The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China

In 2019, the Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China, in which 25 drugs were included. We conducted this study to examine the impacts of NCDP policy on drug utilization and expenditures, and to clarify the main factors contributing to drug expenditure changes. This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019. Drugs related to the “4 + 7” policy were selected as study samples, including 23 “4 + 7” policy-related varieties and 15 basic alternative drugs. Driving factors for drug expenditures changes were analyzed using A.M. index system analysis (Addis A. & Magrini N.’ method). After the implementation of the NCDP policy, the volume of “4 + 7” policy-related varieties increased by 73.8%, among which winning products jumped by 1638.2% and non-winning products dropped by 70.8%; the expenditures of “4 + 7” policy-related varieties decreased by 36.9%. Structure effects (0.47) and price effects (0.78) negatively contributed to the increase in drug expenditures of “4 + 7” policy-related varieties, while volume effects (1.73) had positive influence. NCDP policy successfully decreased drug expenditures of “4 + 7” policy-related varieties with structure effects playing a leading role. However, total drug expenditures were not effectively controlled due to the increasing use of alternative drugs.

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Impact of Volume-Based Drug Procurement Policy on Drug Use Structure of Chinese Public Medical Institutions: A Difference-in-Difference Analysis of Nine Pilot Cities and Twelve Non-pilot Provinces

10.21203/rs.3.rs-888080/v1 ◽

2021 ◽

Author(s):

Jiancheng Lu ◽

Ying Yang ◽

Hongfei Long ◽

Jing Wang ◽

Yuan Shen ◽

...

Keyword(s):

Mainland China ◽

Outcome Variable ◽

Chinese Government ◽

Policy Intervention ◽

Difference In Difference ◽

Drug Procurement ◽

Period 2 ◽

Medical Institutions ◽

The Impact ◽

Alternative Drugs

Abstract Background In 2019, the Chinese government implemented the first round pilot of volume-based drug procurement in 4 municipalities and 7 sub-provincial cities, i.e. “4+7” policy. This study evaluated the impact of “4+7” policy on the use structure of policy-related drugs. Methods Data of China Drug Supply Information Platform (CDSIP) database was used, covering 18,636 public medical institutions from 9 pilot cities and 12 non-pilot provinces in mainland China. “4+7” policy-related drugs were selected as study samples, including 25 drugs in the “4+7” procurement List and 83 alternative drugs that have an alternative relationship with “4+7” List drugs. “4+7” List drugs were divided into bid-winning and bid-non-winning products. Drug Structure Index (DSI) was employed as the outcome variable, and higher DSI refers to the use proportion of higher-DDDc (Defined Daily Drug cost) drugs increased. Difference-in-difference (DID) method was employed to estimate the net effect of “4+7” policy. Results After policy intervention, the DSI of bid-winning drugs significantly decreased (β=-0.233, p<0.0001), while non-winning drugs (β = 0.177, p<0.001) and “4+7” List drugs (β = 0.050, p<0.01) increased. No significant change was found for the overall DSI of alternative drugs (β = 0.013, p>0.05), while a remarkable increase was found in primary healthcare settings (β = 0.033, p<0.05). In three post-“4+7” periods, the increments of DSI for non-winning products were 17.54% (period 1), 18.35% (period 2), and 19.66% (period 3). The DSI of “4+7” List drugs significantly increased in post-“4+7” period 2 and 3 (all p-values<0.05). Conclusions The use proportion of higher-DDDc bid-winning drugs significantly decreased after policy intervention. However, among drugs not involved by NCDP policy, the use proportion of higher-DDDc drugs significantly increased after policy intervention, moreover, the increment was more pronounced at the later periods of policy implementation. The clinical use monitoring and the physician’s prescription behavior supervision should be strengthened.

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The impacts of Chinese drug volume-based procurement policy on the volume and expenditure of antibiotic drugs

10.21203/rs.3.rs-143454/v1 ◽

2021 ◽

Author(s):

Ying Yang ◽

Lei Chen ◽

Xinfeng Ke ◽

Zongfu Mao ◽

Bo Zheng

Keyword(s):

