Study On Pharmaceutical Expenditure Mechanism And Policy In China

BackgroundHigh proportion of expenditure on pharmaceuticals to overall health care expenditure has been the social focus all the time. This phenomenon, that profits from medicine fund Chinese hospitals, not only damages patients'benefit also has a negative effect on long-term development of Chinese health care career. Therefore, research must be carried out into the forming mechanism of excessive expenditure on pharmaceuticals in order to find out influence factors and then to provide recommendations and solutions.This study is the sub-topic funded by the research of"Study on Medical Delivery Management based on Community Health"(No. 70333002) which is a major project of Natural Science Foundation of China.This research seeks to find out the order of severity and influence factors of excessive expenditure on pharmaceuticals by analyzing current situations. On the basis of consultation with experts, it sets up an index system to evaluate the rationality of medical prescription and applies principal component analysis to analyze factors which may affect the rationality of medical prescription so as to provide countermeasures to improve the rationality of medical prescription. The analysis of rationality of medical prescription and Chinese medicine health service system helps to construct problem model system of"high price of medicine", by using theories from health statistics and system dynamics, combining qualitative and quantitative analysis and applying techniques of system dynamics (SD), to build up linear and nonlinear relationship and mathematical relationship between different factors, thereby to determine the functional relationship in the model. By systematically framing, analyzing, simulating and optimizing the model, this research explores internal structure and behavior regulation of our health service system in order to find out reasons for the unbalanced structure and the skewed orientation of policy so as to provide recommendations and solutions.Data used in this study include the investigation materials of earlier period by total topic, data of the 1st, 2nd and 3rd investigation of medical service, data of statistic yearbook and bulletin of country during 1995-2006, and data from domestic and overseas information databases like CBMdisc database, Elsevier database, ProQuest English medical periodical database and Springer English periodical database.MethodologyAfter carrying out qualitative investigation and descriptive analysis on the problem of excessive expenditure on pharmaceuticals, theories from system science, health economics, health statistics and system dynamics, methods of principal component analysis, and modeling techniques of system dynamics were applied to analyze the rationality of medical prescription systematically. System dynamics model of the forming mechanism of drug price was combined so as to make the analysis and reasoning of"high price of medicine"complete and well-reasoned.ResultsAnalysis of current situations: By analyzing problems existing among interest groups in the circulating link of medicine, this research aims at finding out root causes for the unbalanced structure, unreasonable price, disordered market and non-scientific pricing of medicine. The problem of excessive expenditure on pharmaceuticals is a complex one, which is caused by factors of system, mechanism and actual operation. There are measures as reducing price by government's policy, narrowing difference between purchase price and retail price, strengthening moral constraints in medical profession, and correcting professional ethos, all of which can improve the situation but can not solve the problem fundamentally.Construction of index system and analysis of rationality of medical prescription: This research firstly builds an index system on the basis of consultation with experts, then collects evaluation indexes by principal component analysis and comprehensive analysis, and lastly categorizes and prioritizes the influence in order to provide reference frame to improve the rationality of medical prescription. Results of research indicate: index about supervision of medical prescription has the most significant effect on rationality of medical prescription, therefore measures must be taken to strengthen the supervision; index about relationship between medical prescription and doctors also has significant effect, hence this direct relationship must be cut off; index about prescription standards do affect, as a result, evaluation standard of prescription must be fully exploited; the forming mechanism of medical expenses has some effects, consequently special attention should be paid to monitor the rationality of medical prescription of different patients from various forming mechanisms of the medical expenses; different measures to control the prescription should be taken according to each patient's individuality; and attention should be paid to the indirect influence that outer settings of hospitals may have on the rationality of prescription. Research results of the construction of problem model of"excessive expenditure on pharmaceuticals": concept model, logic model and system dynamics model of"excessive expenditure on pharmaceuticals"are constructed on the basis of qualitative investigation of the problem of excessive expenditure on pharmaceuticals and analysis of rationality of medical prescription and by applying system analysis and theories from system dynamics. After analyzing the system, the research stimulates the relationship between factor variables– manufacture enterprises, circulating enterprises, medical institutions, doctors and so on to reveal root causes of"high price of medicine", thereafter to find solutions to problems like imbalance between supplies and demands, unreasonable compensation mechanism and high price of medicine and ultimately to promote the mechanism transformation of the problem of excessive expenditure on pharmaceuticals.Results of intervention experiment of"high price of medicine": the experiment results show that problem of"high price of medicine"is caused by the unbalanced structure, which leads to venality of each main body and weak supervision on drugs'production and sales. During the intervention experiment, we found there was a critical point for the price of medicine and this threshold price was mainly determined by the cost of production and circulating, hence, price should be set around this point. During the intervention experiment of doctors'commission rate and production cost of medicine, we found that in the present medical system, venality of main bodies in links of production, circulating, and consumption collaboratively led to the problem, consequently, benefit chains among main bodies must be cut off. During the intervention experiment of hospitals'commission rate, we found that hospitals paid too much attention to benefits from drugs and pursued high commission rate. This unreasonable compensation mechanism worsened the problem; therefore, restructuring reforms must be carried out from the root to change the operation mechanism of hospitals. Policy suggestions on lowering high proportion of expenditure on pharmaceuticals: measures should be taken separately to improve the rationality of medical prescription and lower the price of medicine so as to control and solve the problem of excessive expenditure on pharmaceuticals. Improving rationality of medical prescription should start from investigation of behavior characteristics of each main body. After carrying out point monitoring to cut off the direct relationship between prescription and doctors, further measures should be taken to better the control mechanism of medical prescription. Only depending on administrative intervention of government can not actually lower the price of medicine. Reducing the price should firstly be based on a reasonable compensation mechanism, then on steps like adjusting standards for medical service charge, increasing government's devotion steadily, decreasing hospitals'profits from medicine, speeding transforms of medical market system, changing hospitals'operation mechanism and eventually strengthening the suitability of medicine.ConclusionThis research is the first attempt applying systematic theories and experiment research to set up an index system about rationality of prescription and problem model system of"high price of medicine", which fills the vacancy of quantitative test tool for"excessive expenditure on pharmaceuticals"and provides advanced quantitative analysis and simulation tools for the establishment of policy of medical science.