Implementation Status And Effect Evaluation Of High-Value Medical Consumables Volume-Based Centralized Purchasing Policy In Shandong Province

BackgroundHigh-value medical consumables are medical consumables that act directly on the human body,have strict requirements for safety,are used clinically in large quantities,have relatively high prices,and are costly for the masses.In recent years,China’s high-value medical consumables industry has developed rapidly,playing a positive role in meeting the health needs of the people and promoting the development of the health industry,but at the same time there are high-value medical consumables market prices are high,competition is disorderly,excessive use of the public reflects the strong,social concern about the outstanding issues,including coronary interventional consumables are more prominent in terms of both usage and cost,and have always been a focus of national and community attention.Since 2019,in order to improve the price formation mechanism of high-value medical consumables,reduce the inflated prices,the national and Shandong provincial governments have introduced relevant policies,the implementation of high-value medical consumables volume-based centralized purchasing policy(hereinafter referred to as "centralized purchasing").However,the current policy research on high-value medical consumables centralized purchasing is mostly at the stage of theoretical research and less empirical research.Based on this,this study analyzes the policy issues from the perspectives of policy content,landing status,implementation effect and stakeholders based on the triangular framework theory of health policy,and provides reference suggestions for further optimization of high-value medical consumables centralized purchasing policy.ObjectiveThe main purpose of this study is to analyze the implementation status and effect of two types of high-value medical consumables centralized purchasing policy in Shandong Province,based on the content of coronary interventional consumables procurement policy,compare and analyze the differences between the high-value medical consumables procurement policy in Shandong Province and other regions,analyze the implementation status and effect of two types of high-value medical consumables centralized purchasing policy in Shandong Province,find out the problems in the process of policy implementation,and put forward countermeasures and suggestions for further improving the high-value medical consumables centralized purchasing policy.MethodsData collection methods:policy documents were mainly obtained from the official websites of national and provincial(autonomous regions and municipalities directly under the central government)medical insurance bureaus,centralized procurement platforms for medical consumables,public resource trading centers,etc.;literature was mainly obtained from domestic and foreign databases such as China Knowledge Network,Wanfang Data Knowledge Service Platform,PubMed,Web of Science,etc.;the quantitative data sources include two parts,namely the procurement data of medical institutions in the province from the centralized procurement platform of medical consumables in Shandong Province,and the usage of consumables and patient cost data of typical medical institutions;the interview data were mainly obtained from the semi-structured interviews with stakeholders,such as health insurance bureau management or handling staff,hospital consumables managers and cardiologists.Data analysis methods:The policy documents were summarized through comparative analysis;descriptive analysis was used to analyze the current procurement status of high-value medical consumables after the implementation of the policy and the trend of changes in the use of consumables and patient costs before and after the implementation of the policy;an interrupted time series was used to assess the impact of the policy implementation on the use of consumables and patient costs;interview data were summarized mainly through the thematic framework method.ResultsThrough the policy combing found that the stent is organized by the state unified centralized purchasing,everywhere in accordance with the requirements of the national unified rules;Shandong independent provincial balloon centralized purchasing policy in the procurement subject,agreed procurement volume,grouping rules and other policy elements set with other regions there are differences.Shandong Province is mainly grouped according to functional attributes and market share,and adopts two forms of price reduction campaign and low price winning bid.Compared with the price reduction of balloons in various regions,the average reduction of balloons in Shandong Province was 91.83%after the implementation of the centralized purchasing policy,second only to Hubei and the seven provinces(autonomous regions and municipalities)Union.Through the analysis of the procurement status of the two types of consumables one year after the implementation of the centralized purchasing policy,it was found that:(1)the completion rates of procurement volume of stents and balloons were 190.76%and 129.47%,respectively,which both exceeded the agreed procurement volume in the first year;(2)large disparity in procurement status between different hospitals,high-value medical consumables procurement is mainly concentrated in tertiary hospitals,the procurement volume and procurement amount is 2.5 times of secondary hospitals;(3)the procurement of stents in each hospital is mainly based on domestic brands,and the procurement volume of domestic stents accounts for more than 60%;the procurement of balloons is mainly based on imported brands,and the procurement volume of imported balloons accounts for more than 92%.In terms of hospital usage,a total of three sample hospitals were investigated in this study,and the analysis of the usage of consumables and patient costs in each year before and after the implementation of the policy revealed that:(1)the usage of consumables in all but one hospital showed a significant upward trend,with a growth rate of more than 14%;(2)In terms of per capita dosage,the per capita stent dosage in each hospital was about 1.6 to 2 after the centralized purchasing.During the same period,except for one hospital,the per capita balloon usage in all hospitals showed a decreasing trend,and was about 2.3 after the centralized purchasing;(3)The per capita cost of stents/balloons for cardiovascular interventional patients in each hospital decreased by more than 80%,and the combination of the interrupted time series results showed that the implementation of the centralized purchasing policy had a significant immediate effect on the per capita cost of consumables for patients(P<0.001),and the per capita cost of consumables for patients decreased significantly.The analysis of interviews with various stakeholders revealed that the following problems are prevalent in the policy implementation process:at the hospital user end,they mainly included low intention to use some varieties and difficulty in predicting hospital demand;on the security of supply side,they mainly consisted of insufficient supply of selected products and untimely accompanying services;on the procurement platform side,they included slow operation of the system,difficulty in retrieval and overly cumbersome operation;in addition,the direct settlement and synergy mechanism of the centralized purchasing policy need to be further optimized.ConclusionsThis study through the centralized purchasing policy combing analysis found that the overall high-value medical consumables centralized purchasing policy in Shandong Province is relatively smooth,the centralized purchasing of price reduction effect is significant.Through the analysis of high-value medical consumables procurement status found that the province’s medical institutions respond positively to the winning results,the overall procurement volume completion rate is high.Through the analysis of the use of consumables and patient cost changes found that the implementation of the policy of high-value medical consumables centralized purchasing plays a positive role in controlling the unreasonable growth of consumables costs and reducing the burden of disease on patients,but in the process of policy implementation there are still many problems to be solved.Based on the above research findings,this paper puts forward the following recommendations.(1)Develop scientific methods for forecasting demand to improve the accuracy of the reporting process.(2)Optimize the supply guarantee mechanism to ensure product supply.(3)Strengthen the construction of procurement platform and improve the level of information technology.(4)Improve the direct settlement and policy synergy mechanism to ensure the smooth implementation of the policy.