Research On The Optimization Of National Negotiated Drug "Dual Channel" Policy Based On Smith Model

With the average life expectancy of the people as a whole,the incidence of chronic diseases,tumors and other diseases has increased to a certain extent,and patients’ demand for innovative drugs has also increased.In order to meet the drug needs of patients,the state carries out medical insurance drug negotiations,but there are always some blocking points and difficulties in the actual implementation of negotiated drugs.In order to solve the problem of "difficult admission to hospitals" of negotiated drugs,the national medical security department and the health department jointly put forward the"two-channel" policy,through designated medical institutions and designated retail pharmacies,to meet the reasonable needs of negotiated drugs in terms of supply security and clinical use.With Smith model as the research framework,this study proposed the ideal policy objective of the "two-channel" policy through the research methods of questionnaire,interview and comparative analysis,studied the background,basis,implementation measures and implementation status of the "two-channel" policy within the scope of Jinan City,and summarized and analyzed the implementation status from the perspective of various influencing factors of the policy implementation.Jinan has included 275 negotiated drugs in the National medical insurance drug Catalog in 2021 into the "two-channel" management,and publicized 96 designated retail pharmacies of "two-channel",distributed in 10 districts and two counties of the city.The "two-channel" policy has achieved certain results.By comparing the implementation status with the ideal policy objective,it is found that there are still some problems in the implementation of the "two-channel" policy in Jinan City,such as the implementation measures do not classify the national negotiated drugs included in the"two-channel";Lack of incentive measures for medical institutions to equip with drugs,not effectively improve the allocation rate of negotiated drugs in medical institutions;The selection mechanism of designated retail pharmacies is not perfect.There are a large number of designated retail pharmacies,but some pharmacies do not actually sell "two-channel" drugs.In view of the above problems,the study proposed specific countermeasures to improve the implementation of the policy,such as the establishment of a "two-channel" drug list dynamic adjustment mechanism,the improvement of medical institutions channel negotiation drug allocation assessment mechanism,the establishment of drugstore selection access and exit mechanism,to avoid the designated drugstores "only in but not out" and "lifetime tenure system".The "two-channel" policy provides a new way for patients to use negotiated drugs and improves the accessibility of negotiated drugs.The only way to better implement the"two-channel" policy is to make it more scientific and rational,improve the policy implementation mechanism,strengthen the coordination among policy implementation agencies,improve the level of pharmaceutical care in medical institutions and pharmacies,and create a good environment for policy implementation.The "two-channel" policy may provide a good direction for the country to continue to deepen the reform of medical system in the future.