Linear Regression ◽

Antibiotic Use ◽

Cefuroxime Axetil ◽

P Value ◽

Chinese Government ◽

Oral Antibiotic ◽

Drug Procurement ◽

Procurement Policy ◽

Antibiotic Drugs ◽

Alternative Drugs

Abstract Background: In 2019, Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China, in which an oral antibiotic agent (cefuroxime axetil) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the potential effect of the "4+7" policy on antibiotic use. Methods: This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Oral antibiotic drugs related to "4+7" policy were selected as study samples, including cefuroxime axetil and its alternative drugs. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of "4+7" policy on the volume and expenditure of antibiotic drugs. Results: Compared with April to December 2018, the total volume and expenditures of cefuroxime axetil and its alternative antibiotic drugs from April to December 2019 increased 41.8% and 18.1%, respectively. The results of segmented linear regression showed that the volume of cefuroxime axetil products significantly increased 161.16 thousand DDDs after "4+7" policy (95% CI: 59.43 to 262.90, p-value = 0.004). For the alternative drugs of cefuroxime axetil, the volume and expenditures significantly increased 273.65 thousand DDDs (95% CI: 90.17 to 457.12, p-value = 0.006) and 3471.66 thousand RMB (95% CI: 1529.70 to 5413.62, p-value = 0.001), respectively. Conclusion: This study provides evidence that the implementation of "4+7" volume-based procurement policy was associated with significant increases in the volume and expenditure of cefuroxime axetil and its alternative drugs. The increase in antibiotic use after the policy needs special attention and vigilance.

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Influence of Chinese National Centralized Drug Procurement on the price of policy-related drugs: an interrupted time series analysis

10.21203/rs.3.rs-403627/v1 ◽

2021 ◽

Author(s):

Ni Wang ◽

Ying Yang ◽

Luxinyi Xu ◽

Zongfu Mao ◽

Dan Cui

Keyword(s):

Time Series ◽

Price Change ◽

Chinese Government ◽

Price Behavior ◽

Drug Procurement ◽

Its Analysis ◽

Significant Difference ◽

The Impact ◽

Alternative Drugs ◽

Pharmaceutical Enterprises

Abstract Background: The Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China in 2019. Under cross-price elasticity theory, the price behavior of pharmaceutical enterprises for policy-related drugs might change. This study aims to examine the impact of "4+7" policy on the price of policy-related drugs.Methods: This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Eighty-two drugs (by generic name) were selected as study samples, including "4+7" policy-related drugs (consisted of winning and non-winning products) and alternative drugs. Single-group Interruption Time Series (ITS) analysis was adopted to examine the change of Drug Price Index (DPI) for policy-related drugs.Results: The ITS analysis showed that the DPI of winning (-0.183 per month, p<0.0001) and non-winning (-0.034 per month, p=0.046) products significantly decreased after the implementation of "4+7" policy. No significant difference was found for the immediate change of DPI for alternative drugs (p=0.537), while a significant decrease in change trend was detected in the post-"4+7" policy period (-0.003 per month, p=0.014). The DPI of the overall policy-related drugs significantly decreased (-0.261 per month, p<0.0001) after "4+7" policy.Conclusions: These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

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Influence of Chinese National Centralized Drug Procurement on the price of policy-related drugs: an interrupted time series analysis

BMC Public Health ◽

10.1186/s12889-021-11882-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ni Wang ◽

Ying Yang ◽

Luxinyi Xu ◽

Zongfu Mao ◽

Dan Cui

Keyword(s):

Time Series ◽

Price Change ◽

Interrupted Time Series ◽

Chinese Government ◽

Interrupted Time Series Analysis ◽

Drug Procurement ◽

Its Analysis ◽

Significant Difference ◽

The Impact ◽

Alternative Drugs

Abstract Background The Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China in 2019. This study aims to examine the impact of “4 + 7” policy on the price of policy-related drugs. Methods This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. “4 + 7” policy-related drugs were selected as study samples, including 25 drugs in the “4 + 7” procurement list and 57 alternative drugs that have an alternative relationship with “4 + 7” List drugs in clinical use. “4 + 7” List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Single-group Interruption Time Series (ITS) analysis was adopted to examine the change of Drug Price Index (DPI) for policy-related drugs. Results The ITS analysis showed that the DPI of winning (− 0.183 per month, p < 0.0001) and non-winning (− 0.034 per month, p = 0.046) products significantly decreased after the implementation of “4 + 7” policy. No significant difference was found for the immediate change of DPI for alternative drugs (p = 0.537), while a significant decrease in change trend was detected in the post-“4 + 7” policy period (− 0.003 per month, p = 0.014). The DPI of the overall policy-related drugs significantly decreased (− 0.261 per month, p < 0.0001) after “4 + 7” policy. Conclusions These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

