Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing program in the United States / 中国药房

OBJECTIVE To learn from 340B drug pricing program （short for 340B program） in the United States， and provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States， and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel” policy in China. RESULTS & CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions， which easily led to duplicate discounts and drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions， coupled with the economic incentives brought by the sale of drugs， the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard， when China is carrying out the construction of designated retail pharmacies under the “dual channel” policy， it is necessary to clarify the selection criteria for designated retail pharmacies， enhance the financial transparency of medical institutions and designated retail pharmacies， establish a scientific prescription circulation mechanism， strengthen the review and certification of insured patients and prescriptions， and improve the supervision and management mechanism. Meanwhile， the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions， so as to achieve the availability of drugs without abuse， and effectively control costs.

Study of salary incentives mechanism for general practitioners from the perspective of integrated incentives: insights of the United Kingdom / 中华医院管理杂志

Optimizing the salary system of general practitioners and establishing a compensation incentives mechanism fitting its needs, would contribute effectively to the development of the general practitioner system in China. Fully leveraging the salary incentive system, the United Kingdom(UK) effectively improved the working enthusiasm of general practitioners and its quality of primary medical services, and limited its medical expenses as well. The authors expounded the incentive mechanism of general practitioners′ salary in the UK from such dimensions as salary model and salary structure, and introduced the implementation effect. Based on Robbins′ comprehensive incentive theory, the authors introduced the internal logic of the UK′s general practitioners′ salary incentive mechanism. Based on the UK experiences, along with existing problems in China, the authors recommended on setting up value-based salary levels, optimizing the salary structure, and establishing a dynamic adjustment mechanism. These ideas are expected to help optimize the salary incentive mechanism for general practitioners in China.

Reasons and enlightenment of the formation of high drug prices in the United States / 中华医院管理杂志

Optimizing the drug price management mechanism and improving the availability and affordability of drugs are important in deepening the medical and health reform. The price of drugs in the United States has always been higher than the world average. The price of drugs, the total expenditure on drugs and the personal burden of patients have shown an increasing trend. By exploring the causes of high drug prices in the United States, the author found that there were four main reasons for the current situation of drug prices in the United States, including the interests of enterprises, the limited competition mechanism of the US drug market, relatively insufficient market bargaining power of the US payers, and opaque mechanism of price formation.Firstly, pharmaceutical companies try to achieve their interests by raising drug prices. Secondly, the price formation mechanism of the United States drug market is affected by the price strategy of pharmaceutical companies, and government policies also indirectly affect the role of the market. Thirdly, the payers in the United States are relatively scattered, so that the market bargaining power is relatively insufficient.Fourthly, due to the numerous drug circulation links and stakeholders, the drug price formation mechanism is opaque and lacks supervision. Therefore, when strengthening drug price management in China, we should build a coordination mechanism between the government and the market on the basis of the existing basic economic system and drug management mechanism, establish the strategic purchase and negotiation position of medical insurance for drugs, enhance the transparency of drug circulation and trading, and establish a scientific pricing system. It is also important to promote drug innovation and ensure drug quality.

Introduction to the Cost Control Measures of Medicaid Prescription Drugs in the United States and Its Enlighten- ment to China / 中国药房

