Essential drugs supply system Choice

 Essential drugs supply system Choice
recommendations on medical and health system (xi) - Reform of the drug supply system, a new round of health system reform
(hereinafter referred to as is to establish The problem is that the basic institutional framework of essential drugs is, particularly with regard to essential drugs supply system (ie, production, procurement and distribution sectors) how to create, the parties have not reached a consensus.
2008   10 14, State medical and health system reform to deepen inter-ministerial coordination at the national Development and Reform Commission Working Group on the website some suggested that use. primary care clinics and other health institutions should all use of essential drugs, medical institutions must also be other types of essential drugs as the drug of choice and determine the proportion. but basically the government proposed a centralized purchasing + uniform distribution model. But the favor of the health sector, and pushing a does not prohibit the production or distribution of non-designated basic drugs, not to food purchase and sale as a few decades ago under the purchase and sale of grain purchase and sale of non-conviction act as , unified procurement, centralized distribution and rational use much different.
In fact, the implementation of essential drugs policy in China for almost 30 years, the revised fourth edition in 2004, essential drugs in accordance with the :
First, failure to help control drug spending growth. In fact, all calculated in accordance with the number of varieties or according to pharmaceutical costs, the majority of medical institutions at all levels of medication (the most conservative estimate is 60-70% ) Select the in medical institutions are widely used, resulting in a large number of essential drugs in the delisting of the situation of cheap products.
Second, the failure to contribute to the promotion of rational drug use. development, rational drug use. Despite the rational use of medicine is not the sophisticated technology, the majority of medical doctors under training should be in a certain acceptance of this technology, but the Chinese drug abuse (especially of antibiotics misuse) of studies and reports can be described as shocking . significant proportion of patients were not only too much medication, and using too much expensive, but the efficacy of drugs is not necessarily very high.
reasons for the formation of these two phenomena can be described as we all know, this is the prevalence of medical institutions side-induced over-consumption . Drug system truly up and running, it will become an important new medical reform work. As a result, security of supply of essential drugs naturally become the focus of attention.
look through international experience, we can see that the system of essential drugs supply system in the Four modes:
1. decentralized procurement: self-organization of medical institutions according to a catalog of essential drugs procurement and distribution, are generally commissioned by the company to operate.
2. Market centralized procurement: the medical use of essential medicines market-based competition, self-select a variety of centralized procurement and distribution model, which does not exclude autonomy, legal persons of public medical logistics company focused on market competition to secure distribution contracts situations;
3. Government centralized procurement: The Government of essential drugs on a regular basis centralized purchasing, distribution and then outsourced to public or private institutions.
4. monopolistic public supply, or prospective purchase and sale model, that the public sector monopoly of the production of essential drugs, procurement and distribution.
first modes of high transaction costs, low efficiency, usually replaced for the second model. In fact, the implementation of the second model is the market of centralized procurement, it is reform the world essential drugs supply system of the main options. s three models of public health care system that has been part of the implementation of the country, from large health care institutions for centralized procurement of essential drugs. As health care institutions are public bodies, so this will be a centralized government procurement purchasing behavior. s four models under the planned economy system was prevalent in today's only in very few countries in the implementation of the planning system is still remaining, in many international literature in English will not be mentioned, almost.
Thus, the re supply of essential drugs security system, we have three paths to choose.
the high road: the market of centralized procurement management
to hold down prices and promote the production of essential drugs, distribution and use, we must first start from the use of forward link reform, that the gradual elimination of public medical institutions cheaper essential medicines in order to have a wide range of needs.
integrated all aspects of research, we found, resulting in public health institutions Control: As a legacy of the planning system, China still has a strict medical services for government pricing, and to take a more low-cost strategy is the most cost pricing. In such circumstances, the Chinese doctors to provide medical services alone can not support their families a living, so the medical institutions and doctors sell drugs as their main source of income.
2. drugs increase the rate of improper disposal of control: the government to allow medical institutions to obtain the corresponding income through sale of drugs, but the fare increase set rate (or profit) of control, the increase rate of the current legal 15% positioning. In this game, the medical institutions will naturally want to purchase and use of recommended prices were relatively expensive drugs, regardless of whether drugs are ; range.
