Study On Risk Assessment Of Centralized Procurement And Use Of Drugs Organized By The State

Objective:To understand the development process of China’s drug procurement system,identify the risks existing in the specific implementation process of the national organization of centralized drug procurement and use system,and conduct assessment and analysis,so as to provide guidance and suggestions for the relevant national departments to carry out further work.Methods:(1)Literature research method: Through literature review to understand relevant concepts,research status at home and abroad,and the history of drug procurement system in China,so as to provide theoretical basis for this study.(2)Field investigation method: purposive sampling method was used to select the investigation hospitals.Interviews with hospital In the form of a forum,we interviewed the relevant persons in charge of the hospital and clinicians to understand the procurement,distribution,use,medical insurance payment,hospital assessment,quality and efficacy,patient feedback and doctor incentive measures of the selected drugs.The random sampling method was used to select the patients who used the selected drugs in the outpatient department,and the on-site interviews were conducted to understand the patients’ understanding of the "4 + 7" pilot scheme and their feelings of using the selected drugs.(3)Risk matrix method: identify the medium and long-term risks of "national mining" through the thematic group discussion method.To investigate the possibility and severity of the medium and long-term risks of the policy by using a self-made risk questionnaire.The results of the survey are assigned value and calculated,the risk is analyzed quantitatively,and the risk matrix is drawn with Excel to show the risk degree intuitively.Results:1.The results of "4+7" pilot survey are as follows:(1)Among the 25 selected varieties,11(44%),6(24%)and 8(32%)varieties were evaluated by one,two and three manufacturers respectively.The overall progress of the pilot work was fast,accounting for 78.51%.(2)The hospital adopts various methods to ensure the priority of the selected drugs.Some primary hospitals are only equipped with selected drugs.There is an increase in the purchase volume of individual substitutes.There are differences in the timeliness of payment collection.Most of the reactions to the efficacy were focused on cardiovascular drugs,and there were great differences in the quality of generic drugs.(3)Local implementation: the reported amount is not accurate.The incentive mechanism for hospital is not perfect;The overall distribution situation in the pilot area is good,but there are still concerns.(4)Patients: 59 patients were investigated,50.85% of them did not know this policy at all.33.33% of the old patients were passive in the use of the selected drugs.26.67% of the old patients who used the traditional medicine in the exchange thought that the efficacy of the drug was not as good as the original one.The price of the selected drugs is too low after the drug cost reduction,and the patients have a skeptical attitude towards the quality of the drug.2.Medium and long-term risk survey results :(1)Due to the lack of hospital supporting reform,the risk probability and influence degree of price reduction are relatively high,which are 3.51 and 3.39 respectively;The experts from different work units had statistically different scores on the possibility of occurrence(F=3.54,P= 0.02).The experts from pharmaceutical enterprises were not sensitive to the risk and thought it was less likely to occur,while the experts from government and research institutions thought it was more likely to occur.(2)The risk of delayed supply of selected drugs was relatively low,with a score of 3.46,but once the risk occurred,the impact was the most serious,with a score of 3.86.(3)The risk score of drug price rebound was low(3.27),but the impact of the risk was only the risk of large-scale supply of drugs not in time(3.71).(4)The probability score of risk reduction in the research and development of modified generic drugs was 3.51,but the impact score was 3.08.(5)The score of risk occurrence possibility of gradual shrinkage of small drug circulation industry was the highest,which was 3.53,but the score of impact degree was relatively low,which was3.31.(6)After the end of the procurement cycle,the probability and impact score of the risk of substitution by other products were the lowest,which were 3.20 and 2.81 respectively.Conclusion:1.Short-term risks :(1)The hospital has the mentality of completing the task,and there is the risk of policy position.The incentive measures are imperfect,there are excessive medical risks and the risk of "rebate" corruption.(2)The supporting incentive measures are not perfect enough,and the local executors have the risk of performing the health insurance policy.The reported usage is inaccurate,the local drug administration department has the risk of quantity supervision and information construction lagging behind.(3)Patients may have the risk of doctor-patient disputes and medication risks caused by poor efficacy of selected drugs in the process of use,and the risk of reduced medication compliance caused by decreased drug costs.(4)There may be risks of drug quality assurance,insufficient production capacity of some products and selected drugs oligopoly in the production process.(5)There may be risk of the improper distribution of the selected drugs in circulation.2.Main risks in the medium and long term:(1)There may be two high-level risks,untimely supply and rebound of drug prices.(2)There is a risk in hospital management that the supporting reform is not in place and the price reduction is difficult,which is easy to be ignored and should be highly vigilant.