OBJECTIVE：To study the cost control measures for Medicaid prescription drugs in the United States ，and to provide reference for medical insurance cost control in China. METHODS ：The policy documents ，academic papers and news reports were studied to comb the practice of drug cost control policy of Medicaid project in the United States and its impact on medical insurance costs. The suggestions were put forward for medical insurance cost control in China. RESULTS & CONCLUSIONS：The cost control measures of Medicaid prescription drugs adopted in the United States include drug utilization management and drug cost control measure. The former included the list of preferred drugs ，pre-authorization and step therapy ， prescription cost limit ，while the latter included the upper limit control of drug expenditure growth ，closed drug list management ， etc. The list of preferred drugs is the basis of a series of drug cost control measures ，which provides a policy framework for prior authorization and step therapy ；pre-authorization and step therapy are the specific ways to controlling the cost ，and the use of low-cost drugs is encouraged through the guidance of specific cases ；the prescription cost limit starts from controlling the drug cost of a single patient and saves the medical insurance expenditure from another angle ；the drug growth caps control is controlling the total cost of medical insurance expenditure from aspect of overall cost ，which is a supplement to the traditional method ；closed drug list management is a new policy attempt to break through the limitation of preferred drug list. The prescription drug cost control measures adopted by Medicaid project can effectively reduce the drug expenditure to a certain extent ，but it also has the possibility of harming the interests of patients because it can interfere with doctors ’prescription right. China should further strengthen the role of medical insurance in the medical service system ，and carefully learn from the management measures of Medicaid drug utilization in the United States ；improve the dynamic control mechanism of medical insurance expenditure ，take special measures for key drugs ； improve the drug list management mechanism ，pay attention to the three links of access， exit and dynamic adjustment ， guide medical cn institutions to use drugs rationally.

UK′s experiences and inspirations in application of refined management in healthcare sector via payment reform / 中华医院管理杂志

UK has initiated since 2014 a new round of healthcare reform of its National Healthcare System(NHS), featuring more resources to the primary level, and made supportive reform method reforms for a variety of innovative mods of diagnosis and treatment. These efforts aim at promoting further refined management and ensure smooth progress of healthcare sector reforms. The authors introduced the historical evolution and latest trends of payment methods reform in the UK, and analyzed the review and update of the Quality and Outcomes Framework of basic medical service contracts for GP practices, which can hopefully provide useful references for the reform of payment methods in China.

Study on the economic evaluation of hospital-based health technology assessment / 中华医院管理杂志

Different from the traditional health technology assessment(HTA), hospital-based health technology assessment(HB-HTA) is mainly based on the perspective of the hospital to carry out economic analysis, commonly used cost-effectiveness analysis combined with budget impact analysis methods. It pays attention to the current medical costs and effects, and supports the hospital′s internal health technology access, purchase pricing, elimination and other decisions. In the context of deepening the reform of medical insurance payment mode in China, the hospital internal medicine decision-making based on HB-HTA is particularly important. Based on the economic characteristics of health technology, the authors analyzed the differences between HB-HTA and traditional HTA in carrying out economic evaluation, introduced the steps, contents, indicators and methods of HB-HTA economic evaluation, and put forward relevant strategic suggestions.

Analysis on the decision-making need of new technology access of tertiary public hospitals in China / 中华医院管理杂志

Objective:To analyze the differences in information needs of doctors, middle managers, and hospital leaders in tertiary public hospitals in the process of new technology access.Methods:From January to October 2018, 1 200 doctors and hospital administrators from 30 tertiary public hospitals in 8 provinces were selected. The importance scores of different positions for decision-making information demand of new technology introduction were collected through questionnaire survey, and the scores were analyzed by SPSS 25.0 software. Descriptive statistical analysis was performed.Results:1 032 valid questionnaires were obtained. Hospital-level leaders, middle-level managers, and doctors scored higher on the clinical application, safety, and effectiveness of technology at home and abroad(more than 4 points, maximum 5 points). Hospital-level leaders and middle-level managers had higher scores on effectiveness, evidence quality, possibility of being covered by medical insurance, ethics and relevant indicators of strategic level, while doctors had higher scores on health economics and organizational indicators.Conclusions:There are some differences in the information demand for new technology access among different positions in tertiary public hospitals. Understanding the decision-making needs of different positions is conducive to promoting the actual implementation of hospital-based health technology assessment standards in China′s public hospitals.

The present situation of clinical application management and assessment of medical technology in China / 中华医院管理杂志

New " management measures and regulations for medical technology clinical use and research" was officially implemented on November 1, 2018. Under the background of the adjustment of the national medical technology clinical application management system, the authors collected and analyzed the research on the clinical application management and evaluation of medical technology from 30 tertiary public hospitals in 8 provinces, as well as other data, summarized the current status and problems, attempted to provide reference for the optimization and system construction of medical technology management and evaluation system in China.

