Research On The Price Mechanism Of Centralized And Volume-based Drug Procurement

Health is an inevitable requirement to promote the comprehensive development of human beings,and a basic condition of economic and social development.Drug is a kind of special commodity that maintain physical health,protect life safety and promote the reproduction of labor force.Since the "4+7" cities pilot program at the end of 2018,China has organized 6 batches of centralized and volume-based drug procurement.At the same time,local governments have also actively organized centralized and volume-based drug procurement in the form of provincial or inter-provincial alliances.The centralized and volume-based drug procurement has promoted the drug price return to a reasonable range,and played an irreplaceable role in improving the availability and affordability of drugs,purifying the environment of the pharmaceutical industry,and improving the efficiency of medical insurance funds.However,objectively speaking,the academic circles pay more attention to the summary of policy level and the discussion of the local effect of policy implementation.There is a lack of systematic and holistic research on the price mechanism of centralized and volume-based drug procurement from the perspective of political economy,and the theoretical progress still lags behind the needs of practice.At the same time,with the deepening of the practice of centralized and volume-based drug procurement,a series of practical problems in the process of price formation,price operation and price regulation and control have become increasingly prominent,but these problems have not attracted enough attention at present.Therefore,under the background of Healthy China strategy,it is an important task to deepen the socialist price theory with Chinese characteristics to objectively understand the difficulties faced by the current new medical reform,grasp the development trend of promoting the normalization of centralized and volume-based drug procurement,and construct the price mechanism of centralized and volume-based drug procurement in China from the theoretical and practical levels.Based on the basic theory of Marxist labor value and price theory,drawing lessons from Marx’s thought of public economy and related theories of public goods,this paper comprehensively studies the price mechanism of centralized and volume-based drug procurement in China from the perspective of political economy by using the knowledge and analysis methods of institutional economics,game theory,drug economics,management and so on.And try to answer the following five questions:(1)what are the attributes of drugs,centralized and volume-based procurement drugs and centralized and volume-based drug procurement itself?(2)How is the price of centralized and volume-based procurement drugs determined and affected?(3)How to realize the price of centralized and volume-based drug procurement,and how to give full play to the function of price adjustment?(4)How is the price of centralized procurement drugs regulated and how can it serve the overall goal of regulation and control in socialist countries?(5)What are the problems in the price mechanism of centralized and volume-based drug procurement and how to optimize it?The research contents of this paper are laid out according to the structure of “General-Separate discussion – Summary”.Chapters 1 to 3 are the general parts.Expounds the research background and significance of this paper,summarizes the relevant research literature,explains the research route of this paper,defines the relevant core concepts and the main theoretical basis.And then,analyzes the generality and particularity of the attributes of drugs,centralized and volume-based procurement drugs and centralized and volume-based procurement services from the perspective of political economy by applying Marxist labor theory of value,price theory,Marx’s public economic thought and related theories of public goods.This paper studies the mechanism of centralized procurement on drug price mechanism,summarizes and forms the analysis framework of centralized and volume-based drug procurement price mechanism,which includes “Four Pricing Participants”,“Three Constituent Mechanisms” and "Two Logical Main Lines".Chapters 4 to 7 are separated discussion parts.First of all,this paper systematically combs and summarizes the evolution process and practical mode of centralized and volume-based drug procurement price mechanism in China since1949,and then focuses on the price formation mechanism,price operation mechanism and price regulation mechanism of centralized and volume-based drug procurement.(1)Price formation mechanism: On the basis of determining the quasi-public product attribute of centralized and volume-based drug procurement,this paper further defines the connotation and characteristics of centralized and volume-based drug procurement price formation mechanism,demonstrates the basis and influencing factors of centralized and volume-based procurement drugs,and constructs the two-party bargaining game model of government and enterprise and the multi-party bargaining game model of campaign enterprises to verify the influencing factors of price formation.Combined with practice,this paper summarizes and abstracts the main problems in the centralized and volume-based drug procurement price formation mechanism.