| Objective:To compare and analyze the adjustment and change of the Medicine Centralized Bidding and Purchasing Policy in Anhui Province. To describe the different practices of main policy participants and the transformation of their behavior and relationship by using stakeholder analysis. To analyze the effect of policy reform from availability, affordability and quality by choosing key indicators like price, cost, quality type, distribution, and equipment. To explain the internal mechanism of the behavior changes of the policy participants. To evaluate the effect of policy reform and to put forward recommendations.Contents:1. Compare and sum up the changes of Medicine Centralized Bidding and Purchasing Policy in Anhui2. Analyze the reform effect of Medicine Centralized Bidding and Purchasing Policy in Anhui3. Describe the transformation of policy participants’ behavior and relationship4. Explain and discuss the policy participants’ behavior transformation from different perspectives5. Put forward suggestions to improve Medicine Centralized Bidding and Purchasing PolicyMethods:Relevant policies, theories and literatures of Medicine Centralized Bidding and Purchasing in Anhui were collected through literature review. Depth interview and questionnaire survey were conducted by means of field investigation and sampling survey. Drugs were selected from the core list recommended by WHO, and the generic names, dosage forms, specifications, packaging, quality types, winning price, prescription information and other data were gathered.The International Reference Price(IRP) was compared with World Health Organization(WHO)/Health Action International agencies (HAI) Standard Survey Method. The effect of policy reform was analyzed by using time sequence analysis in various dimensions and indicators. The behavior and relationship of policy participants were analyzed by the stakeholder analysis. Advice on the accuracy of the evaluation results, the appropriateness of analysis and discussion, and the feasibility of policy recommendations were demonstrated and consulted by experts.Results:1. After the reform, Medicine Centralized Bidding and Purchasing in Anhui had changed in the basic principles, general requirements, methods of bidding evaluation and qualification, drug evaluation indicators and quality type, price and bidding, publicity, purchasing, distribution, settlement. Policy participants focused more on quality than price.2. The effect on the reform of the medicine bidding and purchasing policy in Anhui was compared and analyzed. The affordability of drugs has been enhanced. The average prescription costs and the bidding price of drugs have been significantly reduced. Median price ratio decreased in overall after the reform, but compared with the international reference price, it was still higher than IRP. The availability of drugs has been improved. The types of equipped essential drugs increased while the rate of equipment decreased apparently. Drug delivery situation has not been improved so that the doctor was aware of the shortage of medicines and prescription restrictions The quality of medicine increased significantly and the varieties of high quality drugs increased gradually.3. Behavior and relationship of policy participants were analyzed. Government health departments, medical insurance departments, production enterprises, distribution enterprises, primary healthcare institutions, doctors, and patients were the main participants regarding the medicine centralized bidding and purchasing policy. Policy participants’roles were explained and interest, power, willingness, influence of policy participants were concluded. The relationships of stakeholders were clarified by matrix analysis and quadrant analysis4. Medicine bidding and purchasing policy was necessary in the aspects of politics, economics, society and industry. The results demonstrated that the policy worked efficiently on affordability, availability and quality. From the industry point of view, it was found that the medicine policy had influence on the behavior of each participant in the production, circulation and usage.Conclusions:1. The goal of government policy is changed from "price first" to "quality first".2. The strategy of pharmaceutical manufacturers is changed from "high-price for profit" to "high-quality for profit".3. The wholesale link is compressed to make the price decreased significantly. Distribution should be more timely.4. The strategy of medical institutions gradually is changed from the "supporting doctors by drugs" to "supporting doctors by skills".5. Rational drug habit of doctors needs to be strengthened. The equipment and utilization rate of essential drugs needs to be improved.Recommendations:1. "Double Envelope" evaluation design should pay attention to the balance between price and quality.2. Price measures should be enriched so that the price of drug bidding and purchasing can reflect the value better.3. Pay more attention to drug quality and achieve the maximum efficiency of the pharmaceutical economics.4. Strengthen drug distribution management to reduce the occurrence of drug shortages as far as possible.5. Make clear of responsibilities, rewards, and punishments. Strengthen supervision in order to promote industry consolidation and upgrading.6. Accelerate the building of drug information platform. And ensure the national pharmaceutical market stable.7. Effectively implement the classification of procurement and take a variety of ways to guarantee drug supply.8. Medicine policy reform should be carried out together with medical care policy and medical insurance policy as a whole. |
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