Logic Analysis and Research of China ’s Medicine Reform under the Construction of National Medicine Policy Framework ： Based on the Analysis of the Text of China ’s Medicine Policy in 2009-2019 / 中国药房

OBJECTIVE： To provide reference for improving China’s national medicine policy framework. METHODS： The medicine policy documents of 2009-April 2019 were collected， and then policy texts were categorized according to national medicine policy elements of WHO. According to the number and strength of policies， the construction of national medicine policy framework was analyzed. The main reform measures of different themes were extracted and summarized. On this basis， the logic of medicine reform in China was analyzed. RESULTS & CONCLUSIONS： National medicine policy framework has been established primarily， but it is not balanced， such as the number and intensity of policies on human resources and medicine financing are slightly inadequate. Analysis of China’s national medicine policy framework reveals that： （1） in the process of construction， “quality assurance” and “affordability” are the two main policy lines， and “quality improvement” and “cost reduction” are the two main policy objectives； （2） the construction of national medicine policy framework has a phased reform focus， and it has gone through a process from “demand-side reform” to “supply-side and demand-side reform”； （3） the importance of medicine procurement in the reform has been strengthened continuously. It is suggested to strengthen the balance of national medicine policy， improve human resources， medicine financing and rational medicine use policy construction； it is also suggested to strengthen top-level design， establish a multi-department collaborative decision-making and coordination mechanism， and enhance the coordination of medicine policies； in addition， the role of procurement links reform should be further played .

Study on new medical technology access index system for tertiary public hospitals / 中华医院管理杂志

Objective To establish a scientific and comprehensive evaluation index for new technology access in tertiary public hospital, so as to provide a tool for new technology access management system and scientific basis for decision-making. Methods This study collected data from eight provinces nationwide including 30 tertiary public hospital based new technology access application, catalogued dimensions of application. It also referred to the European Union, Denmark, Canada and other countries in forming the hospital health technology assessment form, along with two rounds of Delphi expert consultation. Results The new medical technology access index system of China′s tertiary public hospitals was preliminarily formed, including 5 first-level indexes and 24 level-2 indexes. Conclusions The two rounds of expert advice have a high degree of consistency, indicating that the indicators are in line with the actual situation of hospital management in China, yet with rooms of constant improvement in practice.

Implementation Effects,Risk Prediction and Policy Suggestion of"Two-invoice System"in the Field of Pharmaceutical Distribution in China / 中国药房

OBJECTIVE:To provide policy suggestion for the effective implementation of"two-invoice system"policy in the field of pharmaceutical distribution in China. METHODS:By analyzing current mode and problems of pharmaceutical distribution in China,the implementation background of"two-invoice system"was understood.At the same time,main points of"two-invoice system"policy were reviewed and summarized;the effect of the policy promotion and the potential risks could be inferred,and the corresponding policy suggestions were put forward. RESULTS & CONCLUSIONS:At present,there are many problems in the field of pharmaceutical distribution in China,such as low concentration of industry,confusion of circulation order,numerous relevant parties of interest chain and endless violations. The implementation of"two-invoice system"has realized the consistency of invoice flow,logistics and cash flow,through clearly defining production enterprises,strengthening invoice management of circulation enterprises and public medical institutions,guaranteeing drug supply in remote areas, constructing information platform,compressing circulation link,integrating circulation enterprises,implementing"point to an area"completely. It is conducive to effectively improve regulatory efficiency of government departments and the concentration of pharmaceutical distribution industry,and is expected to reduce the virtual high drug price through linkage with other policies. The"two-invoice system"policy framework of provinces(regions,cities)is adjusted according to practical situation of different districts based on the national policy,corresponding practice and exploration have been carried out. The"two-invoice system"has its own adaptability in the implementation process,which may cause drug shortages,local protectionism and new interest chain. The author puts forward the countermeasures,such as timely assessment of the implementation of the"two-invoice system",taking various measures to ensure the supply of drugs,setting up appropriate policy transition period,and strengthening coordination and cooperation among relevant departments so as to response to potential risks during the implementation of the"two-invoice system"policy.