Drug supply system: Only full competition, to really protect!

drug supply system: the only fully competitive in order to truly protect !

recommendations on medical and Health system (X) - the drug supply system reform

"value for money, survival of the fittest," the basic competition rules of the market economy, can not play a role in the pharmaceutical industry, the root cause in the previous articles have analyzed.Caused by the domestic pharmaceutical market of cheap Drugs are the root causes of the shortage of medical institutions and doctors do not want to use cheap drugs, cheap drugs are not allowing the market demand.Because there is no market demand, pharmaceutical manufacturers would not want the production, distribution companies are naturally reluctant to distribution.In fact, a competitive system of production and supply of drugs has been formed in the country, there is no reason why these two industries to achieve through market competition, survival of the fittest, because as the demand for drugs by the lack of medical institutions,"and eliminating the inferior merit," incENTive.The authorities hope some cENTralized, monopoly, return to the planning system"purchase and sale," putting the cart before the circulation model to solve the problem (ie" fixed-point production, centralized procurement, direct distribution, and strictly control the spread rate"and the planned system, way of thinking), is simply impossible to achieve success; only to the drug supply system can fully exploit the market competition mechanism, it will take for the drug supply system reforms in the right path.

1 .Price control to cancel the medical industry, to achieve Health care market pricing, the price of medical services medical staff fully reflect the value of medical technology and services to enable medical personnel charges for medical services only through access to adequate Health care to their human capital and its services commensurate with the value of the income, so that charges for medical services by medical institutions will be able to achieve full compensation, the total elimination of the"Drugs make medicine" mechanism.

medical institutions and doctors want to eradicate high preference for buying and selling Drugs, cheap drugs act exclusion, the first is to straighten out the price system of medicine, medical personnel to reflect the value of medical technology and services to the medical service price adjustmENT to a reasonable level to achieve Health care services reasonable pricing, change"to drugs make health" system.Does not eliminate"the drugs make health" system, medical institutions prefer to resolve the behavior of buying and selling a few high-priced drugs is not possible because the government set prices below its cost of medical services, financial subsidies and not enough income to make up for gaps in medical institutions conditions, medical institutions, only through the sale of drugs at high prices to break even, it can only allow medical institutions to achieve full compensation through the sale of drugs at high prices.Therefore, to solve the medical institutions much neglected essential drugs, drug prices higher, the greater the amount of purchase and sale of medical situation, the price of medical services, rationalize the pharmaceutical pricing system is essential.

was advocated by vigorously raise the solution to financial compensation"to Drugs make Health" problem.But this path will not work: First, if the full compensation fiscal practices of medical institutions, will inevitably lead to the problem of inadequate incENTives, the end result is a complete lack of enthusiasm of doctors, which will inevitably lead to low efficiency of medical institutions, medical poor quality of service and a serious shortage of supply of medical services.Full compensation for the financial system almost certainly also have soft budget constraint problem, ultimately leading to financial overwhelmed.That is, there is no ability to fully finance all medical institutions to support Health care services while ensuring the supply shortage is not apparent. national Health care system under the planned economy and the UK's public health system has been fully proved this point, we do not need to repeat the same mistakes.Second, if the increase in the implemENTation of financial subsidies but still the difference between the subsidy system, which is to increase subsidies for medical institutions but not the full financial burden of operating costs, medical institutions, medical institutions, financial compensation is still lack of some income through the sale of Drugs to make up, which in fact does not change drawbacks of heavy current medical system, medical institutions, financial compensation to 10% of operating costs and compensation of 60% there was no real difference in the system, so long as to allow medical institutions to make money through the sale of drugs to make up for the lack of financial compensation, and still maintain its pharmaceutical retail monopoly to sell drugs at high prices can not change the Health care sector, selling high-priced drugs situation.Again, if full compensation is only part of the financial public medical institutions, medical institutions, the remaining charges for medical services only through the profit and sell drugs, break even, then the full amount of compensation not to mention the financial efficiency of the problems the lack of medical institutions can not receive financial or subsidized medical institutions still face a rationalization of medical services and drugs parity relations, if you do not change the current pattern of medical distorted price system, this part of the self-financing medical institutions will still be there and sell drugs at high prices, the incentive to sell high-priced drugs.

from the above analysis we can, want to solve the relatively isolated low-cost Drugs, medical institutions purchase and sale of high-priced drug preference, first of all need to increase the price of medical services, medical personnel, to reflect the value of medical technologies and services, making Health care services by medical staff only charge is enough to get their human capital and the value of medical services commensurate with income.Only under this premise, be possible to universal access to basic medicines.Of course, in order to prevENT the high price of medical services and medical institutions to induce patients with excessive consumption, as fully as possible the medical service market is essential.At the same time, improve the reputation of the medical institutions and doctors of third-party mechanism and mature payment system is also essential.

