The Study On The Operating Mechanism Of National Essential Medicines System Based On The Perspective Of The Major Stakeholders

In2009, the construction project of China’s national essential medicine system began to implement. In the past three years, various problems have emerged. For example, the production enterprises of essential drugs do not produce after winning the bid, quality of essential medicines can not be guaranteed and medical institutions do not use according to the regulations. These issues will affect the implementation process and the effect of essential medicine system.China’s history of the study of essential medicine system is not long. The researches mostly focus on the question of how to solve the problems of essential medicine system implementation process, however, lack of the explorations of an operating mechanism of essential medicine system from the systemic and overall point of view. Studying the behavior rules of the major stakeholders of essential medicine system implementation from the perspective of stakeholders with related theories, specially, game theory, and researches is helpful in finding the problem and the root cause in the implementation. And building an operating mechanism of essential medicine system on this basis can inhibit major stakeholders’ reverse behavior, mobilize their enthusiasm to cooperate with the system implementation, promote the healthy operation of essential medicine system and achieve the goals of essential medicine system.This paper learns from the researches in fields of stakeholder theory, game theory and structural equation model and do study on the behavior of major stakeholders of essential medicine system, the composition of the operating mechanism of essential medicine system, the correlation between essential medicine system operating mechanism and implementation performance, etc. From all these, we hope that it can assist in solving problems of the construction of China’s essential medicine system.This study suggests that major stakeholders’ behavior is the key to affect the essential medicine system running. This paper analyses major stakeholders’ interest demands with the public goods theory, the economic theory, the public choice theory, etc, and focuses on the game behavior between government and production enterprises in essential drugs’production, supply and use link. After studying on quality regulatory, bidding and purchasing based on mixed strategy game model and evolutionary game model, this paper conclude the key point to ensure essential medicines’ quality regulatory work effectively. That is reducing illegal income from substandard drugs produced by pharmaceutical companies, improving the amount of fines for illegal enterprises, reducing the cost of government regulation, rewarding pharmaceutical companies for producing standard drugs reasonably and increasing the loss of absence of government regulation. During bidding and purchasing, scientific and reasonable cost accounting should be formulated to develop guidance prices of exclusive varieties and to avoid artificially high prices. Government should support the technical transformation of pharmaceutical companies, reduce the cost of production and improve the normal interests of winning enterprises to ensure compliance behavior and supply capacity. The scientific and reasonable bidding price can guarantee the reasonable interests of enterprises, and at the same time it can reduce the illegal probability. Increasing the penalties for incompliance behavior and the reputational damage of absence of government regulation, reducing the cost of government regulation and improving the success rate of it is an effective method to inhibit or reduce violations of essential medicine tender enterprises. Improving the degree of standardization and centralization can effectively reduce the cost of government regulation and improve the success rate of it.In the essential medicine use link, this study analyses the single-stage game behavior of government regulators and public medical institutions through supervisory game model. It reveals that the probability of public medical institutions’ prescribed use of essential medicines is inversely proportional to monitoring cost, and is directly proportional to the sunk costs of regulatory authorities’nonfeasance and the punitive amount of public medical institutions’ violations. The study of public medical institutions’ belief revision to the monitoring behavior of regulatory authorities, namely the study of multi-stage game behavior, shows that the persistence of government regulatory actions can reduce violations of public medical institutions. The analysis based on the principal-agent theory about the behavior of government and public hospitals shows that if only the government pays public hospitals a regular wage (i.e. reasonable compensation), public hospitals would accept the government’s requirements of using essential medicines. If the government wants public hospitals actively promote the national essential medicine system or use the essential medicines beyond the prescribed ratio, the government must give them a certain percentage of reward, including economic incentives and non-economic incentives. This paper uses a pioneer analysis about the game behavior of doctors and patients with chronic diseases based on the evolutionary game theory. It reveals that the probability of chronic’s reports to the government about the doctors’ nonuse of essential medicines is related to the doctors’ additional revenue by the nonuse of essential medicines and the fine turned over after investigated by the regulatory authorities. The more the additional revenue is, the greater the probability of patients’ reports is. Conclusively, the patients’ decision-making power and the cognition of utility of essential medicine use should be improved, the health insurance policy about essential and non-essential medicines should be formulated scientificly and the patients’ economic benefits from essential medicine use should be increased. All this can improve the effect of patients with chronic diseases on supervision on doctors’ use of essential medicines. Additionally, doctors using essential medicines should be given reasonable reward.This paper constructs a systemic operating mechanism about promoting the implementation of essential medicine system that contains incentive mechanism, constraint mechanism and security mechanism. On the basis of the current problems that occur in the implementation of essential medicine system and the analysis of game behavior among the four major stakeholders, the author holds that the operating mechanism about promoting the implementation of essential medicine system should consist of three components. Those are the incentive mechanism that improves the related people’s working enthusiasm, the constraint mechanism that guarantees the related management activities proceed normatively and orderly and the security mechanism that provides material and spiritual foundation for the system running. This paper will analyse the major content that three mechanisms contain and explain the mechanism of action.This paper uses the structural equation model to do an empirical research on the relationship between the constructed operating mechanism of essential medicine system and the implementation performance of essential medicine system. Then, it verifies the prominent positive correlation between the constructed operating mechanism and implementation performance. Lastly, it validates the scientificalness and effectiveness of the operating mechanism that structured on the basis of the theoretical analysis from a practical point of view.