Department of Public Administration, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China.
Department of Pharmacoeconomics, Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing 211198, China.
Int J Environ Res Public Health. 2022 Apr 3;19(7):4285. doi: 10.3390/ijerph19074285.
Volume-based drug purchasing by China's health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.
中国医保体系的药品按金额采购目前是全球规模最大的团购。将医疗体系近半市场的药品供应权以超低价换取有限的药品供应后，对患者和资金负担、药物可及性和临床疗效有何影响？我们旨在验证该政策的有效性，探讨问题背后的原因，确定监管重点和合作措施。我们使用了 2019 年至 2021 年的文献和报告数据，进行利益相关者分析和健康影响评估，展示了各个维度的利益和风险分担。分析方法是多维标度模型，可视化了有问题的关联。共有 79 篇论文（61 篇出版物和 18 篇其他资源）被纳入研究，确定了 22 项效果和 36 个问题。结果表明，药物的可负担性良好，但可及性较差，药物质量和用药合理性降低的风险较高。患者的用药需求得到保障，医生的临床用药处方权受到限制，不合理的评价指标限制了公立医院向价值和服务型组织的转型，医保基金的可持续性和政策推广面临风险，制药公司的创新步伐加快。高共现频率相关的问题被分为以下几个集群：成本控制、药物可及性、制度合理性、政策公平性、药物质量和道德风险。这些发现表明，中国在减轻患者负担和降低基金支出方面取得了短期成功，但在保障供应、质量控制和疗效跟踪方面仍存在不足。该研究为中国和其他中低收入国家提供了重要的经验教训。
