基于间断时间序列的药品带量采购政策实施效果研究

Study on the implementation effect of drug purchase policy based on discontinuous time series

药品带量采购是协同推进医药服务供给侧改革的关键措施,在完善以市场主导的药品价格形成机制、发挥医保基金战略性购买作用方面具有重要意义。为探究药品带量采购政策对中标产品和替代产品药品费用的影响,抽取2016年第三季度至2021年第四季度调脂药、精神兴奋药、抗肿瘤药和止泻药在全国城市公立医院连续18个季度的销售数据,以2019年第四季度为政策干预点,采用两组间断时间序列回归方法,分析政策干预前后样本药品费用指标的变化。结果显示:短期内中标产品相比于替代产品药品费用显著降低;长期来看,中标产品药品费用增长趋势显著下降,不同类别药品的长短期政策效应存在差异,且受药品可替代性、医院政策执行具体措施等影响。为进一步完善带量采购政策,应科学制定带量采购药品品种遴选原则,健全医保药品支付标准制度,完善激励机制,引导医生和患者优先使用中选品种。

Drug volume purchase is a key measure to jointly promote the supply-side reform of medical services, and is of great significance in improving the market-led drug price formation mechanism and giving play to the strategic purchasing role of medical insurance funds. In order to explore the impact of drug volume purchase policy on the drug costs of bid-winning products and alternative products, the sales data of lipid-lowering drugs, psychoactive drugs, anti-tumor drugs and antidiarrhetics in national urban public hospitals for 18 consecutive quarters from the third quarter of 2016 to the fourth quarter of 2021 were selected, and the fourth quarter of 2019 was taken as the policy intervention point. Two groups of discontinuous time series regression methods were used to analyze the changes of sample drug cost indicators before and after the policy intervention. The results showed that the drug cost of the bid-winning product was significantly lower than that of the substitute product in the short term;In the long run, the growth trend of drug costs of bid-winning products has declined significantly, and the long-term and short-term policy effects of different types of drugs are different, and are affected by drug substitutability, specific measures of hospital policy implementation, etc. In order to further improve the purchase policy with quantity, we should scientifically formulate the selection principle of drug varieties with quantity, improve the payment standard system of medical insurance drugs, improve the incentive mechanism, and guide doctors and patients to give priority to the selected varieties.