Game among stakeholders in the implementation of centralized drug procurement reform：challenges and countermeasures / 中华医院管理杂志

ABSTRACT

Many stakeholders are involved in the implementation of centralized drug procurement , namely government agencies ,drug bidding or procurement agencies ,pharmaceutical companies ,medical institutions ,doctors ,patients and health care institutions among others.The game falls into three stages.The first is that between government agencies or drug procurement agencies and medical institutions or doctors ;the second is that of price negotiations between the hospital and the winner pharmaceutical enterprise ; the third is that between doctors , patients and medical insurance agencies.Major setbacks found in the implementation of such a policy are as followsdisappearance of classic inexpensive drugs from the market ;rebates and commissions in the second bargainingphenomenon ;slow progress in the implementation of the purchase with quantity indication policy ;rapid rise of medical costs for national health insurance.Recommendations by the authors include optimization of the centralized drug procurement ;improvement of the public hospital performance appraisal system and talent evaluation system ;promotion of the purchase with quantity indication policy ;building of the game pattern of equal‐footing negotiation between hospitals and pharmaceutical companies ; and introduction of the payment management of medical insurance .