、渠道、研发、生产，我们一定要意识到企业在不同的阶段他们的方法一定不一样，根据企业的不同阶段，一定要用与之相匹配的企业经营管理的这些经验。

而这种经验不能完完全全自己摸索，如果纯粹靠自己摸索，一定会有很大的挑战难度，付出很多的成本。

销售导向，充满了草莽性和灰色性

中国民营企业在发展过程中一定是销售导向的，销售团队在整个团队、整个公司里面是最有话语权、最有狼性，同时也可能是最霸道的一个部门，因为整个公司是靠销售去体现我们的这种市场价值。

中国的民营企业，不管是哪一个行业，天生就充满了草莽性和灰色性，这是诞生的环境和背景下的中国的特色。

不成体系，用纯实践碰壁来找方法

从整体上来看，大多数企业是不成体系，但是实际上，研发有专业的一套研发的方法论能确保产品能顺利立项、顺利报批。生产也有专门的一套方法能够帮我们去极大的降低成本、提升效率。不过，我们观察到在营销上，几乎所有民营企业很弱的部门-市场部。表现就是我们和任何一家公司去聊产品的策略、市场策略、销售策略的时候，没有几家说得清楚的，这是我们遇到的很常见的情况。

为什么民营企业市场部普遍很弱呢？原因无非是两个：

一个原因是公司不重视，就是公司对市场部普遍不重视，认为就是花钱的部门，也没有创造什么价值。

另外的原因就是没人才，找不到真正懂市场的、具有专业市场方法论的人，很稀缺。事实上这种专业的人是有的，不过不在民企这个圈子，而是在外企。

但是事实上，我们看到优秀的企业，市场部都是比较强的，外企不用说了，民营企业的龙头公司，也都越来越重视，大家也意识到，以前纯靠人海战术打江山的时代，正在慢慢过去，公司发展到现在阶段了，也需要用更专业的手段去更聪明的做事，效果会更好。所以，我们给很多企业去辅导专业的市场策略主题，教他们怎么样去定位细分市场、找到精准客户画像、勾勒出精准的经销商画像，并制定一套销售切实可行的销售策略和落地方案，很多企业发现效果果然不同。

这就是我们所总结的，我们所看到的中国的医疗器械企业所面临的普遍的一些挑战。

4.两点应对

这些挑战其实不难，我们是可以去解决的。

向成功者、优秀者学习

这学习的对象是谁？

对于中小型的民营企业，我们可以去向那些优秀的、头部的民营企业、上市公司去学习他们之前是怎么走的，他们所总结出来的经验，以及教训是什么。

对于国内龙头的民营企业，可以向外企去学习外企有优势的地方。比如市场部的专业技能，销售预测的准确性，企业对终端客户的把控，搭建KOL的体系，渠道管理的体系等等，外企普遍具有相对成熟的方法论，非常值得我们去学习和借鉴。

As business owners, executives or team leaders, we must learn to be humble. Of course we must have confidence in ourselves, but don’t think that we are the best in the world. Every company has something to learn from. We must have a clear thinking and logic, and a very calm mind. We need to know what shortcomings we have. Knowing your own shortcomings is not for telling the world, but for self-improvement so as to enhance your competitiveness.

learn from full practitioners

We need to learn from those who fully practice. This is also the law that the teachers on our "Medical Learning" platform discovered when they went to corporate training and counseling.

Only teachers who have fully practiced and have worked in the industry for 10 or 20 years can tell the truth in the industry and can really solve problems. If the teacher has not practiced, it is you who paid him Come to the class, the result is that you have to take a class with him in turn, telling him what is IVD, demonstration meeting, fees, account opening, delivery, dealers... This is the difference. And with a teacher with more than 20 years of experience, he will understand in seconds at the beginning, and then share with you the excellent experience of other companies in the industry or the best practices in the industry he has seen. This is the value that a professional teacher can bring.

We have a bold judgment that the next 10 years of medical devices will still be a golden decade, but this golden decade is aimed at some specific groups. These specific groups have two characteristics. The first characteristic is that they are private enterprises or domestic manufacturers.

The second feature is that their business operations, management, and marketing must know how to stand on the shoulders of giants, that is, they will use a more professional methodology to guide our operations and management. This is an upgrade of ours. A need for transformation. We must change our thinking and concepts, and use all available forces to enhance the overall competitiveness of the enterprise in an all-round way.

When we do these two things, it is possible that we will enter our own golden 10 years, otherwise it is just the sand that was washed away during the whole process of the big waves washing the sand.

Carnegie said: "We can't change things that are bound to happen, but we can change ourselves."

In the face of today's fierce competition in the medical device industry, we may also need to have such a mentality and practical actions.