4+7 "按量采购对中国药品使用的预期和非预期影响:自然实验研究》。

IF 2.4 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Dantong Zhao, Zhongliang Zhou
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引用次数: 0

摘要

背景:在全球范围内,以量为基础的药品采购被视为一种控制医疗保健费用的措施。2019年3月,中国启动了基于批量的药品集中采购(CVBDP),也被称为“4+7”政策。包括陕西省西安市在内的11个城市被设立为试点。本研究旨在考察“4+7”政策对陕西省市县级医院原研药和仿制药使用的预期和非预期影响。方法:本研究数据来源于陕西省药品器械集中采购平台(SDACPP)。2017年4月至2019年11月,共纳入118种政策性药品(包括25种“4+7”政策性药品和93种仿制药)的111999份药品采购订单记录。政策目录药品分为中标药品和非中标药品。以限定日剂量(DDDs)和人民币(CNY)作为结局变量。采用差异中的差异(DID)方法来估计政策的净效应。结果:“4+7”政策实施后,中标药品、政策清单药品、政策相关药品数量均有所增加。在市级医院中,替代药物,特别是原料药的数量出现了意想不到的增长。政策清单药品和非优胜药品支出下降,替代药品支出意外增加。仿制药和市级医院的数量和支出变化都比原厂和县级医院大。结论:“4+7”政策在仿制药替代和医药支出控制方面发挥了积极作用,且在市级医院效果更明显。市级医院原料药数量的意外增长表明,城市地区存在中标药质量差、患者对中标药依从性较低或医生逐利行为的潜在风险。为了解决这些问题,需要对医生的处方和财务激励进行更多的规定和监督。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intended and Unintended Impacts of '4+7' Volume-Based Drug Procurement on the Use of Drugs in China: A Natural Experimental Study.

Background: Volume-based drug procurement is regarded as a pharmaceutical cost-containment measure in healthcare provision globally. The Centralized Volume-Based Drug Procurement (CVBDP) launched in March 2019 in China, also known as the '4+7' policy. 11 cities, including Xi'an city in Shaanxi Province, were set up as pilots. This study aims to examine the intended and unintended impacts of the '4+7' policy on the use of original and generic drugs in city-level and county-level hospitals in Shaanxi, China. Methods: The data used in this study came from the Shaanxi Drug and Apparatus Centralized Procurement Platform (SDACPP). In total, 111,999 drug procurement order records of 118 policy-related drugs (including 25 '4+7' policy-list drugs and 93 alternative drugs by generic name) from April 2017 to November 2019 were included in analyses. Policy-list drugs were divided into bid-winning and non-winning drug products. The volume and the expenditure of the drugs served as the outcome variables, measured by Defined Daily Doses (DDDs) and Chinese yuan (CNY), respectively. A difference-in-differences (DID) approach was used to estimate the policy's net effect. Results: After the '4+7' policy, the volume of bid-winning, policy-list, and policy-related drugs increased. An unexpected increase in volume was observed among alternative drugs, especially original drugs in city-level hospitals. The expenditure of policy-list and non-winning drugs declined, whereas that of alternative drugs unanticipatedly increased. Changes in volume and expenditure were both greater in generic drugs and in city-level hospitals, compared to their original and county-level hospital counterparts. Conclusions: Our findings highlight the positive effects of the '4+7' policy on generic drug substitution and pharmaceutical expenditure containment, which are greater in city-level hospitals. The unanticipatedly incremental volume of original drugs in city-level hospitals suggests the potential risk of the poor quality of bid-winning drugs, lower compliance with bid-winning drugs among patients, or physicians' profit-seeking behaviors in urban areas. More regulations and supervisions for the prescription and financial incentives of physicians are needed to address these concerns.

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来源期刊
Healthcare
Healthcare Medicine-Health Policy
CiteScore
3.50
自引率
7.10%
发文量
0
审稿时长
47 days
期刊介绍: Healthcare (ISSN 2227-9032) is an international, peer-reviewed, open access journal (free for readers), which publishes original theoretical and empirical work in the interdisciplinary area of all aspects of medicine and health care research. Healthcare publishes Original Research Articles, Reviews, Case Reports, Research Notes and Short Communications. We encourage researchers to publish their experimental and theoretical results in as much detail as possible. For theoretical papers, full details of proofs must be provided so that the results can be checked; for experimental papers, full experimental details must be provided so that the results can be reproduced. Additionally, electronic files or software regarding the full details of the calculations, experimental procedure, etc., can be deposited along with the publication as “Supplementary Material”.
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