3. Medicare improper payment mechanism options: the existing urban and rural health care institutions to use more items paid by way of settlement with the medical institutions. For the existing This payment method can be described as waves.
to cure effective. In fact, with the promotion of universal health care, especially in co-ordination of medical insurance into the clinic, the people who take medicine from the main pay Medicare patients into their own bodies. health care institutions into pay mode, which can effectively influence and even change the behavior of medical institutions. In fact, in some places, health care institutions have begun the reform of payment mechanisms, and gradually the ;. in the However, the total amount of prepaid system with a monopoly is not conducive to encourage competition, will reduce the service quality induced by medical institutions and even less service, so in many countries are competitive, pay Reform is for the second point, the addition of rate regulation.
fact, we can cancel the constant increase rate of the control drugs. alternative approach may be to the Government of basic drugs on the maximum retail price controls of medical institutions and retail pharmacies alike. As a result, medical institutions and increase the specific rate of retail pharmacies differentiation, its profit depends on the amount of the high efficiency of drug procurement. In short, the implementation of the maximum retail price cap regulation under the difference in increase rate. In fact, the , but does not make clear.
fixed fare rate to cancel the control of drugs and replace them with the maximum retail price cap regulation, complemented by reform of health care payment mechanisms, essential drugs supply system to be focused onto the market purchasing the high road.
in such a system, medical institutions, is still the main purchasers of drugs. Since changes in Medicare payment mechanism drugs, fixed-rate deregulation increases, the difference increases the rate of implementation, medical institutions are no longer in patients with excessive consumption of drugs inducing power, it will become a normal market players to choose cost-effective medicines. Therefore, the way medical institutions purchase drugs can be varied.
In many cases, surface drug procurement to improve the efficiency of the pressure, the same medical institution will naturally organize themselves (for example, by association) for group purchasing, to control the drug procurement cost. In this situation, the Government (especially the health administrative departments) to come forward for policy-oriented centralized bidding and procurement, it is not necessary; in particular, is widely popular cumbersome procedures, which greatly increase the unnecessary transaction costs (even including rent-seeking costs), should be completely canceled.
Therefore, whether the normal implementation of the basic drug system, the key is health care institutions and medical institutions, not in its production and circulation. If the majority of the insured to the use of drugs from the basic substantive concessions, and the medical institutions from the basic prescription drug benefits to the substantive, then the sale of low-cost essential drugs will become general the focus of drug sales, all kinds of retail pharmacies and medical institutions will purchase a large number of natural essential drugs affordable.
In this case, the competitive market environment will naturally bred appropriate essential medicines distribution model, which is in circulation links, high efficiency, low cost drug distribution model. In fact, the field of pharmaceutical distribution in China, this model has been generated. In these models, the pharmaceutical wholesale enterprises engaged in both wholesale and retail business. On the one hand, such direct business and many pharmaceutical companies to establish a stable supplier relations, establishment of a national distribution network and regional logistics and distribution center; the other hand, the establishment of such enterprises in all regions of Chain Drug Stores, and at the same time and regional pharmaceutical distributors, and medical institutions to establish a stable supplier relations. through regional distribution network, medical institutions and retail pharmacies on the medical needs of the information can be effectively delivered to the pharmaceutical wholesale enterprises, pharmaceutical wholesale enterprises to issue orders to the pharmaceutical companies, pharmaceutical companies-to-order requirements the drugs sent to the regional logistics and distribution center, then the resulting chain of local pharmacies, pharmaceutical distributors and suppliers of medical institutions. This mode of supply and demand has greatly accelerated the transmission of information, greatly reducing the flow of the middle part of the drugs, shortening the business processes, significantly accelerated the rate of drug distribution, significantly improves the cash flow rate, greatly reducing the cost of sales. In short, the model's core strengths is its highly efficient logistics and distribution, with a features.
is worth noting that such companies or models in various public hospitals in general (especially the top three hospitals with large amounts of drugs) of tangible and intangible obstacles encountered, as in the existing medical and health system, especially in the medical institutions, scientific and rational drug use, have a certain need. However, in the health care system, medical payment system and reform of the health care system is not the case, the basic drug system could be implemented. Once the health care and medical services supporting the implementation of the reform together, the basic drug system can be effectively implemented, the market-based distribution system is adequate to protect the supply of essential drugs. This is the best way to re-establish basic medicine system.
expedient: health care institutions to implement the centralized procurement of essential drugs < br> Qian Wenyi above, with the promotion of universal health care, health care institutions will be paid by the major pharmaceuticals. Moreover, the end result of improved health care system is payers. There is no doubt, paid health insurance sector as a medicine who, out of consideration of cost control, you can also combine some of their own centralized bidding commonly used drugs, and distribution of designated medical institutions. In other words, essential drugs The supply system can theoretically take the government of centralized procurement.
