Analysis and optimization of policy tools for TCM formula granules in China / 中国药房

OBJECTIVE In order to analyze the current situation of policy tool allocation in China’s TCM formula granule industry， and provide a theoretical basis for the high-quality development of the industry. METHODS Based on the perspective of policy tools，“ TCM formula granules” was used as the keyword to retrieve the official websites of departments directly under the State Council such as the National Medical Products Administration and the National Administration of Traditional Chinese Medicine， as well as provincial governments. The relevant clauses in the policy documents related to TCM formula granules in China from 1993 to 2022 were encoded， and then the application of policy tools was summarized and classified. RESULTS & CONCLUSIONS A total of 12 national documents and 77 provincial documents were ultimately selected， involving 556 relevant policy clauses. It was found that among the relevant policy tools， environmental policy tools had the highest degree of attention， accounting for 62.6%； the proportions of demand-oriented policy tools and supply-oriented policy tools were less， accounting for 17.8% and 19.6%， respectively. From the perspective of policy tools， the use of demand-oriented policy tools in current policy texts was relatively simple， and various policy tools were given low attention； from the perspective of policy objectives， the proportion of use of environmental， demand-oriented and supply-oriented policy tools were not balanced enough. It is suggested to increase the proportion of demand- oriented policy tools to meet international competition； emphasize the use of supply-oriented policy tools to strictly control product quality； consolidate the use of environmental policy tools to standardize quality standards. On this basis， we will coordinate the overall situation， balance the use of various policy tools and promote the development of TCM formula granule industry.

Discussion on the effect of medical insurance payment system reform on promoting the construction of medical alliance / 中华医院管理杂志

The reform of medical insurance payment system could promote the transformation of medical services from price medical care to value medical care, which is very important to promote the construction of medical alliance. The authors discussed the reform of medical insurance payment system to promote the construction of medical alliance, and the order of medical alliance covering medical services and seeking medical treatment.For medical service providers, the reform of medical insurance payment system helped to promote the construction of closer medical alliance, guided the sinking of high-quality resources, helped to form a smooth referral mechanism, and strengthened the supervision and assessment of medical behavior. For the demanders of medical services, the differentiated medical insurance reimbursement proportion policy within the medical alliancewas more conducive to attracting the first consultation at the grass-roots level. At the same time, patients had a wider choice of medical treatment and more freedom of choice. In view of the problems existing in practice, the authors suggested that a variety of medical insurance payment and performance systems with value-based medical care as the core should be implemented to deepen the development of medical alliance, the medical insurance system and municipal subsidies should jointly undertake the salary subsidies for sinking medical personnel, and integrate the grass-roots fragmented health care business with the help of medical insurance payment tools, and promote the coverage expansion of the medical insurance reform of the medical alliance based on policy guidance.

Practice and enlightenment of the construction of medical alliances in Guangzhou / 中华医院管理杂志

Construction of medical alliances could help structural adjustment of medical resources, promote the shift of medical and health investment to primary level, improve the overall effectiveness of the medical service system, and better meet the health needs of the people. Guangzhou has established a multi-form and multi-level medical alliance system in accordance with local conditions. According to the distribution characteristics of medical resources in the districts under the jurisdiction of Guangzhou, these districts were divided into areas of controlled development, those of stable development and those of encouraged development. Different strategies were taken for various medical alliances. Advantages of traditional Chinese medicine were given full play in community health management and elderly care services, alliance of traditional Chinese medicine specialists was established to provide residents with continuous medical and health services. An appropriate medical insurance payment system was established to promote the implementation of the hierarchical diagnosis and treatment system. However, there were still such problems as unbalanced distribution of medical resources, insufficient leverage role played by medical insurances, and rooms of improvement in the ability of primary medical services.

Investigation on Synergistic Effect between Centralized Drug Quantity Purchase Policy and Medical Insurance Reimbursement System / 中国药房

OBJECTIVE：To investigate the synergistic effect and deficiencies between centralized drug quantity purchase policy and medical insurance reimbursement system ，and to provide feasible suggestion to further improve its synergistic effect. METHODS：The literature analysis method and policy evaluation method were adopted to expounds the direct and indirect synergistic effect between the current centralized drug quantity purchase policy and medical insurance reimbursement system in China，and analyze the existing problems so as to put forward the feasible suggestions. RESULTS & CONCLUSIONS ：The centralized drug quantity purchase policy had a direct impact on the payment mode of medical insurance reimbursement system in technical level ，performance evaluation in effect level and process control in management level. The indirect synergy included ： centralized drug quantity purchase policy could promote the adjustment of drug supply security system to adapt to the reform of medical insurance payment ；it could adjust the pharmaceutical market ，and affect the reform of medical insurance reimbursement system. The disadvantages were as follows ：the varieties of selected drugs was still narrow ，and there was room for further improvement in purchasing scope and medical insurance fee reduction ；“one-size-fits-all”payment standard for unselected drug might weaken pharmaceutical companies ’enthusiasm for generic drug research and development. Therefore ，the next step is to significantly expand the variety and scope of procurement ，and appropriately liberalize the medical insurance payment restrictions for drugs with fewer varieties ；coordinate medical insurance reimbursement policies and procurement programs ，and improve the rationality and perfection of medical insurance payment ；guide the medical institutions to change the concept from “price-based medical treatment ”to“value-based medical treatment ”，take into account the interests of all parties in the market ，so as to form a comprehensive coordination adjustment mechanism of drug price and medical insurance reimbursement system.

Synergy of Centralized Drug Volume-based Purchasing and Medical Insurance Negotiation Policy / 中国药房

OBJECTIVE：To investigate the s ynergy between centralized drug volume-based purchasing （called“volume- based purchasing”for short ）and medical insurance negotiation policy. METHODS ：From the aspects of economic and social benefits ， the synergy of volume-based purchasing and medical insurance negotiation was analyzed by using the methods of literature analysis，policy interpretation and interview. The corresponding suggestions were put forward for the problems of the supply and use of drugs. RESULTS & CONCLUSIONS ：The synergy of volume-based purchasing and medical insurance negotiation in terms of economic benefits include medical insurance fund management optimization to improve fund utilization efficiency improvement ； medical insurance fund payment optimization to reduce transaction cost ；network promotion of medical security information platform to reduce the cost of information exchange. The synergy of volume-based purchasing and medical insurance negotiation in terms of social benefits includes relevant index assessment of drug quality evaluation to improve drug quality evaluation system ； medical service level improvement to form compound medical insurance payment mode under total budget management ；enterprise supervision driven by market to reduce the pressure of government supervision. The relevant departments should continue to strengthen the comprehensive management of medical institutions to reduce the phenomenon of irrational drug use ；strengthen policy convergence ，avoid the poor implementation of medical insurance drug adjustment policy ，so that the policy dividend of volume-based purchasing and medical insurance negotiation can benefit the people more through system reform ，optimal allocation of funds ，etc.