Analysis of Drug Purchase and Pricing Decision under the Mode of Procurement with Target Quantity

Objective To study the reasonable pricing strategy to effectively reduce the risk of drug supply disruption.This paper studies the vertical competition between drug purchasers and pharmaceutical enterprises,and the horizontal competition between different pharmaceutical enterprises.Based on the wholesale price of drugs made by pharmaceutical enterprises,drug purchasers adopt different procurement strategies.Methods A multi-stage game model was used to analyze the collusion and competition between two drug procurement parties.Results and Conclusion(1)Enterprise B can choose the optimal game strategies according to the stability of enterprise A;(2)Two procurement parties should choose collusion when the risk of supply interruption is low;(3)Emergency dual sourcing strategy is better than single sourcing strategy;(4)The optimal procurement quantity is irrelevant to the monotonicity of the stability of enterprise A in Cournot game.Through numerical analysis,the optimal decisions of pharmaceutical enterprises and drug purchasers are obtained respectively.

The Status Quo and Countermeasures of“4+7”Quantity Purchase in China

Objective To understand the effectiveness and problems of centralized drug procurement in China by analyzing the implementation of the“4+7”pilot work for centralized drug procurement in China.Methods The current situation and existing problems of drug procurement in China were analyzed through the literature research method.Results and Conclusion At present,good social benefits have been achieved for China’s drug procurement through pilot projects in several cities,but there are some serious problems.The proposed countermeasures will help to improve the procurement of pharmaceuticals in China.

药品集中带量采购对糖尿病患者住院费用的影响

目的评价药品集中带量采购对糖尿病患者住院总费用及各类构成费用的影响。方法基于研究医院的9852份糖尿病患者病案首页数据,整理患者基本信息、医疗服务利用信息及各项医疗费用信息,综合运用普通最小二乘法(ordinary least square,OLS)和倾向性得分匹配法(propensity score matching,PSM)进行数据分析。结果集中带量采购政策确实能够降低糖尿病住院患者的药品费用(t=-2.27,P<0.05),但是对住院总费用、医疗服务性费用影响不显著。OLS回归低估了药品集中带量采购对患者检查化验耗材费用的增费效应(t=2.26,P<0.05)。结论在进一步加强宣传教育的同时,要有序扩大药品集中带量采购,系统推动医药领域集约式改革,持续放大改革红利,实现患者总体医疗负担减轻,让政策福利遍及更多患者。

国家组织药品集中采购和使用试点对临床用药管理与使用的影响

目的调查国家组织药品集中采购和使用试点(以下简称“‘4+7’试点”)的影响,提出政策建议,为进一步推行国家组织药品集中采购提供参考。方法用焦点组访谈法,对北京、上海、广州、西安和沈阳5个试点城市的64位医疗保险管理者、卫生行政管理者、医院管理者和医师代表进行访谈。用问卷调查法,就政策影响对5个试点城市的509位医师和498位患者进行分层抽样调查。结果医师对“4+7”试点的认可程度高,认为药品的临床效果达标,不良反应处于常态水平。患者给予中标药品正向反馈,对中标药品的接受度较高,试点降低了患者的医疗费用,患者满意度较高。试点也存在医院为达成政策实施目标而限制医师的处方权、医师工作量加大但激励不足等问题。结论药品集中采购的积极影响明显,但要实现控制药品总费用、保障药品供应和“三医联动”的目标,还应平行推进相关配套改革措施,如加快医疗保险支付改革,依托药品临床综合评价以真实世界数据推动药品的遴选和合理使用,调整医药费用结构,促进公立医院绩效及薪酬制度改革,推进行业监管和医疗卫生服务精细化管理等。

国家组织药品集中采购的卫生经济学理论基础及完善建议

探讨国家组织药品集中采购的卫生经济学理论基础和实践。总结国家组织药品集中采购的8条经验及存在的一些问题。评价国家组织药品集中采购的效果。建议从确保质量、供应、使用和回款4个方面,对药品带量采购进行全方位的监测。

我国非国家组织药品集中采购模式比较

目的比较分析我国各省市的药品集中采购方案及相关政策,探讨各地非国家组织药品集中采购模式的特点。方法围绕采购内容、采购规则等比较分析各地的非国家组织药品集中采购模式的特点,以及采购内容、采购环境、采购规则之间的内在关系。结果我国目前的非国家组织药品集中采购模式可划分为药品集中采购组织(group purchasing organization,GPO)、非过评仿制药带量采购、专项药品带量采购、带量议价以及分类采购框架下的带量采购5种。我国非国家组织药品集中采购的特点是分品种、分批次,以政府主导为主,执行机构主要为医疗保障局。结论目前,各地的非国家组织药品集中采购仅覆盖了部分品种的药品,对非过评仿制药进行集中采购是未来的重要趋势,建立公平、科学的质量分组规则是非国家组织药品集中采购亟待解决的重要技术问题。

上海试点医疗保险药品带量采购的实践与思考

介绍上海试点医疗保险药品带量采购的实践,在分析试点特点、总结试点成效的基础上,思考药品集中带量采购当前正在及今后可能面临的挑战,建议通过引入综合评价、优化医疗保险支付等方式理性应对“后带量采购”时代的挑战。