Study On Spillover Effect Of The National Centralized Drug Procurement Policy

Since the National Medical Insurance Bureau launched the reform of centralized national drug procurement mode in 2019,and achieved substantial price reductions for winning products.It has achieved remarkable results in reducing the economic burden of patients,saving medical insurance costs,and purifying the circulation environment.This policy reshaped the market structure through major adjustments to price signals and redistribution of purchases,which will have a profound impact on the policy-related drugs.Most of the existing studies focus on winning products,it mainly involves the change of purchasing situation of winning products in different hospitals,regions and therapeutic field before and after the implementation of the policy.However,there are shortcomings in research methods and sample selection,and only a few scholars used rigorous econometric models to quantitatively evaluate the effect of the implementation of the policy.Therefore,this study selects alternative drugs as the research object,which is not only innovative in the research perspective,but also can effectively alleviate the possible endogenous problems by using the Difference-in-Difference model to evaluate the policy effect.Firstly,using the data of alternative drugs procurement from public medical institutions in Beijing and Zhejiang Province between 2018 and 2019,this study assessed the impact of the first round of national centralized drug procurement policy on the procurement of alternative drugs of winning products by constructing difference-in-difference model.The result showed that the implementation of the policy significantly decreased the number of Defined Daily Doses(DDDs)and the total expenditures of alternative drugs by 17.0% and 18.7%(all p-values<0.01)respectively.Although the Defined Daily Drug Cost(DDDC)of alternative drugs were on the rise,it only increased by about 1.61%(p-value<0.01)compared with before the implementation of the policy.It found that the price fluctuation of the alternative drugs of winning products were small,and there was no surge in consumption after the implementation of the policy.Then,the evaluation of a series of robustness tests showed that the main regression results were relatively robust.Finally,reach the following conclusions:(1)After the implementation of the national centralized drug procurement policy,the overall defined daily doses and the expenditures of alternative drugs have declined,but the linkage price reduction effect brought about by the implementation of the policy has not been reflected.(2)The implementation of the policy has a greater impact on alternative drugs with conditional substitutability.(3)The increase of defined daily doses of alternative drugs in individual therapeutic fields after the implementation of the policy deserves attention.(4)The fiercer the competition between winning products and alternative drugs,the better the price reduction effect.(5)After the implementation of the policy,the number of Defined Daily Doses(DDDs)of alternative drugs in primary medical institutions showed an upward trend.Therefore,this study held the view that policy makers can moderately increase the market share of businesses competition,continuously improve the bidding mechanism of selected drugs,and strengthen the supervision of the use of winning drugs in hospitals,so as to promote the smooth implementation of the national centralized drug procurement policy.