However, in reality, we really have to adopt this model, it is worth considering carefully. If in some areas, the market focused on the existence of procurement and supply of medicines distribution services company, and the competition is fierce, then the public health care sector is no need to reinvent the wheel complete, self-organized centralized purchasing and distribution. market competition, that is, the market using the centralized procurement model, can effectively promote low-cost essential drugs use. public health care institutions can put energy savings, from other aspects, for the insured to provide better health care services.
course, if in some areas, such as remote areas or economically underdeveloped areas , the market may not be centralized procurement model, which not many companies are willing to provide medicines in these areas, centralized procurement and distribution services, then the public health care agencies have a responsibility to make up for market failures, carry out the government centralized purchasing, to ensure that insured persons to obtain a relatively affordable essential drugs. In fact, this pattern is particularly suited to economically underdeveloped areas of new rural cooperative medical care.
exactly what procurement model, can the health care institutions and medical institutions, according to local conditions, self-negotiation . The key is to follow a fair, open and fair procedures, reflecting the public financing, democratic decision-making, management in accordance with the concept of public service management.
fact, according to the recommendations of the World Health Organization and the international experience, many countries in the security of supply of essential drugs, and really focus on the implementation of government procurement policy. especially the public sector procurement of essential drugs, they use this model, at least for the public sector so the government budget expenditure section. some countries and regions to implement universal free medical care system (eg India), public medical institutions out of the bulk drugs by the government pay the bill, the centralized procurement by the government a matter of course. In other countries (eg Australia), public health insurance agency, for cost control reasons, also organized centralized purchasing, for the designated medical institutions to provide health insurance affordable medicines. As medical institutions in these countries does not exist medical institutions, regardless of who purchases, as long as reliable and inexpensive drug quality, attract more patients will naturally come.
government shortcomings of centralized procurement model may easily lead to non-standard is even corruption. a considerable portion of the English literature, summary of discussion focused on the lessons of such practice, and in order to achieve the institutionalization of centralized government procurement and standardization. Undoubtedly, the government centralized procurement to be successful, no matter what it is purchased, must meet the following elements: (1 ) the Government (or public sector) is itself the object of consumer purchases; (2) centralized procurement must be competitive; (3) centralized procurement must be highly transparent.
However, in China there is a strange phenomenon. people see a doctor to take medicine pay with one hand I was, second to health care institutions, and in addition to the NCMS, the health care sector is not owned by the health administration department of the jurisdiction. However, the public sector procurement of drugs by the health administrative departments are control, namely the implementation of the mandatory health insurance sector is not involved in government bidding. In this way, they formed a pattern that the purchaser of drugs is neither pay, nor the actual consumer, but it can enforce payment and consumers use their purchasing the drug. as those who pay the health care sector who pay just to be medicines, and medical institutions on the purchase price of drugs do not know, nor care. This pattern could effectively control the basic quality and price of drugs is doubtful. In the famous procedures, does not know the quality of medical problems, but also can not choose other similar drugs do not bid. Therefore, in the context of the Chinese system, even with the government of centralized procurement, but also must be careful.
in the reconstruction the supply of essential drugs among the security system, government procurement can be said to focus on the second choice, only as an expedient measure, in specific areas to be careful for a particular use case.
One tree bridge: the quasi-essential drugs purchase and sale
However, just in China, the sun does not go off road, not by expediency, but is a single-plank bridge popular. health administrative departments embrace, is to restore just the idea of purchase and sale based on the model. According to the suggested that the specific implementation of the program this line of thinking may be as follows: first, the essential drugs list from the central to the formulation, about 400 kinds; Second, the provinces developed 3-5 years of production, procurement, distribution and use plans; third , fixed-point implementation of the provincial units of production, centralized purchasing, uniform distribution, forced to use. The purchase and sale of the practice will not only undermine the field of pharmaceutical production and circulation of the competition, but also the reform of the health care system is not much help. key The point is that the main health care system reform is not on drugs will be able to return to the planning system implementation.
