| 1.ObjectivesStudy the operation mode of medicine medical insurance negotiation mechanism of Jiangsu,Jiangxi,Chengdu and Qingdao.To understand the results and experience gained since the implementation of the negotiating mechanism,and find out the problems at all stages of the negotiations.Summed up the internal and external environmental factors what domestic medicine medical insurance negotiations are facing.Finally,the relevant countermeasures and suggestions are put forward.2.Methods(1)Literature research.By collecting literature,understand and learn about the domestic medicine medical insurance negotiations situation,and understand the drug price negotiations in developed countries.(2)Depth interview.Interviews with relevant staff involved in medicine medical insurance negotiations in Jiangsu,Jiangxi,Qingdao,Chengdu.(3)Questionnaire survey.A questionnaire survey of work status and degree of accreditation was carried out on medicine insurance agencies and pharmaceutical companies staff who participate in medicine medical insurance negotiations in Jiangsu,Jiangxi,Qingdao,Chengdu.(4)Expert scoring method.Select 10 experts,ask them score the advantages,disadvantages,opportunities and threat factors for the continued implementation and promotion of medicine medical insurance negotiation mechanisms by a questionnaire survey.3.Results(1)Analysis of four modes of operation: In the overall process of negotiations,medicine selection,substantive negotiations,the implementation of management methods,four places have been formed with the characteristics of the mode of operation.(2)The relevant staff of the negotiations: A questionnaire survey was conducted on 68 staff members on both sides of the negotiations,Health insurance agencies 21 people,accounting for 30.9%;Pharmaceutical enterprises 47 people,accounting for 69.1%.Health insurance agencies,male 14,accounting for 66.7%,females 7,accounting for 33.3%;Pharmaceutical enterprises,male 25,accounting for 53.2%,females 22,accounting for 46.8%.All of the subjects are undergraduate and above,master’s degree and above are 9(42.9%)and 12(25.5%)in health insurance agencies and pharmaceutical companies.The average score of the business familiarity of the respondents was 23.35.(3)The importance of the content of the negotiations: The respondents in this study believe that the importance of the negotiation content from large to small is “Reduce drug prices,buy drugs and handsel drugs”,“Payment standards and risk sharing”,“Patient access conditions”,“Settlement method”,“Health management services and distribution and other additional terms”.(4)Problems at all stages of the negotiations: In the preparatory phase of the negotiations,“The relevant data information is difficult to obtain” is the two sides reflect the most,accounting for 85.7% and 70.2%.In the substantive negotiation phase,“The use of negotiation skills is not rich and proficient” is the medical insurance agencies staff reflect the most,accounting for 57.1%;“The right of both sides to discourse is not equal” is the Pharmaceutical companies staff reflect the most,accounting for 74.5%.In the implementation phase of the agreement,“Drug exit list is difficult to implement” is the medical insurance agencies staff reflect the most,accounting for 61.9%;“There is a situation that is not specified in the agreement” is the Pharmaceutical companies staff reflect the most,accounting for 61.7%.(5)Analysis on the Recognition Level of Current Negotiation Mechanism: A total of 70 questionnaires were distributed and 68 valid questionnaires were collected.The effective recovery rate was 97.14%.Respondents included 21 staff members of medical insurance agencies,47 of pharmaceutical companies.In terms of business familiarity,the average score of respondents in all aspects was greater than 3(4 points system).The lowest score is “Management of the implementation of drug negotiation projects”.There were 3 items’ business familiarity’s differences were statistically significant of the two parties in the negotiation(P<0.05): The basic principles of the drug negotiation process should be followed;Negotiation objectives in the substantive negotiation process;The total score of business familiarity.The scores of respondents in pharmaceutical companies were higher than those of health insurance agencies.In the recognition of the negotiating mechanism,every survey item’s average score was higher than 4(5 points system)in the recognition of the overall effect of the negotiation mechanism except “which is conducive to maintaining the price system of pharmaceutical companies”.The average score of all aspects of “preparation of the negotiations”,“substantive negotiation”,“implementation of the negotiation agreement” and “negotiation project’s supervision and evaluation” was higher than 4 except “patients taking drugs is quick and easy”.There was no statistically significant difference(P>0.05)between two types respondents in all aspects of “the overall effect of the negotiation mechanism”,“preparation of the negotiations” and “negotiation project’s supervision and evaluation”.But in the recognition of the substantive negotiation,there was statistically significant difference(P<0.05)between two types respondents in the "negotiations between the two sides in an equal,cooperative,harmonious atmosphere".Healthcare agencies’ respondents have higher scores than pharmaceutical companies.And in the recognition of the implementation of the negotiation agreement,there were statistically significant differences(P≤0.05)between two types respondents in the “After the agreement entered into force,the medical insurance agency will be strictly in accordance with the agreement” and “The fund pay to pharmaceutical companies timely and reasonable”.Healthcare agencies’ respondents have higher scores for than pharmaceutical companies.(6)Analysis of Internal and External Environmental Factors: To summarize the advantages,disadvantages,opportunities,threats when medicine medical insurance negotiations continue to implement and promote by SWOT-PEST model.And then ask experts score on the factors,the expert authority coefficient of this survey is 0.7245(Cr=0.7245).The average scores of experts with internal Strengths were 7.70,which higher than 8 points is that medicare coverage expanded,the strength of the Fund increased,increasing the bargaining chip(S2).The average scores of experts with internal weaknesses were 7.07,which higher than 8 points is that there are still shortcomings in the current management of negotiating mechanisms(W1).The average scores of experts with external opportunity factors were 7.77,which higher than 8 points is that national policy support,in line with the trend of medical reform(O1)and the national implementation of the serious illness policy further protects the fund source(O3).The average scores of experts with external threats factors were 7.36,which higher than 8 points is that the lack of supporting laws and regulations(T1)and relevant departments are not smooth convergence,there are sector interests of the game dilemma(T3).Result display that opportunity is greater than the threat in external environment,advantages outweigh the disadvantages in internal environment now.4.Conclusion(1)Four places have formed a more perfect mode of operation of the negotiations,and respondents have a higher degree of recognition of the overall effectiveness of the negotiation mechanism.(2)The existing negotiating mechanism problems include: In the preparation phase,the relevant data information is difficult to obtain.In the substantive negotiation phase,the use of negotiation skills is not rich and proficient,and the right of both sides to discourse is not equal.During the implementation phase of the agreement,it’s difficult for the medicine to withdraw from the list,and there is a situation that is not specified in the agreement.(3)Contradictory points between negotiate both sides: First,the two sides of the negotiating power is not equal,is not conducive to creating an equal,cooperative and harmonious atmosphere of the negotiations.Second,After the entry into force of the agreement,the medical insurance agency can’t implement in accordance with the agreement due to public opinion and other reasons.Third,fund payment is not reasonable,payment is not fast enough.(4)According to the current internal and external environmental conditions,we should focus on the SO strategy,continue to improve the management level,accumulate experience in negotiations,increase bargaining chips. |
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