| Objective:Through the S-CAD method,the paper studies the policy elements of national essential drug full guarantee system,and forms a framework of national essential drug full guarantee system elements with rigorous logic and comprehensive interests of all parties,so as to provide feasible suggestions for national policy-making and further improve the accessibility of national essential drugs.Methods:By means of network query and literature search,the relevant policies and research literatures of drug full guarantee at home and abroad were sorted out and summarized.Combined with expert interviews,from the perspective of policy analysis,the four elements of policy value position,policy objectives,policy means and policy expected results were determined in turn.According to the consistency,sufficiency and feasibility of S-CAD method by expert consultation,the effect,efficiency,stakeholder recognition and implementation of the four elements of the policy were scored,and the policy elements were modified and improved according to the score,so as to finally form the four element framework of the national essential drug full guarantee system.Results:Finally,three policy value positions were formed in the selection of policy elements:increasing availability of national essential drugs(V1),increasing affordability of national essential drugs(V2),and improving the effect of disease prevention and treatment(V3);Six policy objectives:free drug selection should meet the basic clinical needs,considering the financial burden(G1),sufficient production and supply of free drugs(G2),high quality and low price of free drug procurement and distribution(G3),clinical first choice of free drug use(G4),specification of free drug use for patients,convenience(G5),and establishment of sustainable and stable financing mechanism(G6),Six policy instruments:drug selection(S1),drug production and procurement(S2),rational drug use(S3),patient education(S4),supporting policies(S5),fund-raising(S6),and four policy expected results:reducing the medical burden of patients(ER1),narrowing the difference between disease medical services and drug utilization,promoting the fair access of covered drugs(ER2),and improving the quality of life of patients To promote the standardized management of chronic disease patients in primary medical institutions,effectively promote the hierarchical diagnosis and treatment and family doctor contract service(ER3),improve the effect of clinical disease control and improve the health status of patients(ER4).In the process of policy evaluation,we find that some effective measures have been formed in the selection of policy elements,including V1-G1、V1-G2、V1-G3、V1-G4、V1-G5、V1－G6、V2-G1、V2-G6、G1-S1、G6-S6、S6-ER1、S5-ER3,which need to be retained in the consistency evaluation.In these links,the stand of purpose,the means to achieve the purpose and the means to measure the expected results are all effective;In the necessity assessment,V2G1、V2-G6、G1-S1、G6-S6、S5-ER3 are the elements that can be retained.In these links,the position of purpose representative,the means to achieve the purpose and the means to measure the expected results are all necessary,and there is no excessive waste of resources;In the adequacy assessment,V2-G1、V2-G6、G1-S1、G1-S6、G6-S6、S1-ER1、S5-ER3 are the elements that can be retained.In these links,the purpose represents the position,the means to achieve the purpose,the means to measure the expected results are sufficient,and there is no shortage of the policy resources.At the same time,there are also some unreasonable elements in the selection of policy elements,including V2-G4、V3-G2、V3-G3、V3-G6、G2-S4、G3-S4、G6-S3、G6-S4,which need to be modified or eliminated in the consistency assessment,indicating that the purpose in these links can not effectively represent the position of the central government and the means can not effectively achieve the purpose;In the necessity assessment,V3-G2 is the link that needs to be eliminated;In the adequacy assessment,V2-G4、V2-G5、V3-G3、G2-S4、G2S5、G3-S1、G3-S5 are the links that need to be modified or eliminated,which indicates that the purpose representative position and means to achieve the purpose in these links are insufficient,and the policy resources are insufficient.V3-G2 is the link that needs to be eliminated,which indicates that G2 is not enough for the implementation of V3.In the feasibility evaluation,stakeholders agree with the policy,especially the public;In the aspect of policy implementation,the local government has the largest executive power,followed by the grass-roots medical institutions,and the public and pharmaceutical enterprises have low executive power.Conclusion:The national essential drug full guarantee system should contain the key elements in the study of policy elements and the policy elements that need to be retained,and abandon the policy elements that need to be eliminated,which can promote the effective realization of the policy value position.Based on the policy elements that need to be modified,this paper puts forward the following suggestions:to formulate different free drug fund management models in the early,middle and late stages of the policy;From the perspective of rational drug use by doctors,health education for patients and implementation of supporting policies,we should strengthen the role of rational use of free drugs in improving the affordability of national essential drugs;We should take measures to improve the level of primary medical services and improve the effect of disease prevention and treatment;To increase the affordability of national essential drugs,we should increase the policy objectives of formulating reasonable drug full guarantee mode;Increase policy means to achieve free drug procurement and distribution with high quality and low price,and indirectly improve the effect of disease prevention and treatment.Thus,the national essential drug full guarantee system can be used as a reference to ensure the accessibility of national essential drugs and further improve the national essential drug supply guarantee ability. |
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