Research On The Effect Of The Proportion Of Pharmaceutical Expenditure Policy On Medical Expenditure And Prescribing Behavior

The rapid growth of medical expenditure and pharmaceutical expenditure is one of the problems faced by all countries in the world.The proportion of pharmaceutical expenditure in the total medical expenditure in China is significantly higher than the average of OECD countries.China's health administration department expects to reduce pharmaceutical expenditure and medical expenditure by implementing the proportion of pharmaceutical expenditure policy,controlling the proportion of pharmaceutical expenditure in total medical expenditure,reducing over-prescription,and promoting rational drug use.However,with the problems of increased inspection costs and the difficulty in landing 36 negotiated drugs brought by the proportion of pharmaceutical expenditure policy,further analysis and evaluation of the proportion of pharmaceutical expenditure control policy are needed.First,basing on the theory of relative price difference between national drug and medical services,this paper uses the Organization for Economic Cooperation and Development(OECD)database from 2006 to 2015,the proportion of pharmaceutical expenditure of basic medical insurance hospitalization in China from 2008 to 2016 and wage data from 2008 to 2016 to construct a cross-sectional data model and a panel data model,and analysis the domestic and international experience of the impact of wage on the proportion of pharmaceutical expenditure.China has implemented the proportion of pharmaceutical expenditure policy without considering its variety law.Secondly,data was obtained from China basic insurance tertiary medical institution sampling database in Beijing,Tianjin,Shenyang,Shanghai,Fuzhou and Chongqing(2008-2016).Taking lung cancer,breast cancer,colorectal cancer,cholecystitis(treatment as surgery)and acute myocardial infarction as examples.This study measured the trend of hospitalization expenses,details of hospitalization expenses and composition of hospitalization expenses from 2008 to 2016,and evaluated the influence of the proportion of pharmaceutical expenditure control policy on hospitalization expenses in China.Finally,taking using high-priced negotiation drugs in hospitals as an example,take into account expert interviews,the impact of the proportion of pharmaceutical expenditure control on hospital prescribing behavior was analyzed.The results show that there is a negative correlation between the proportion of pharmaceutical expenditure and the average wage,so the influence of the average wage should be taken into account in the subsequent adjustment of the proportion of pharmaceutical expenditure control policy.The policy of the proportion of pharmaceutical expenditure has a significant impact on diseases mainly treated with drugs,controlling the increase of drug costs and total medical expenses.It has not expected impact on the medical expenses of the diseases mainly treated by surgery.Different types of diseases or same type of diseases under different treatment have different the proportion of drug costs in total medical expenses and cannot approach a "one-size-fits-all" management.In order to solve the impact of the proportion of pharmaceutical expenditure control policy on the use of high-priced negotiating drugs in hospitals,it is possible to allow the negotiation drugs to exclude the assessment of the drug proportion and use social pharmacy to supply negotiation drugs.