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State policy of maintaining the innovative forms of employment in the context of the economy digitalization

Regional Economy ◽

10.36818/1562-0905-2020-3-9 ◽

2020 ◽

pp. 81-90

Author(s):

Olha Mulska ◽

Olha Levytska ◽

Valentyna Kutsyk

Keyword(s):

Information And Communication Technologies ◽

System Analysis ◽

Employment Policy ◽

Socially Responsible ◽

State Budget ◽

Economic Relations ◽

Functional Flexibility ◽

Leading Role ◽

Methods Of Synthesis ◽

Information And Communication

The purpose of the study is to analyze current trends in the evolution of forms of employment under the influence of the economy digitalization, as well as to substantiate the directions and means of public policy to regulate the conditions of effective employment in the new realities. Methods of synthesis and system analysis, groupings, logical analysis, strategic management, and system analysis were used in the research. The most significant characteristics of the sphere of employment in the conditions of the economy digitalization, in particular quantitative flexibility, functional flexibility, and space-time flexibility, are defined. The spheres of economy in which new professions are most in demand in Ukraine in the conditions of development of digitalization processes of the national economy are identified, in particular information and communication technologies, biotechnologies, medicine, energy, and its accumulation, power networks and energy consumption management, transport, especially water and air transport, education, and ecology. The directions, spheres, branches, and concrete sub-branches where new professions are in demand in the conditions of the economy digitalization are defined. The paper emphasizes the leading role of the information and communication technology sector, the development of which largely determines the emergence of new professions. The paper provides the conclusion that in this situation the new forms of employment cover great innovative potential, as well as shadow aspects (informal agreements), which exacerbate the problem of insufficient filling of social funds and reduction of tax revenues to the state budget. The priorities of effective employment policy in Ukraine in the global digitalization of economic relations are outlined based on the principles of flexicurity, best practices, and implementation of innovative solutions in building mutually beneficial and socially responsible relations between employer and employee.

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Drug Utilization Studies – An Overview

International Journal of Pharmaceutical Sciences and Nanotechnology ◽

10.37285/ijpsn.2010.3.1.2 ◽

2010 ◽

Vol 3 (1) ◽

pp. 803-810 ◽

Cited By ~ 3

Author(s):

Shalini S ◽

Ravichandran V ◽

Saraswathi R ◽

BK Mohanty ◽

Dhanaraj S K

Keyword(s):

Drug Utilization ◽

Evidence Based ◽

Future Trends ◽

Medical Prescription ◽

Drug Usage ◽

Current State ◽

Patterns Of Use ◽

Drug Utilization Studies ◽

Drug Expenditures

Aspire of the Drug Utilization Studies (DUS) is to appraise factors related to the prescribing, dispensing, administering and taking of medication, and it’s associated. Since the middle of twentieth century, interest in DUS has been escalating, first for market-only purposes, then for appraising the quality of medical prescription and comparing patterns of use of specific drugs. The scope of DUS is to evaluate the current state and future trends of drug usage, to estimate roughly disease pervasiveness, drug expenditures, aptness of prescriptions and adherence to evidence-based recommendations. The increasing magnitude of DUS as a valuable investigation resource in pharmacoepidemiology has been bridging it with other health allied areas, such as public health, rational use of drug, evidence based drug use, pharmacovigilance, pharmacoeconomics, eco-pharmacovigilance and pharmacogenetics.

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Concerns or Desires Post-Pandemic: An Extended MGB Model for Understanding South Korean Residents’ Perceptions and Intentions to Travel to China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052542 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2542

Author(s):

Guanghui Qiao ◽

Xiao-li Zhao ◽

Luqi Xin ◽

Seokchool Kim

Keyword(s):

Mass Media ◽

Latent Variables ◽

Structural Equation ◽

Mainland China ◽

Negative Influence ◽

Positive Influence ◽

Extended Model ◽

South Korean ◽

Structural Relationships ◽

China Post

In this study, we examined South Korean residents’ travel-related behavioural intention for mainland China post-COVID-19 using an extended model of goal-directed behaviour. To do so, we integrated South Korean residents’ perceptions of country image (PCI), mass media, and concerns about travel into the framework of the original model of goal-directed behaviour (MGB). Structural equation modelling was used to identify the structural relationships among the latent variables. The results show that mass media had a positive influence on South Korean residents’ perception of China’s image, a negative influence on residents’ concerns, and a positive influence on residents’ behavioural intentions for travel overseas. Meanwhile, PCI had a positive influence on residents’ attitude towards travel overseas. The theoretical and practical implications of the study are discussed.

