| Safeguarding drug supply is a key step in achieving the strategic goal of "access to basic health care for all and improving health for all".Since the beginning of the new century,the CPC Central Committee has issued several policy papers on "Essential Drug System".Especially after 2009 when the essential drug system was reconstructed,medical institutions at all levels in China have basically established the essential drug system,laying a good foundation for the supply,price standard and reasonable use of essential drugs.In 2018,the State Council’s institutional reform program re-arranged the responsibilities of essential drug system and assigned its full authority to the National Health and Safty Commission’s responsibilities.At this stage,the National People’s Congress is also actively promoting the "Basic Health Care and Health Promotion Law" legislation and strengthening the legal construction of essential drugs.However,with the development of social economic system transformation and social living standard,people’s demand for drugs increases steadily and drug supply environment changes continuously.Besides,the contradiction between the drug supply and drug demand becomes increasingly prominent and the development of the essential drug system enters the bottleneck period.These problems not only threaten the continuous advancement of "Healthy China",but also seriously damage the people’s basic health rights and interests.Therefore,methods,such as optimizing the top-level design,improving system efficiency and implementing effects,to regulate the market of essential drugs,to constrain medical institutions’ behavior and to meet the people’s demand for essential drugs has become a key in consolidating and improving national essential drug system and meeting people’s growing need for a better life in the new era.Based on the background,this paper,by means of establishing national essential drug system,studies the national essential drug system through the research idea of “Clarifying goals——Analyzing goals——Achieving goals”,for solving the problem of essential drugs.It discusses the main contradictions in terms of the basic objectives of the essential drug system,essential drug supply price and essential drug use,based on which it explores the path to solving the existing block factors and establishing the essential drug system.In terms of the specific research idea,the article starts from the connotation of essential drug system and its status in drug supply guarantee system,clarifying the role of essential drug system,a public system,in solving the problem of drug use.Then based on the realistic problems and contradictions in medication,it analyzes the main contradiction in people’s drug demand at this stage and further clarifies the primary goals of essential drug system.After these,it further analyzes the gap between the current essential drug system and the institutional mechanisms that people need at this stage to solve the problem of drug demand.Taking the gap as the key in the innovation and transformation of essential drug system,it explores effective methods to fill the gap to resolve the contradiction between drug supply and people’s drug demand,to promote essential drug system and the construction of “Healthy China”.(1)clarifying goals-clarifying the primary goals of China’s essential drug system at this stage from practical problemsThis paper first analyzes the goal of the essential drug system from the practical problems and summarizes the three major problems in the field of drug supply,drug price and drug use by referring to many empirical research literature and news reports.The problems,in other words,are shortage of drugs under inadequate supply and unfair loopholes under imbalanced supply structure,excessive drug burden caused by the increase of drug price and the defects of the reimbursement mechanism,and drug safety problem under quality defects and drug misuse under improper prescriptions.Then it,focusing on the problems,clarifies the primary goal of essential drug system at this stage,which are solving the problem of drug supply and making up for imbalanced drug use,helping drugs return to reasonable prices and compensating for the proportion of medical costs,eliminating quality defects and promoting rational use of drugs.Only by achieving the goal of the essential drug system can we completely solve the problems and contradictions in the field of people’s drug use,and effectively safeguard the people’s health rights and promote the construction of “Healthy China”.(2)Analyzing goals-analyzing the gap between the reality and objectives and indicating the reform direction of essential drugsThrough the comparison of the intrinsic characteristics of the system and the essential drug system,the paper points out that the gap between the design of the essential drug mechanism and the objective is mainly reflected in the following three points.First,the coordinating mechanism of the essential drug system is not well designed.On the one hand,there is a lack of interest-sharing mechanisms among multi-stakeholder groups,existing a problem of interest coordination among the relevant groups.The goal of the essential drug system is contrary to the individual goal,adding the costs of achieving the goal of essential drug system.On the other hand,the coordination of government duty and market responsibility is unknown.There exists the problem of the “offside” and “vacancy” of government responsibility in the essential drug system,with limited management resources not effectively used.Second,the supervision mechanism of the essential drug system is not perfect.For one thing,the compensation fund operation of essential drug system lacks effective supervision.The capital investment and capital operation of the current essential drug system in this stage not only lack objective evidence of capital investment,effect evaluation on capital operation and monitoring indicators,but also lack information disclosure mechanism for capital use and optimizing mechanism for capital operation.For another thing,the supervision mechanism of the production and supply of essential