| BackgroundAnti-tumor drugs are a class of drugs used after tumor diagnosis,postoperative and maintenance treatment.As China’s aging process continues to intensify,the incidence of tumors continues to rise,and the demand for anti-tumor drugs has increased significantly.However,the pre-development costs of such drugs are relatively high.They are mostly patented drugs or exclusively produced drugs,and the prices are relatively high.The burden of medication is heavy for patients,and even catastrophic health expenditures for families occur.In order to reduce the price of drugs and ease the burden of medication for patients,Chinese medical insurance department has introduced a drug price negotiation model,and the medical insurance department negotiates with the manufacturer to reduce the price of medicines.However,there are relatively few studies on the availability and affordability of anti-tumor drugs used by patients before and after drug price negotiations,and there is a lack of quantitative analysis of the purchase of anti-tumor drugs in the negotiated drugs.Based on this,this study analyzes the effect of policy implementation from the perspective of changes in the availability and affordability of anti-tumor drugs before and after price negotiations,and provides a systematic scientific basis and scientific basis for future drug price negotiation policy improvements and data support for the effect of policy implementation at the provincial level.ObjectiveIn this study,after the anti-tumor drugs are included in medical insurance through negotiation,the changes in drug availability and affordability are studied,and the factors affecting the implementation of the policy are analyzed from the perspective of the stakeholders of the medical insurance department and medical institutions,provide targeted suggestions for further improving the drug price negotiation policy.MethodsThis article retrieves relevant policy documents for the inclusion of anti-tumor drugs in medical insurance negotiations through the national and Shandong Provincial Government,the Health Commission,the Human Resources and Social Security Bureau,the Medical Insurance Bureau,and the Drug Collection Center.Using policy analysis method to incorporate anti-tumor drugs into medical insurance negotiation related policies to collect and sort out the policy content,find the similarities and differences of policies,and lay the foundation for subsequent data analysis.References were collected for price negotiation of anti-tumor drugs through CNKI,PubMed,Web Of Science and other domestic and foreign databases.Use the Shandong Province Pharmaceutical Centralized Procurement Platform to collect the anti-tumor drug procurement data in Shandong Province,and collect the retail pharmacy procurement data through the major drug supply companies in Shandong Province.Use the China Health Statistics Yearbook,Shandong Statistics Yearbook and Yaozhi data to collect public data needed for research.Carry out quantitative analysis from two aspects of drug availability changes and affordability changes,using indicators including type,total,WHO/HAI availability indicators,limited daily expenses and catastrophic health expenditures,combined with intermittent time series analysis.The model determines the impact of policies on drug purchases.Conducting qualitative interviews with stakeholders of medical insurance and medical institutions,finding out questions that cannot be explained by data analysis,and sorting out the current status of policy implementation and existing problems.ResultsThe study found that at the level of policy implementation,the differences between policies are mainly manifested in the differences in payment methods,indications,proportions of medicines,and total compensation for medical insurance.The negotiated products are mainly anti-tumor drugs.Among them,only 17 anti-tumor drugs in the national drug price negotiations clearly stated that the negotiated drugs used by medical institutions do not account for the proportion of drugs,and the total amount of medical insurance is calculated separately.After anti-tumor drugs were included in medical insurance through negotiation,all the availability indicators have increased to a certain extent,and the construction of discontinuous time series models proved that the implementation of policies has a certain impact on the purchase of anti-tumor drugs by medical institutions.The types of purchases of medical institutions rose from 22 to 40;the number of anti-tumor drugs with the indication of "lung cancer" changed the most,from 4 to 9 types.The total purchase and total amount showed a steady increase in 2016-2018,2019 The trend of rapid increased in the year,and the procurement was mainly concentrated in the procurement of tertiary medical institutions,which was more than three times that of the procurement of secondary medical institutions;The total purchases in 2016-2019 are mainly anti-tumor drugs with indications of "multi-indication","lymphoma" and "lung cancer".The total annual purchases of the above three accounted for more than 65%of the total purchases.The indications are The purchase of "multiple myeloma" and "renal cell carcinoma" accounted for a relatively small proportion,not exceeding 3%;Anti-tumor drugs show that under the same indication classification,there is a situation that one drug is purchased more;combined with the intermittent time series analysis model,the six drugs that meet the conditions,the models have statistical significance(p<0.05).The availability of anti-tumor drugs in Shandong Province rose from low availability before negotiation(28.27%in 2016)to high availability(63.61%in 2019).In terms of affordability,the absolute value of the daily cost reduction in the four negotiations was 2,000 yuan,a drop of more than 50%,and the anti-tumor drugs indicated for "colorectal cancer" had the largest drop of 66.93%,the anti-tumor drugs with indications of "gastric cancer" had the smallest drop,which was only 38.46%.Before the implementation of the policy,there were only 4 types of anti-tumor drugs that urban residents could afford,and rural residents had no affordable anti-tumor drugs.After the implementation of the policy,more than half(57.5%)of urban residents could afford anti-tumor drugs.However,there are still no affordable drugs under the classification of "lymphoma" indications.Under the 7 indications,rural residents have at least one type of medicine to afford.However,the affordability and availability of 23 anti-tumor drugs are at a low level.Only "gefitinib tablets" is a drug that is relatively affordable and highly available.Conclusion and suggestionsThis study found that,on one hand,with the continuous development of drug negotiations,the policy content has gradually been relatively improved,the proportion of drugs and the total prepayment of medical insurance have been improved.In the process of implementing new policies in Shandong Province,reviewing the deficiencies of previous policies,government introduce supplementary policies for amendments promptly.On the other hand,through the analysis of anti-cancer drug purchase data,it is found out that the availability and affordability of anti-cancer drugs for patients have increased to a certain extent,but there is still a heavy burden of medication and economic pressure.Finally,the incorporation of anti-tumor drugs into medical insurance negotiations still has problems such as poor policy implementation,insufficient procurement intentions of medical institutions,limited types of purchases in retail pharmacies,insufficient competition in the drug market,and further improvement in affordability.Based on the above research,in order to ensure the sustainability of medical insurance access drug negotiation,the following suggestions are made.1 Fully consider the coordination between different policies to ensure the implementation of policies.2 Increase the enthusiasm of medical institutions to purchase,and effectively improve the availability of anti-tumor drugs for patients.3 Improve the "dual-channel" purchase of drugs and expand the ways for patients to purchase drugs.4 Explore multiple financing models for medical insurance to further reduce the burden on patients.5 Encourage production enterprises to carry out drug research and development work,form market competition and reduce drug prices.6 Improve the drug price negotiation policy and supervision system to ensure the implementation of the policy. |
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