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The Government’s Point of View
Drug Policy in China
China National Health Development Research Center
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Related Ideas of Health Care Reform

No serious diseases in community, serious diseases in city or county, Difficult
miscellaneous diseases in level three hospitals
Family
doctor
medical insurance reimbursement policy inclined to community
The essential drug system
The

To reduce the proportion of drugs and medical supplies in total health
expenditure in respect of labor value of doctor
Improve
the registration fee, manual examination fee
control of prescription drug varieties and dosage
All kinds of drug proportion regulation etc.
Strict

Cut off the relationship between doctor’s income and hospital service revenue
The
annual salary system
income is not included in the doctor's performance appraisal
Department
All of which above means that the future drug
use quantity is not increase too fast！
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1
Drug policy objectives
1. Accessibility to the essential drugs
2. To meet the needs of multi-level market
3. The rational use of drugs
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The current approach -- health field
The

focus is to establish a national system for essential drugs
The essential drugs list
Zero profit drug (Community medical institutions drug zero rate→Public
hospitals drug zero rate)

Community medical institutions can only use of essential drugs→ Public
hospitals should be equipped with essential drugs


Drug centralized bidding and purchasing by province

Etc.
Therefore,
the policy focus is not innovative drug,
the essential objective is not rational drug use, but to control cost!
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The problems
Varieties in essential drug catalog increased significantly, far
exceeding the international level.

Patient flow to the hospital in reverse, and the goal of ailment
treatment in the community does not achieve.

Cheap and good curative effect medicine
quickly disappears, and the actual effect of essential drugs
is worrying.

Essential drugs cannot be innovative drug, and only low price
drugs win the biding.

The starting point of essential drug definition is questionable.

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Common international practices





The essential drug is accessible to everyone, and not
binding with the hospital level.
The essential drug does not exclude the innovative drug.
Rather than common diseases, the essential drug is used to
solve the major health problems.
The evaluation on the major health problems is on the basis
of burden of disease.
Price should not become the obstacles of essential drug
selection. If a drug has a great advantage in efficacy or
safety, price compensation is suggested in order to improve
the drug availability.
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3
Why not follow Common international practices

The core problem is
In the absence of effective cutting the
relationship between doctor wages
and department income, medical
insurance department will worry that
introducing expensive drugs will lead
to medical insurance fund collapse.
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The current approach -- medical insurance field



Expanding medical insurance coverage has been
initially completed.
The reform of payment system is ongoing.
The feasibility of three
networks combination are considered.
The core interests is the medical insurance
fund can not be deficit！
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The question now





The starting point of reform is not rational drug
use, but to control cost!
Because the government only pays attention
to institutional reform, and cares little about
the micro-technology, the policy can not be
implemented.
Only attach importance to the overall
situation, not emphasizing the fine management.
However, little sinks the ship.
At present, many local medical insurance funds
are the signs of the crash.
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Top 15 Cardiovascular Medicine
in 2012（RMB100m）
Types of Medicine
Cardiovascular Medicine Total
Cereb. + Periphe. Vasotherap*
All Other Cardiac Preps
Calcium Antagonists Plain (monotherapy)
Cholest & Trigly. Regulator
Angiotens-II Antag, Plain (monotherapy)
Coronary Therapy （ not including Calcium
Antagonists Plain and Nitrites）
Treatment for phlebeurysma, systemic
Nitrites & Nitrates
Beta Blocking Agent Pln (monotherapy)
Ace Inhibitors Plain (monotherapy)
Angiotens-II Antag (combination)
Diuretics
Antihypertensive (not herb)
positive inotropic drug
Cardiac stimulant, not including cardiac glycoside
Other CVD medicine
2012
535.24
154.88
120.19
48.35
47.98
34.60
23.16
14.57
14.37
12.86
12.02
9.87
5.05
4.25
2.99
1.86
28.23
Notes: Cereb. + Periphe. Vasotherap includes Herba Erierontis, Deproteinized Calf Blood Extractives Injection, Ginkgo Leaf Extract and Dipyridamole Injection,
Ginatol, Ginkgo Biloba Extract, Egb, Interactions of Ginkgo biloba extract, Duxil, Flunarizine Hydrochloride Capsules, Mailuoning and Deproteinized Calf Blood
Extractives Injection, etc..
Source: data collected by National Institute of Hospital Administration, from over 1600 hospitals with more than 100 beds all over China, including Chemicals and
Chinese Traditional Patent Medicines that have proven curative effects and follow western formulation processes, such as, Salvia Miltior. Co, Ginkgo Leaf
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formulation and Herba Erierontis, etc..
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Why not the pursuit of fine management?

The social atmosphere, keen eyes effect.

Private capital is rarely involved in medical
field, and the government's
administrative atmosphere leads to the lack of
real reform courage.

Pharmacoeconomic evaluation needs top-level
design and strong financial support, but it
is difficult to do now.
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Despair？

Some managers are aware of the
current drug policy problems.

They do not exclude innovative drug.

They hope the academia to provide strong
evidence for drug screening.
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Use NBA word

Let's face it

Let’s loyal to the ideal
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