Study On The Impact Of "4+7" Procurement Model On Shenzhen’s Drug Expenditure

Objective:To analyze the changes in the amount and structure of related drug purchases in Shenzhen before and after the first round of pooled procurement of medicines organized by nation（"4+7"procurement）,and analyze the impact of this policy on drug procurement in Shenzhen.And provide a reference for reasonable reduction of drug costs and improvement of the Centralized procurement of drugs organized by state policy.Methods:Export all drug procurement data from January to December 2019 from the data platform of Shenzhen Quanyao.com.Drugs are divided into 4 categories:selected drugs,original drugs under the same generic name,generic drugs under the same generic name,and similar alternative drugs according to Monitoring Plan for Centralized Drug Purchase and Use Project Pilot Launched Organized by State.At the same time,Drugs are divided into chronic disease drugs and non-chronic disease drugs.according to the New Pharmacology（17 edition）.SPSS 21.0 was used to analyze the data.Statistical descriptions were made on the cost utilization rate and composition ratio of"4+7"related drugs.The A.M Index System Analysis Method was used to analyze the purchase amount and structure of"4+7"related drugs in terms of purchase amount,purchase price,purchase quantity and substitution effect.Taking 3 months as a time period（T）,the first quarter of 2019 before the implementation of the policy is the base period（T₀）,and the second quarter（T₁）,third quarter（T₂）,and fourth quarter（T₃）are all Compared with the first quarter（T₀）.When the index of each dimension is greater than 1,it will prompt the increase in purchase amount,purchase price and purchase quantity,and the emergence of medicines with high average daily prices to replace medicines with low average daily prices.Results:Through the data cleaning and merging,50978 data are finally included,involving71 varieties,139 product regulations,and 200 products,among which the selected drug products involve 25 varieties,55 product regulations,and 97 products;alternative drug products Involving 46 varieties,84 quality regulations,and 103 products.Overall situation of drugs’cost:From T₀ to T₃,the total purchase amount of 71related medicines decreased from 289.54 million yuan to 241.14 million yuan,with a decrease of 16.71%,and the largest decline was the T₁ period,which was 69.16 million yuan less than T₀,with a decrease of 23.89%;The minimum unit of preparation was increased to 94.00 million.Procurement situation of different types of products:From T₀ to T₃,the purchase amount of 25 selected drugs increased from 23.4415 million yuan to 54.56 million yuan,an increase of 132.75%,and the proportion of the total purchase amount increased from 8.10%to 22.63%.The minimum unit of preparation was increased from 8.81 million to 41.33 million,accounted for 43.97%of the total procurement volume from 12.10%.At of the end of December 2019,the cumulative purchase volume of 23 of the 25 selected drugs reached the annual target task volume.From T₀ to T₃,the original drug purchase amount was reduced from 117.21 million yuan to 47.68 million yuan,the proportion decreased from 40.48%to 19.77%;the number of purchases was reduced from 16.43 million minimum preparation units to7.17 million minimum preparation units,the proportion decreased from 22.56%to7.62%.The purchase amount of generic drugs under the same generic name was reduced from 38.30 million yuan to 13.87 million yuan,the proportion was reduced from 13.23%to 5.75%;the number of purchases was reduced from 11.90 million minimum preparation units to 5.68 million minimum preparation units,the proportion was reduced from 16.34%to 6.05%.The purchase amount of alternative medicines increased from 110.59 million yuan to 125.03 million yuan,the proportion increased from 38.19%to 51.85%;the number of purchases increased from 35.67 million minimum preparation units to 39.82 million minimum preparation units,the proportion decreased from 49%to 42.36%.A.M Index System Analysis Method:From T₁to T₃,the cost index of 71 related varieties of drugs increased from 0.76 to 0.83;the quantity growth index increased from1.11 to 1.31;the price index decreased from 0.67 to 0.64;From T₁ to T₃,the cost index of 25 selected drugs increased from 2.15 to 2.33;the quantity growth index increased from 4.06 to 5.07;the price index was 0.72;the substitution index decreased from 0.74to 0.64.The cost index of the original drug increased from 0.35 to 0.41;the quantity growth index increased from 0.32 to 0.38;the price index was 0.87;and the substitution index decreased from 1.25 to 1.21.The cost index of generic drugs increased from 0.41to 0.43;the quantity growth index increased from 0.52 to 0.57;the price index decreased from 0.80 to 0.78;the substitution index decreased from 1.00 to 0.97.The cost index of alternative medicines increased from 1.04 to 1.13;the quantity growth index increased from 1.00 to 1.13;the price index decreased from 0.99 to 0.95;the substitution effect index fluctuated between 1.03 and 1.05.From T₁ to T₃,the substitution index of drugs for chronic diseases were 1.02,1.04,and 1.01,respectively.The substitution index of antiepileptic drugs was 1.02,1.05 and 1.03.The sedative and analgesic substitution index was 1.10,1.12,1.06.Conclusions:（1）Since the implementation of Shenzhen’s"4+7"policy,the goal of reducing drug prices and controlling drug costs has basically been achieved.（2）The number and amount of purchases of some alternative varieties are on the rise,which deserves attention.（3）The original research drugs,alternative drugs have the phenomenon that drugs with high average daily prices replace drugs with low average daily prices.It is necessary to strengthen the procurement and use supervision of these drugs.