drugs is not perfect,which provides an opportunity for the profit in the circulation and use of drugs,influencing the implementing effects of the system.Third,the incentive mechanism of the essential drug system needs to be further improved.On the one hand,the incentive mechanism for the production and supply of essential drugs is not perfect.The country does not strictly regulate the operation of the compensation mechanism,and some compensation mechanisms are inefficient and wasteful,which threatens the sustainable operation of the essential drug system.On the other hand,the incentive mechanism to guide the rational use of essential drugs is not yet sound.Although currently government has introduced the incentive measures for implementing essential drugs by the way of performance evaluation and economic incentive to get rid of the linkage between drugs and doctor’s income and to standardize the drug use behavior of doctors,the incentive mechanism is relatively general,lacking operability,and the incentive effect is always not ideal.(3)Achieving goals-exploring the path to achieving the goal of the essential drug systemTo guarantee the feasibility and maneuverability of the national essential drug system,the study takes the theory of health justice as the value orientation,considers the shareholder theory as the coordinating means,and takes the institutional change path as theoretical guidance for achieving the goal of the national essential drug system.At the same time,it studies the international community,summarizes and perfects the practical evidence for China’s essential drug system by learning from mature experience of foreign countries and regions in the implementation process,as well as advanced experience of essential drug exploration in many provinces and regions,and puts forward feasible suggestions to achieve the goal of essential drugs,including:(1)supply target implementation path: from the optimization of medical resources allocation to the improvement of the legal security system.The specific measures include optimizing the structural allocation of medical health resources,perfecting the legal security system of the national basic drug system,improving the compensation mechanism of manufacturing and distribution firms in the essential drug system,establishing information detection mechanism for the production and supply of essential drugs and improving compensation mechanism for essential drug use in medical institutions.(2)Price target implementation path: from perfecting planning management system to strengthening the supervision and training process.The specific measures include purifying essential drug distribution,exploring the free supply of essential drugs,improving the essential drug reimbursement mechanism,and improving the income structure of medical personnel.(3)Drug use target implementation path: from perfecting planning management system to strengthening the supervision and training process.The specific measures include strengthening guidance and management of drug use safety,improving the rationality and rigor of the selection of essential drugs,improving supervision mechanism for prescription by medical staff,strengthening pharmacy education and pharmacist training system and establishing long-term mechanism for rational drug use.In terms of the structure,the paper is divided into six parts.The logical structure and content of each part are set as follows:The first is the introduction part.It introduces the background of the topic,reviews the current research situation at home and abroad,and defines the related concepts of the essential drug system.Then it introduces the theory of health justice,the theory of stakeholders,institutional theory and establishes the theoretical framework of essential drug system.Health justice is the cornerstone of social fairness and justice and is the important point in the "fairness of starting point ".Besides,improving health fairness and ensuring the fair distribution of health resources is both the design principle of the system and the goal of the system.Therefore,this paper chooses the theory of health justice as the guidance of the top-level design for the essential drug system.Since the essential drug system covers a wide range of groups,the current drug supply problem is largely due to those groups who only care about their own interests.The misconduct of shareholders will seriously hinder the way of achieving the goal of essential drug system.So,in the construction of the essential drug system,it is necessary to coordinate the different roles under the system and to clarify the functions of each role in the framework of the essential drug system.Therefore,this paper introduces the theory of stakeholders and institutional theory to guide the essential drug system.A system cannot be successful if it lacks the timely adjustment during the implementing process,so does the essential drug system.The paper takes the theory of institutional change as a guidance,grasps the practical demand and orientates the root of problems to guide the essential drug system.Chapter One is an overview of the national essential drug system.The concept,characteristics,connotation and function of the national essential drug system are analyzed,and the national essential drug system is constructed in all directions.In this paper,the history of China’s essential drugs system is reviewed,and the development of its national essential drugs is divided into the stage of introduction,preliminary establishment and comprehensive implementation.This paper introduces the construction of the national essential drug system at all stages and the achievements in the system implementation.By introducing the historical background of the establishment of the essential drugs,it highlights the importance of perfecting the national essential drug system.Chapter Two analyzes the goal of China’s essential drug system and the defects of design mechanism.Based on the analysis of the goal of the essential drug system from practical problems this paper summarizes the three major problems in the field of drug supply,drug price and drug use,namely,the shortage