this line of thinking focused on the reform of the selection of essential drugs, production and marketing chain, trying to rationalize it by a few a link to restructure China's basic drug system. On the surface, this line of thought well founded, but also from the World Health Organization and the international literature to find a lot of cause, because these documents do to focus on these a link. concentration of relevant foreign government procurement practices, are often used to support the idea of potential purchase and sale mode. However, little understanding of a number of conditions people should understand the basic drug system up and running in China, the root causes of failure, of course, many factors, but mainly in the health care system in the absence of an incentive mechanism to encourage end-consumer market accounted for most of the drugs in public health agencies are reluctant to use the relatively inexpensive basic medicines, but the extensive use of relatively expensive essential drugs.
Obviously, mechanically or even distort the view of many foreign literature, in fact, essential drug system in China will have been distorted because misplaced. attempt the field of pharmaceutical production and circulation of ideas to find solution to the problem is a typical ; gourd gourd Monk judge the case. treatment. not from the start to solve the problem at source, not only can not cure, even the standard can not cure, and even more government mess. basic medicine system in China does not play its due role, the fundamental problem is not in its supply system market, but in the distorted system of health care system. hope to use models to solve China's prospective purchase and sale of essential drugs problem in the system is completely futile. more Moreover, the popular government of centralized procurement does not mean that China standard purchase and sale mode.
, of course, the idea of quasi-purchase and sale of medical and health services is not unaware of the distorted system of systems, but rather a means of advocating government by force, forcing the public sector significantly increased the proportion of use of essential drugs . There is no doubt that the reason for using coercion, or because the existing system of public medical institutions do not have enough incentive to promote the relatively inexpensive use of essential drugs, no driving force to promote the rational use of various drugs . compulsion must be accompanied by the implementation of top-down, endless examination, assessment, and such measures are almost never in any field have had the desired effect, but will bring endless problems, especially power control assessment for the relevant people to open up a ideas, as long as the implementation of the fixed production, fixed bid, fixed delivery, all work according to plan, the government can develop production plans, tendering plan, distribution plan, everything can be run by the Government. for the implementation of this plan, the Government will in the production and circulation, respectively, authorized or commissioned two companies to achieve monopoly, and full supervision of these enterprises.
fact, this model simply is not feasible, the Government of production, bidding, delivery of any regulation is always a process not in place, because the idea is to assume that the Government has sufficient manpower, power and control means to on hundreds of even more drugs to regulate the production and circulation. In reality, these assumptions do not hold.
First, we can not find enough people to monitor drug production and circulation of each link, we assume that government regulators to work 24 hours without sleep, but in fact this is not possible. Second, the government workers a day actively regulatory power lie? If the higher unit Government can not spend a huge human and material resources for drug quality and dose of daily testing, Bottle inspection, nor the ability to control any act of the enterprise. Third, the price surely die, business monopoly, the expected manufacturing enterprises improve the quality of drugs, improve service levels, as good as the water of the month, while innovation is even more the question. In the planning system, not to mention the complexity of pharmaceutical production and sales of such business activities, even such as pencils, glue and other simple items executive power and rent-seeking space. to determine point of power production and distribution companies to determine prices and distribution costs of distribution power to force the basic drugs used in the power of public medical institutions, etc., will undoubtedly increase the health administration department of a large number of rent-seeking space , is likely to lead to commercial bribery and administrative corruption prevailed. In fact, the current system of drug procurement bidding as strengthening the powers of the administrative department of health, has exposed this problem. the so-called a significant increase in health administration departments the power of intervention in the market, will make existing problems worse. This Administrative System, in fact, to further increase the probability of occurrence of administrative corruption and scale, is likely to destroy a group of cadres.
What is more, if in order to save as a tilt. This approach is likely to lead to the national pharmaceutical market sector segmentation and serious local protectionism, the domestic pharmaceutical business enterprises will become bigger and stronger within the foreseeable future, the establishment of a unified national reform of the pharmaceutical market will become remote target impossible. make such a rather than the result of market competition.
essential drugs supply system of quasi-purchase and sale mode, absolutely last resort. although it might be able to solve some problems in the short term, but it is a single-plank bridge, can only lead us to a narrow and dangerous path.
article by Professor School of Government to provide Gu Xin!