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The Government’s Point of View Drug Policy in China China National Health Development Research Center 1 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! 2 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 3 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! 4 2 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. 5 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. 6 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. 7 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! 8 4 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. 9 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 10 formulation and Herba Erierontis, etc.. 5 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. 11 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. 12 6 Use NBA word Let's face it Let’s loyal to the ideal 13 7