| BackgroundUnder the operation mode of "medicine for medicine" in public hospitals,high drug costs and heavy drug burden have increasingly become the topic of patients’complaints.The cancellation of hospital drug mark up in China has not completely solved the problem of drug costs.In order to further reduce the price of drugs,Chinese government departments have been exploring new drug procurement mode.The mode is constantly changing,and finally the current centralized drug procurement mode is formed.Centralized procurement of drugs plays an important role in ensuring drug quality,reducing drug prices,purifying drug industry and standardizing medical service behavior.Since the establishment of the National Health Insurance Bureau in 2018,it has successively implemented 4+7 centralized drug procurement pilot,pilot expansion,the second and third batch of national centralized procurement with quantity.The number of procurement varieties is increasing,the scope of procurement is expanding,and the procurement rules are constantly improving.The development of drug procurement with quantity has a certain impact on all interest groups.Medical services are highly professional.Doctors,as an important part of health service providers,have the right to prescribe drugs and control the whole medical service process.At present,many studies are analyzing the drug data before and after drug procurement with quantity,but few articles are on drug procurement with quantity The drug data before and after the implementation of drug purchase were analyzed,and the drug use behavior of doctors was investigated as a supplement to the reasons for the data changes.Therefore,through the questionnaire survey of doctors in a tertiary hospital and the analysis of drug purchasing data,this study explored the changes of drug use results,and promoted the rational development of drug purchasing policy with quantity.Research objectiveThe purpose of this study is to investigate the changes in the use of drugs in selected hospitals before and after the centralized purchase of drugs,including drug price,drug use quantity,drug use cost,etc.,and to conduct questionnaire survey and interview with doctors in relevant departments of the hospital to explore the real drug use behavior of doctors,so as to supplement the reasons for drug use changes.The research objectives can be divided into the following aspects:(1)Price changes and reasons of selected drugs before and after centralized procurement(2)Changes and reasons of the quantity of selected drugs before and after centralized purchasing(3)Changes and reasons of the use cost of selected drugs before and after centralized purchaseResearch methodIn this study,a class-A hospital was selected as the sample hospital.The hospital participated in the pilot expansion of national drug volume procurement and the second batch of centralized drug volume procurement in December 2019 and April 2020.During this period,the reform of national medical insurance system(medical insurance payment reform)and drug supply guarantee system(essential drug system,etc.)did not have a significant impact on the use of relevant selected drugs in our hospital,and the relevant data and system rules of purchasing drugs with quantity were preserved in the hospital information system.Data sources mainly include drug use data,questionnaire survey and in-depth interview.The drug use data is mainly the use data of one year before and after the centralized purchase of drug varieties,which comes from the outpatient his system of a 3A hospital.In order to avoid the impact of the epidemic on the science and accuracy of this study,the study will eliminate the January to March seriously affected by the epidemic,and finally determine the relevant data of the first and second batch of purchased drugs from April to December in 2019 and April to December in 2020 for statistical analysis.The questionnaire data is a questionnaire survey of 95 outpatient doctors in a 3A hospital.A total of 87 questionnaires were collected.The sample doctors are cluster sampling of outpatient doctors with drug prescription right who are mainly involved in the purchase of drugs.The survey content is mainly about doctors’ cognition of drug volume purchase policy and changes in drug use behavior.In addition,in-depth interviews were conducted among the director of drug supply department,director of medical insurance office,outpatient doctors and patients.All data were input by Excel,and analyzed by SPSS 10.0.The main analysis method was descriptive analysis,and Wilcoxon paired sign rank sum test was used for inferential analysis.In order to ensure the accuracy of the data,the whole investigation was completed by myself,and all the data were checked again.Results(1)After the implementation of centralized procurement of drugs,the price of selected drugs decreased significantly.Compared with before the centralized purchase,the prices of two kinds of drugs increased,and the prices of 41 kinds of drugs decreased to varying degrees,with an average decline rate of 70.36%.The main reasons for the price changes are:the replacement rate of manufacturers is high before and after the centralized purchase,most of the selected drugs are imitation drugs,the price drops significantly,and the doctor’s medication habits change greatly before and after the centralized purchase.(2)After the implementation of centralized procurement,the use frequency of selected drugs increased,but there was no statistical significance(P>0.05).There were 18 kinds of DDDs increased and 24 kinds of DDDs decreased.Further calculation showed that the number of users of most drug varieties decreased compared with that before centralized collection,with statistical significance(P<0.05).The dosage of some drugs increased compared with that before purchase.The main reason for the quantity change is that the price of some original drugs decreased and the number of drugs used increased;however,due to the clinical effect of drugs and the medication habits of patients,the patients changed the drug varieties or medical places,and some patients lost;the doctor’s cognition of the policy or the patient’s reimbursement led to the increase of the dosage.(3)After the implementation of centralized drug procurement,the use cost of most selected drugs decreased,and the average daily cost of patients decreased.The main reason is that the price of drugs decreased significantly after centralized purchase,and the total cost of drugs decreased due to the decrease of the number of patients.Drug consistency evaluation eliminated some low-cost drugs,which led to the increase of some drug costs.Conclusion and suggestionThe findings are as follows(1)The decline of drug prices is easy to lead to monopoly of low-cost drugs,which greatly changes the medication habits of doctors,(2)The decline in the number of drug users leads to the loss of hospital patients,reducing the number of outpatient services.Moreover,the policy for drug use provides an opportunity for "large prescription",and the dosage of some drugs increases.(3)The decrease of drug use cost reduces the income of some doctors with low professional titles,but there is the phenomenon of changing drug varieties,so there is still the risk of invisible increase of total drug cost.Based on the above conclusions,the following suggestions are put forward:regular hospital training to promote the understanding of the policy between doctors and patients;prescription review combined with performance appraisal to standardize the drug use behavior of doctors;avoid one size fits all to ensure the multi-level drug use needs of patients. |
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