of drugs under inadequate supply and unfair loopholes under imbalanced supply structure,excessive drug burden caused by the increase of drug price and the defects of the reimbursement mechanism,and drug safety problem under quality defects and drug misuse under improper prescriptions.Then it,focusing on the problems,clarifies the primary goal of essential drug system at this stage,which are solving the problem of drug supply and making up for imbalanced drug use,helping drugs return to reasonable prices and improving the affordability of medicines,eliminating quality defects and promoting rational use of drugs.Based on clarifying the operational goal of the basic drug system,the paper further analyzes the gap between the desire and the reality and studies the defects in the design mechanism.The study argues that there is no interest-compatible mechanism among the multi-stakeholder in the design of the operational mechanism of the system,which makes the system less effectively competitive.In terms of the coordination and supervision of the system operation,the coordination between the government duty and the market responsibility is not clear,and the supervision mechanism is not perfect.The lack of scientific operation mechanism in capital use makes the system operation less effective.In terms of the incentive mechanism in system operation,the incentive mechanism to guide essential drug use for medical personnel is not perfect,and the compensation mechanism of medical institutions is not perfect,which makes the system operation lack the internal driving force.Chapter Three starts from the successful experience of international essential drug system and the exploration experience of domestic essential drug system.On the one hand,the essential drug system of many countries in the world has been relatively mature,accumulating a lot of successful experience.Although the content of drug policy has different characteristics due to the difference in the level of economic development and the structure of pharmaceutical industry in different countries,the international community gradually forms some common trends with implementation of essential drug system.These successful practices and trends are worthy of our careful consideration.On the other hand,the domestic essential drug system has been carried out for many years,and some useful experiences in implementing the essential drug system have been explored in practice.This chapter studies the implementation experience of essential drugs from the aspects of drug availability,drug affordability and rational use of drugs,and puts forward feasible measures to improve the essential drug system,providing practical support for deepening the reform of China’s essential drug system.Chapter Four analyzes the feasibility and maneuverability of the goal of essential drug system in China.This chapter,based on the research results of the previous three chapters which thoroughly explain the current goal,gap between the goal and reality and the method to achieve the goal,analyses the macro-environment of the feasibility of goal of essential drug system.First,it demonstrates the feasibility of achieving the goal of the essential drug system based on the analysis of external conditions.Subsequently,it demonstrates the maneuverability of achieving the goal of the essential drug system based on the analysis of the theory of the path.Then,with a comprehensive grasp of the basic information of the stakeholders and their interests,it explores diversified policy participation mechanism and benefit expression mechanism,to fully coordinate the interests of different stakeholders,to make individual goals serve the overall goal,and to promote continual innovation of the system.Finally,IN the process of achieving the national essential drug system,it points out the country should be given the strategic focus and the political guiding role in the system innovation to fundamentally guarantee the standardization and effectiveness of the system operation.Chapter Five talks about the strategies for improving national essential drug system and perfecting China’s drug supply guarantee system,based on the analysis and summary from previous chapters.Starting from the problems in the three major fields of essential drug system,the paper analyzes the causes,explores effective solutions and finally achieves the goal of essential drug system.It achieves the goal of essential drug supply guarantee by optimizing the structural allocation of medical health resources,perfecting the legal security system of the national basic drug system,improving the compensation mechanism of manufacturing and distribution firms in the essential drug system,establishing information detection mechanism for the production and supply of essential drugs and improving compensation mechanism for essential drug use in medical institutions.It achieves the goal of essential drug price guarantee by purifying essential drug distribution,exploring the free supply of essential drugs,improving the essential drug reimbursement mechanism,and improving the income structure of medical personnel.It achieves the goal of essential drug use guarantee by rationally adjusting essential drug list,strengthening guidance and management of drug use safety,improving supervision mechanism for prescription by medical staff,strengthening pharmacy education and pharmacist training system and establishing long-term mechanism for rational drug use.Essential drug system has been charged with important tasks by history and reality.The implementation and improvement of the system are directly related to the establishment and perfection of national medical and health system as well as the construction of “Healthy China”.With more national attention paid to people’s health,the importance and necessity of the national essential drug system will be further recognized.Accelerating the improvement of the national essential drug system,enhancing national health and achieving a high degree of unity of desire and reality are the common expectations of the country and the people. |
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