(2)Price operation mechanism:Under the guidance of Marxist price theory and circulation theory,this paper defines the connotation and characteristics of centralized and volume-based drug procurement price operation mechanism,determines the two levels of centralized and volume-based drug procurement price operation,and analyzes the process and influencing factors of the two levels.This paper reveals the mechanism of regulating the Four Pricing Participants through the production,distribution,exchange and consumption in the process of social reproduction,and focuses on the regional spatial differences of the price operation of centralized and volume-based drug procurement through the empirical model,summarizes and abstracts the main problems in the price operation mechanism in combination with practice.(3)Price regulation mechanism: Guided by the general theory of macro-control in socialist market economy countries,and from the point of view of better dealing with the relationship between efficiency and fairness,this paper further defines the connotation characteristics of the price regulation mechanism of centralized and volume-based drug procurement,and explains the necessity and influencing factors of the price regulation of centralized and volume-based drug procurement.This paper analyzes on the action mechanism of the three main means of price regulation and control of drug centralized procurement,and abstracts the main problems in the price control mechanism of centralized and volume-based drug procurement in China.Chapters 8 to 10 are the summary parts.First of all,the relevant practices and experience of the United Kingdom and the United States are summarized,and used for reference.Then combined with the theory and practice of the price formation mechanism,price operation mechanism and price regulation mechanism of centralized and volume-based drug procurement in China,this paper puts forward the optimization direction and specific path.(1)From the point of view of optimization goal,it is mainly to carry out the classified procurement of "one main and two wings and multi-pole support".(2)From the point of view of optimization result,it is mainly to achieve cost-benefit consideration of the effectiveness evaluation of centralized and volume-based drug procurement.(3)From the specific path of price mechanism optimization,it mainly includes the optimization of price formation mechanism,the optimization of price operation mechanism and the optimization of price regulation mechanism.The main conclusions of this paper include the following five aspects:(1)As a special commodity,drugs have great particularity in the aspects of use value,value formation,value determination and so on.Centralized and volume-based procurement drug belongs to quasi-public goods.Centralized and volume-based drug procurement service is a public service provided by the government based on the maintenance of "public interests".(2)The price formation mechanism of centralized and volume-based drug procurement is a price formation mechanism guided by the government and dominated by the market.Centralized and volume-based drug procurement does not change the value of drug price,but it can affect the formation of price by regulating the relationship between supply and demand,the structure of competition and so on.(3)The price operation mechanism of centralized and volume-based drug procurement includes two levels: One is price realization process and another is price adjustment function.From the provincial differences of price operation,a obvious problem is that the selected price of hanging inversely with the economic development level of the selected place.(4)Based on the general theory of regulation and control in socialist market economy countries,the price regulation mechanism of centralized and volume-based drug procurement has established a regulation and control system supplemented by economic and legal means,supplemented by administrative means,focusing on promoting the reproduction of labor force,promoting the all-round development of human beings and realizing common prosperity.(5)The optimization of price mechanism of centralized and volume-based drug procurement should adhere to the goal orientation of classified procurement and the result orientation of cost-benefit consideration.The specific optimization path includes the optimization of price formation mechanism,the optimization of price operation mechanism and the optimization of price regulation mechanism.The possible innovation points of this paper mainly include the following four aspects:(1)Based on the perspective of political economy and its analysis methods,this paper systematically studies the price mechanism of centralized and volume-based drug procurement in China,fills in the gap in the field of theoretical research,and may enrich the connotation of the times of socialist price theory with Chinese characteristics.(2)This paper holds that centralized and volume-based drug procurement is a public service provided by the government to safeguard the "public interest".As a kind of system design,it does not change the price value of drugs,but it can guide or restrain the formation of drug prices by adjusting supply and demand,competition and other price influencing factors.This paper further constructs game models to verify this conclusion.(3)Under the guidance of Marxist price theory and circulation theory,this paper constructs two levels of centralized and volume-based drug procurement price operation mechanism,and reveals the mechanism of price operation to regulate the economic relationship and economic operation of Four Pricing Participants through the links of production,distribution,exchange and consumption in the process of social reproduction.(4)In this paper,the Country-Product-Dummy Method is used to study the provincial differences in the operation of centralized and volume-based drug procurement prices in China,and it is found that the price of selected drugs is inversely linked to the level of economic development in the supply provinces.