2 .Elimination of public sector monopoly on the drug retail

As mENTioned earlier, the retail aspect of medicine is a public sector monopoly to sell Drugs at high prices, the fundamental reason for selling high-priced drugs.Therefore, in order to eliminate low-cost essential drugs is no market, and the higher purchasing price of drugs the greater the amount of the anomaly, we must gradually reduce and ultimately eliminate the public sector in the pharmaceutical retail monopoly on.To do this, you need to take the following reform measures:

First of all, to achieve"separation of managemENT from operation." If you still maintain"control to do one" system, as the industry regulator administrative department of Health is still held in public medical institutions and the owner, the department will use its industry to continue to maintain its regulatory powers under the medical institutions medical services and pharmaceutical retail monopoly sectors, health fair competition in the pharmaceutical industry not possible to eliminate Drugs in public hospitals will not be the monopoly of retail sales.

Second, the right to release the retail sales of prescription Drugs, allowing community pharmacies sell prescription drugs.Most of the existing chain of pharmacies are selling prescription drugs should be given to the right.

again, removing ENTry controls, encourage private hospitals and other medical institutions in the development of new, lower the whole society's dependence on public hospitals, to break the monopoly of public hospitals.

Finally, the reform of public Health and medical insurance reimbursemENT system where the right of lawful possession of prescription Drugs sold in retail pharmacies and private medical institutions are publicly funded should be identified as the designated Medical and Health care institutions.

Clearly, in this system, the patiENT will have a more fully autonomous right to choose, either from the hospital, patients can buy prescription Drugs from pharmacies, but also for those who enjoy free medical care or Medicare patients, no matter from where to buy drugs can be reimbursed, how can high public hospitals sell drugs, sell drugs at high prices? Of course, these points need to be a technical requirement, that is, the standardization of prescription and social, that is standardized prescription writing, prescription information transparent.

3. cancel the fare increase rate control

had earlier pointed out, increase rate of control is the leading medical institutions prefer an important reason for buying and selling high-priced Drugs, it is also the control measures, leading medical institutions and pharmaceutical drugs by conspiring to raise the wholesale price, then the kinds of kickbacks in the form of drugs to medical institutions rebates wholesale model.To eliminate this inefficiency, high cost of drug sales model, in order to eliminate Health care organizations and pharmaceutical companies conspired to raise prices for drugs, incENTives, purchase and sale of medical institutions in order to eliminate the preference for high-priced drugs, medical institutions, pharmaceutical net price rate control policy must be abolished.

on the increase rate of the control, there are now a very extreme claim, that is,"zero increase rate" the so-called"zero sales slip", the relevant governmENT departments advocate the implementation of essential Drugs at least zero sales slip.However, this proposed policy in favor of the people may not realize the absurdity of this proposition: First, if only to allow sales of medical institutions, essential drugs, medical institutions are also allowed to sell non-essential drugs, basic drugs sales slip must be zero ( Not to mention the Government's capacity, a positive control), but other drugs can increase sales, apparently serious medical institutions and doctors will prefer to bring greater economic benefits to the non-essential drugs, essential drugs in the cold it will not be avoid; Secondly, to avoid the first outcome, medical institutions need to dictate a certain percentage must be used essential drugs (this is the relevant departments of the basic drug system, a proposition), the problem is the right drug choice the basic rights of doctors, but also for doctors to achieve rational use of drugs must be given a right, and whether both the rational use of drugs involved in a strong professional skills but also has great individual differences, so the ratio on the use of essential drugs will bring infinite endless bickering and bargaining, in addition to the implementation of coercive measures also must be accompanied by top-down, endless examination, assessment, such administrative management in almost every area has never produced a desired effect, the medical services and the rational use of this highly specialized field even more unlikely to produce the effect claimed by the government departments, it is more likely to have a"political conspiracy Medicine","capture" and"rent-seeking"; Third, the more extreme approach is to require part of the medical institutions such as community Health service centers (stations), township hospitals, village clinics all use of essential drugs and must be zero sales slip, and by way of financial compensation to achieve the full full compensation for medical institutions (and regardless of whether the Government's fiscal capacity).The problem is, if these medical institutions and sell drugs without any income, then why insist that medical institutions and sell drugs? Direct implementation of"medical separation", so that medical institutions to focus on Health care, and the functions of the sale of drugs to pharmacies and other retail organizations all opposed to the more simple and feasible?"Medical isolation" was originally proposed by congress a reform goal, but also developed universal, and has been shown to control drugs expenditure, to achieve an effective system of rational drug use.Relevant government departments around the big bend, redundant, additional agencies, laborious to carry out"zero sales slip","expenditure" to do?

supporting reform in the case has not been completed, if the governmENT controls drug prices that still has to maintain the necessary Drugs can be taken to set the maximum retail price of control.However, in the pharmaceutical retail market to full competition, medical institutions, pharmaceutical retail monopoly has no conditions, especially in the Medicare payment system has been fairly good condition, the Government's drug price control policy such as government pricing of prescription drugs can cancel enough competition in the market can fully control the drug prices near the cost of its supply.Naturally, the so-called Special Drugs pricing policy has also lost a single reason to exist.In this case, the new drug approval and drug pricing are no longer linked to pharmaceutical companies who would be no need to conduct unworthy of the name of the"drug" innovation.

