Research Institute of Health Development Strategies, Fudan University, 130 Dong An Road, Shanghai 200032, China.
Department of Sociology and Legal Studies, University of Waterloo, 200 University Ave. W. Waterloo, Ontario, Canada N2L 3G1; Munk School of Global Affairs, University of Toronto, 315 Bloor Street West (At the Observatory) Toronto, Ontario, Canada M5S 0A7.
Soc Sci Med. 2014 Nov;120:40-8. doi: 10.1016/j.socscimed.2014.05.033. Epub 2014 May 20.
The prescribing behavior to prescribe high-priced drugs has been hypothesized to be related to the increasing drug expenditures in China, but little empirical evidence exists. The purpose of this study was to examine whether Chinese physicians, driven by financial incentives, tend to prescribe high-priced drugs. The 2000-2008 drug data in the Yangtze River Basin Hospitals' Drug Use Analysis System were analyzed to examine the prescription patterns of penicillins and cephalosporins in Shanghai. Among the top-100 drugs (by volume), cephalosporins cost as 1.1- 2.3 times as penicillins and their volume was 1.7-18.2 times. Revenues generated from prescribing cephalosporins were 3.4-24.2 times as those from prescribing penicillins. The tendency of prescribing relatively high-priced drugs was observed given the same chemical name, dosage, and specification but different trade names. Furthermore, high-priced drugs remained on the top-100 list with increasing volumes, while some lower-priced drugs exited from the list due to decreases in volumes. Facing the policy dilemmas, the Chinese government needs to implement a new financially rewarding system in which hospitals and physicians are able to achieve financial gains in a cost-effective way including prescribing similar drugs with lower prices. Reforming hospitals' payment methods is necessary and feasible to reshape financial incentives of healthcare providers. The combination of the global budget policy and financial incentive measures would be likely to change providers' prescribing behaviors towards a cost-effective direction.
在中国，高价药品的处方行为被认为与不断增加的药品支出有关，但实证证据很少。本研究旨在考察中国医生是否受经济激励的驱动而倾向于开高价药。本文分析了长江流域医院药品使用分析系统 2000-2008 年的药品数据，以考察上海青霉素和头孢菌素的处方模式。在销量前 100 位的药品中，头孢菌素的价格是青霉素的 1.1-2.3 倍，销量是青霉素的 1.7-18.2 倍。头孢菌素的处方收入是青霉素的 3.4-24.2 倍。即使是相同的化学名、剂量和规格但不同商品名的药品，也存在开高价药的趋势。此外，高价药品的销量不断增加，而一些低价药品由于销量下降而退出前 100 名。面对政策困境，中国政府需要实施新的经济奖励制度，使医院和医生能够以具有成本效益的方式获得经济利益，包括开具有较低价格的类似药品。改革医院的支付方式是必要的，也是可行的，它可以重塑医疗服务提供者的经济激励机制。全球预算政策和经济激励措施的结合，可能会改变提供者的处方行为，使其朝着具有成本效益的方向发展。