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Building the New Socialist Countryside: Tracking Public Policy and Public Opinion Changes in China

The China Quarterly ◽

10.1017/s0305741016000369 ◽

2016 ◽

Vol 226 ◽

pp. 456-476 ◽

Cited By ~ 3

Author(s):

Matthias Stepan ◽

Enze Han ◽

Tim Reeskens

Keyword(s):

Public Policy ◽

Public Opinion ◽

Urban Areas ◽

Mainland China ◽

Chinese Government ◽

Significant Shift ◽

Political Consequences ◽

Rural And Urban Areas ◽

Rural And Urban ◽

The Social

AbstractEver since the introduction of the national political programme of “Building a new socialist countryside” (BNSC) in the early 2000s, renewed focus has been cast on how the Chinese government manages the gap between its rural and urban areas in the new millennium. Previous research has mostly studied the social and political consequences of the BNSC initiative without paying particular attention to its effects on public opinion. In this article, we present an analysis of the 2002 and 2008 waves of the mainland China subset of the Asian Barometer. Our results show a significant shift in the perceptions of the rural population in respect to how much impact government policies have on daily life. This shift brings rural perceptions more in line with those of the urban population in 2002. The paper concludes with the implications of our findings for the study of the relations between public opinion and public policy in China.

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Improving public housing policies that target low-income households: The value of adding proximity to discretion

Environment and Planning C Politics and Space ◽

10.1177/23996544211041119 ◽

2021 ◽

pp. 239965442110411

Author(s):

Lauro Gonzalez ◽

Fernanda Lima-Silva ◽

Marlei Pozzebon

Keyword(s):

Public Housing ◽

Low Income ◽

Implementation Process ◽

Positive Influence ◽

Housing Policies ◽

Collective Case Study ◽

Street Level ◽

Leading Role

Research on street-level bureaucrats has examined the various ways in which these professionals have implemented public policies in areas such as healthcare, education, and security, often emphasizing the role played by discretion in the implementation process. Despite its importance, the concept of street-level bureaucracy has scarcely been approached by housing studies. This study focuses on the role of street-level workers in the delivery of public housing to the lower-income population. We affirm the value of complementing street-level discretion with the concept of proximity, a premise borrowed from the microfinance literature, to increase the understanding of the interactions and relationships established between street-level workers and policy recipients during the implementation process. Such complementarity may contribute to a more accurate understanding of the housing policy implementation dynamics on the street-level and the possible adjustments to meet local needs. To explore this issue, we used a theoretical lens inspired by Goffman’s frame analysis that points to the importance of relational mechanisms that characterize the interactions between street-level workers and beneficiaries. These lenses were applied to a collective case study of Minha Casa Minha Vida-Entidades, a Brazilian subprogram in which street-level workers linked to social housing movements assume a leading role in the planning and execution of interventions. The results indicate that the combination of proximity and discretion has a positive influence on the implementation of housing policies. Our analysis shows the existence of nonprofit-oriented arrangements that may present different features and nuances at the implementation (micro) level and contribute to the (macro) debate on housing policies.

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The efficiency of a dynamically insulated wall in the presence of air leakages

Thermal Science ◽

10.2298/tsci0401083k ◽

2004 ◽

Vol 8 (1) ◽

pp. 83-94

Author(s):

Angela Kalagasidis-Sasic

Keyword(s):

System Analysis ◽

Ventilation System ◽

Building Envelope ◽

Leading Role ◽

Outdoor Climate ◽

Dynamic Insulation ◽

Building Components ◽

Heat And Moisture ◽

Alternative Designs ◽

Indoor And Outdoor

The movement of air in and through the building envelope often plays a leading role in the transport of heat and moisture into the building. It is caused by pressure and temperature variations around the building envelope inbuilt ventilation system, occupancy, etc. In order to improve the energy consumption, alternative designs for the ventilation systems are considered. One of them is a dynamically insulated wall as an inlet unit for the supplying air. In order to predict the performance of a dynamically insulated wall, it is necessary to make an analysis of the building as a system. This paper presents such system analysis which takes into account the interaction between the building components and indoor and outdoor climate, both in terms of the air leakage and heat and mass transfer to and from the building components. It is shown that, in the presence of air leakages (unintentional openings) in the enclosure of the building, the efficiency of the dynamic insulation is significantly decreased.

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