4 .Medicare paymENT system reform, encouraging medical institutions to cut medical expenses

if the"new Health care reform," the goal really is"that all people can enjoy the basic right to health" then"new Health care reform," the focus is by no means"basic medicine system"."The new medical reform," the key is how to rebuild the medical institutions and doctors incENTives to achieve health care institutions and the interests of doctors and patients,"Incentive Compatibility." Specific to the Drugs, and that is how to create an incentive to make rational use of medical institutions and doctors.Rational use of drugs by doctors, pharmaceutical companies and wholesale companies will naturally be a reasonable production of drugs, a reasonable distribution of drugs.

in the presENT"to Drugs to support medical" system, medical institutions concerned about the profitability of drug rather than the cost of drugs.For Zhicijiagao drugs, but also a lack of incentive to be resisted.Because of this, those of poor quality, there is no medical innovation small business can survive.Some pharmaceutical production and sales companies by way of rebates, the Zhicijiagao sell drugs to medical institutions.In order to compete, those who focus on innovation, focus on quality, production and marketing of branded pharmaceutical companies, also have added to the so-called"commercial bribery" among the ranks.Under the current system of medical institutions, pharmaceutical companies conduct business because of the current Health care system is the distortion of medical institutions and doctors inevitable result of distorted incentives.

So the whole"new Health care reform" blueprint of how the role of a nexus of medical institutions and doctors to establish a reasonable incENTives.

doctors and medical institutions to use information and knowledge advantage to induce over-consumption of medical services in patiENTs with the problem, on the one hand and credibility through market competition mechanism to overcome the other hand, to Health insurance through a third party payment system as the main to overcome.Because the health insurance sector has sufficient capacity to have a professional team and professional skills, implementation, and medical institutions, information and knowledge between the symmetric, thus greatly weakening the Health care institution"induced demand" capability.In addition, as health insurance to bring together a large number of the insured to have enough bargaining power of market forces and medical institutions that can ensure the quality of medical care under the premise of reducing health care costs.In addition, the reform of health care payment methods are also essential, the practice of States also indicated that by service payment system is often easy to induce an excess supply of medical care and medicines, so easy to make health care costs continue to rise.Paid according to a poll in the outpatient, inpatient DRGs implemented by third-party payment system, medical institutions will find ways to control medical costs, of course, does not induce over-consumption of medical services in patients, but as far as possible to lower costs diagnosis and treatment programs.

capitation system in accordance with, in order to increase their income, outpatiENT agencies will naturally try to save money, of course, will not knowingly purchase Zhicijiagao Drugs.They can decide on the direction of this poll the use of fees, so the bulk will naturally be used to improve the wages of its outstanding medical staff, to reward them to attract more insured, and thereby get more head fee.

by disease in the pay system, hospitals have sufficiENT control of the enthusiasm of the total medical costs in hospitalized patients, which will take effect as low-cost and reliable diagnosis and treatment programs.Under the rules of the game in this, medical institutions can not prefer to use high-priced Drugs to the exclusion of reliable efficacy of essential medicines.

course, in such a paymENT system, in order to effectively restrict medical institutions by reducing the quality of medical services to reduce the cost of the practice of full competition between medical institutions is particularly important, because competition between medical institutions gives enough patients the option of the poor quality of medical services that the medical institutions will be eliminated in patients.In such a competitive constraint, in order to survive and develop, medical institutions not to reduce the quality of medical services to reap profits.American management medical practice has confirmed this.

medical institutions and medical attENTion when the cost-effective Drugs, pharmaceutical production and distribution industry, market competition will naturally lead to"survival of the fittest" situation to happen.High efficiency, good quality, low cost pharmaceutical businesses to become bigger and stronger through competition, and those low efficiency, quality, reliable, high cost of improper means to rely on the survival of pharmaceutical businesses will be natural selection, to include the vast majority of essential drugs, including drug prices will naturally fall.China's production and distribution of generic drugs market concentration will bring the survival of the fittest through competition in the market situation in the natural increase.

Note: This study was funded by the Chinese Academy of Social Sciences researcher Zhu Hengpeng community to provide!