国家基本药物制度在降低药品价格方面的效果：中国四个省份的实证研究
Effects of the National Essential Medicine System in reducing drug prices: an empirical study in four Chinese provinces.
作者信息
Song Yan, Bian Ying, Petzold Max, Li Lingui, Yin Aitian
机构信息
State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Av. Padre Tomás Pereira Taipa, Macau, 999078 China.
Center for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Box 100, S-405 30, Gothenburg, 40530 Sweden.
出版信息
J Pharm Policy Pract. 2014 Sep 17;7(1):12. doi: 10.1186/2052-3211-7-12. eCollection 2014.
OBJECTIVES
The rapid increase in drug expenditure has become a major source of public criticism in China. In 2009, the National Essential Medicine System (NEMS) was launched in China to control drug prices and improve access to medicines. This study investigated whether and to what extent the prices of essential medicines were reduced after the introduction of NEMS.
METHODS
Data were obtained from 149 public primary healthcare centers (PHCs) in four Chinese provinces (Shandong, Zhejiang, Anhui and Ningxia) using a facility-based survey. In total, 10,988 essential medicines were investigated. Individual price differences and a price index were used to measure price changes for three different lists: 2009-2010, 2010-2011, and 2009-2011.
RESULTS
In the comparison between 2009 and 2010, a median decrease of 34.4% [95% confidence interval: 30.4%-39.1%] was observed in drug prices and the number of drug sales increased by 1.5%. The higher the retail price in 2010, the more the drug sales increased compared with 2009 (χ (2) = 75.9, p < 0.01). The drug revenues in 100 of the 149 surveyed PHCs decreased by an average of 39%. Where the available data allowed price changes for 2009-2011 to be assessed, drug prices were reduced significantly in 2010, but a modest decrease was seen in 2011. The Laspeyres index was less than 100 and the Paasche index was larger than the Laspeyres index in 2010 and 2011, which indicated that the frequently prescribed drugs usually had higher prices and any price reduction was milder.
CONCLUSIONS
The introduction of NEMS in PHCs in China led to price reductions in essential medicines. However, more-expensive drugs were preferred in the postreform period. Most PHCs had less drug revenue and could encounter financing dilemmas after the implementation of NEMS. Policy options such as improving the compensation mechanism and rational use of drugs should be further promoted in PHCs.
目的
药品支出的快速增长已成为中国公众批评的主要来源。2009年，中国启动了国家基本药物制度（NEMS）以控制药品价格并改善药品可及性。本研究调查了NEMS实施后基本药物价格是否以及在多大程度上有所降低。
方法
通过基于机构的调查，从中国四个省份（山东、浙江、安徽和宁夏）的149家公立基层医疗中心（PHC）获取数据。总共调查了10988种基本药物。使用个体价格差异和价格指数来衡量2009 - 2010年、2010 - 2011年以及2009 - 2011年这三个不同清单的价格变化。
结果
在2009年和2010年的比较中，药品价格中位数下降了34.4%[95%置信区间：30.4% - 39.1%]，药品销售量增加了1.5%。2010年零售价格越高，与2009年相比药品销售量增加得越多（χ(2)=75.9，p < 0.01）。在149家接受调查的PHC中，有100家的药品收入平均下降了39%。在可获取数据以评估2009 - 2011年价格变化的地方，2010年药品价格显著下降，但2011年下降幅度较小。2010年和2011年拉氏指数小于100且帕氏指数大于拉氏指数，这表明常用药物通常价格较高且任何价格降低都较为温和。
结论
中国基层医疗中心实施NEMS导致基本药物价格下降。然而，改革后更昂贵的药物更受青睐。大多数基层医疗中心药品收入减少，实施NEMS后可能会面临资金困境。应在基层医疗中心进一步推动改善补偿机制和合理用药等政策选择。
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