| ObjectiveTo analyze the influence mechanism of essential drugs centralized purchasing policy (EDCPP) on medicine price in Chongqing. Analyze how the policy effects the prices and the relationship between different stakeholders, to provide suggestions to perfect the EDCPP.Contents1. The practice and implementation of EDCPP in Chongqing.2. Evaluate the effect of essential drugs centralized purchasing policy in Chongqing on drug prices and lead the stakeholder analysis.3. Analyzed how EDCPP effects the prices and formed an influence mechanism.4. Give suggestions to perfect the EDCPP and drug price.Data source and MethodsCollected essential drugs centralized purchasing policy, theory and literature at home and abroad through literature review; and summarizes the practice and experience; Through individual depth interview with stakeholders representatives, understand the stakeholders’interests and appeal in the essential medicines procurement; Design drug prices questionnaire, and collect drug generic names, types, specifications, packing, purchasing price and other information.Compare essential drugs prices of Chongqing after the implementation of centralized procurement with before and with Beijing’s prices. Use the World Health Organization (WHO)/Health Action International agencies (HAI) Standard Survey Method to make comparison with the International Reference Price (IRP). Use the stakeholder theory to analyze the roles of different interest groups play in drug procurement process and analyze the drug price forming mechanism. Invite experts to give advices on the accuracy of conclusions, the appropriateness and feasibility of suggestions, and puts forward some countermeasures to promote affordable drug prices.Results1. According to the Theories of Trade Cost and Pharmacoeconomics, analyzed how the EDCPP in Chongqing developed and operated. EDCPP of "two-envelopes" and Net Trade were compared with Chongqing’s, which found the EDCPP in Chongqing consists a price constraint mechanism which consist of into-market-price, listing-price and deal-price, and a price protection mechanism which consist of "proper price for low-price drugs and supply protection".2. After the implementation of EDCPP in Chongqing, compared the prices in 2013 with which in 2011, parts of essential drugs was decreased, Such as Aspirin, Clarithromycin, Cephalexin, Enalapril, Domperidone. The Affordability had been improved, Captopril, Nifedipine and Domperidone cost less than 2011. The price of low-price drugs (drugs that are no more than 5 yuan) was increased, such as Ranitidine, Metronidazole, Nifedipine, And Captopril.3. After the implementation of constraint mechanism in Chongqing EDCPP, Into-Market-Price, Listing-Price and Deal-Price come into play, prices showed a decreasing trend. This lead government and medicine exchange to drop prices, drug producing enterprises, Drug supplying enterprises to fight for market share, helped patients save their money. But there are still some problems, such as purchase volumes is too small to lower price, the price is still not reasonable enough, the MPR is 5.71, much high than the IRP, etc.4. Protection mechanism in Chongqing EDCPP helped to achieve reasonable price and good supply. Compared with the 2013 Beijing essential drug procurement prices, drugs from same producing enterprises with same dosage, form and specification raised reasonably. For example, the price of Ranitidine and omeprazole capsules is higher than Beijing’s purchase price of 0.93 yuan and 0.71 yuan respectively. This protection mechanism encourage producing and supplying enterprises initiative. But in practice, there still were drug price and supply problems.5. Formed a price-influenced mechanism of Chongqing’s EDCPP. Clarified the influence of purchasing policy on prices, and comb the relationship between prices, supply and quality.Conclusions1. After the implementation of EDCPP, the price of essential drugs is rationalized. The high ones had been controlled and the lower ones had been protected.2. After the game between stakeholders-----the exchange, pharmaceutical production enterprise and county procurement consortium, the implementation of constraint mechanism of into-market-price, listing-price, deal-price has obtained certain result in lower prices.3. Lower drug prices has reasonable increased and guaranteed the supply. Set low-price drugs’ specifically library to protect drug prices and the enterprise’s reasonable profit. By the mean of screening distribution enterprises, improved concentration, reduce disorder competition.4. Found the problems in drug procurement process in Chongqing, such as drugs’ price form, supply, etc. Suggestions are given for improvement.Suggestions1. Break the information asymmetry, and develop reasonable into-market-price and listing-price2. Expand the exchange’s economies of scale, efficiency of drug purchase, strengthen participation of medical institutions, and use the market mechanism to reduce the deal-price.3. Perfect price protection policy to guarantee the reasonable distribution costs and improve the efficiency of distribution, in order to guarantee basic drug accessibility.4. Coordinate the relationship between stakeholders and ensure the policy benefits.5. Strengthen essential drug procurement process supervision, to ensure the better implementation of the policy. |
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