The Separation Of Dispensing From Prescription Policy And Medicine Pricing

With the imbalance of Chinese population structure and the accelerated aging rate,Chinese public hospital-led medical market is facing more and more challenges,such as large prescriptions,high medical costs,and induced overtreatment.These problems have intensified Contradictions between doctors and patients,and incidents of malignant injuries and doctors have emerged one after another.Looking to the bottom of the question,the root causes of these problems are mainly related to the medical system of "medicine to support medical treatment" and "medicine industry".In order to fundamentally solve the problem of "difficult and expensive medical visits" and optimize the allocation of medical resources,China has successively introduced a series of the separation of dispensing from prescription(SDP)policy.This article is based on the current medical market and system background,based on the perspective of the pharmaceutical supply chain,to study the reform performance of the medicine separation reform policy under different market structures.The research results show that:(1)In the case of complete competition in the pharmaceutical market,the medical market is Theoretically,there is no problem which to to cover hospital expenses with medicine revenue;(2)In the case of imperfect competition in the pharmaceutical market,hospitals and pharmaceutical companies actually achieve the effect of "bundling sales".Under the hypothesis of drug homogenization,the drug market competes for output,and the degree of SDP is internalized by the pharmaceutical supply chain.At this time,the SDP policy is nothing more than transferring the zero price difference of drugs to the medical service fee to make up for the loss of the hospital.The problem of "expensive medical treatment" is still unresolved;(3)Under the assumption of drug heterogeneity,as the degree of separation of drugs increases,the degree of collusion between doctors and drugs decreases,and the negotiation power of drug companies increases,leading to double marginalization.Adjusting the price of diagnosis and treatment services alone cannot maintain the balance of the entire pharmaceutical supply chain.At this time,SDP not only reduces the profit of the hospital,but also exacerbates the problem of"expensive medical care" for patients due to the increase in the total cost of treatment;(4)The equilibrium drug prices and the prices of diagnosis and treatment services under SDP policy are related to the concentration of the drug market and the quality of hospital diagnosis and treatment services.With the increased competition in the pharmaceutical market and the reduction in the quality of diagnosis and treatment services,the inflationary effect of diagnosis and treatment prices brought about by the medicine separation reform policy can be curbed to a certain extent.In addition,the degree of differentiation in drug quality will also affect the results when the this reform policy reaches equilibrium:(5)Since price and quality are strategically complementary,the increase in the degree of differentiation in drug quality will enhance the relative monopoly power of high-quality drugs,and increase the relative monopoly power of high-quality drugs.Its ability to set high prices.In the case of incomplete market coverage,the market shows a stronger preference for high-quality,and patients are more willing to pay high prices for high-quality.This has led to a situation in which the strong,the stronger the weak,the weaker,and the low-quality drugs are gradually being ruled out.Out of the market,patient welfare suffers.In the generalized model,the quality of medical service is endogenous.It is found that regardless of whether it is the hypothesis of heterogeneity or homogeneity of drugs,as the degree of separation increases,the investment in hospital diagnosis and treatment service quality decreases,and it deviates from the industry’s optimal investment level.Because the positive effect of cost input cannot be fully rewarded at this time,then cost input incentives are insufficient at this time.The implementation of SDP policy has not solved the problem of "expensive medical care",but has produced the effect of "bad money driving out good money".High-quality doctors will be squeezed out of the medical market or enter other levels of hospitals,resulting in high-quality public hospitals.Medical resources are in short supply.