广西：建立健全药品短缺分级应对机制

<正>近年来,广西壮族自治区聚焦临床用药需求和群众用药难点,建立健全短缺药品分级应对机制,强化协同联动和监测通报,及时应对处置药品短缺问题,有效保障群众就医用药需求。高位推动部署建机制2022年年初,自治区政府分管副主席专门作出批示,要求建立短缺药品分级应对体系。自治区卫生健康委迅速行动,抓好落实。     

用系统化制度保障短缺药品供应

正在应对药品短缺问题上,江苏省在思想上高度重视,在信息上深入关注,在供应上重点保障,在责任上对应分摊,将短缺药品供应保障纳入政府绩效考核工作体系,明确各设区市人民政府对地区短缺药品供应保障工作负有领导责任。2017年,江苏省进一步健全短缺药品监测、储备和部门联动机制。江苏省药品集中采购平台供应率已连续多年保持在96%以上。以临床需求为导向以制度建设为主线早在2012年,江苏省就由多个政     

言论

<正>国务院副总理刘延东:中国正在加快推进健康中国建设,同时积极参与全球卫生治理,愿与世界各国、国际组织和民间团体共同行动,携手应对全球健康问题,并通过南南合作,促进发展中国家卫生事业发展。全国人大常委会副委员长李建国:改革完善短缺药品供应保障机制事关群众用药安全和健康福祉,要密切监测药品短缺情况,实行短缺药品供应保障分类精准施策,解决好低价有效药、"救命药"、"孤儿药"以及儿童用药的供应,破解"廉价药荒"问题。     

江苏 “组合拳”保障“救命药”供应

正2017年,江苏省进一步健全完善短缺药品部门会商联动机制,在全省建立了短缺药品信息"每月零报告"制度。针对不同短缺原因,对短缺药品实施分类应对。对一些局部性短缺品种,通过寻求替代产品或进行区域内协商调剂的方法予以解决。对价格倒挂的药品,由省公共资源交易中心开展询价采购。对成因复杂、临床必需的短缺药     

药品集中带量采购中药品短缺风险及防范对策*

为减少在药品集采工作中可能会面临的短缺风险，从经济学角度剖析了药品集采的本质，利用供需模型从理论上探讨药品集采可能存在的供给短缺。同时，从不同利益相关者角度深入挖掘集采引起的药品短缺风险来源，并系统梳理英国、美国、德国以及世界卫生组织在药品集采方面所采取的风险控制措施，归纳总结其经验及对我国的启示。借鉴各国遵循 “物有所值”原则制定的集采方针并结合各项集采法律法规和监管方法，吸取减少集采药品短缺风险的经验，我国可以通过出台集采药品法律法规、建立药品信息平台和改革现有医疗机构体制等措施，进一步完善集采药品短缺风险防范对策。     

河北：监测小平台 评估大作用

正河北省坚持以建强工作队伍为根本,着力提升药品供应保障能力。依托三甲医疗机构药学人员技术力量,成立河北省药品监测评价中心,解决无人干事的问题。河北省药品监测评价中心充分发挥自身职能,建强信息平台,多维度开展监测,并第一时间发出预警,同时为药品临床合理使用提供重要依据。一是借助短缺药品信息直报系统开展监测预警。健全省、市、县、乡四级短缺药品监测预警体系和分级应对机制,     

江苏打通短缺药保供“最后一公里”

前几年,各地频现“救命药”严重短缺、断供现象,近年来,江苏省以建立让人民满意的服务型政府为目标,通过“放管服”推进政府治理方式现代化,创新监测预警前移、分级储备、简化院内制剂调剂使用手续等措施,健全药品供应保障制度,打通供需链条,破解长期存在的药品短缺“老大难”问题,全省药品配送率多年保持在96%以上,回应了人民诉求。     

广西:合纵连横稳供应

正广西坚持以人民健康需求为导向,充分发挥联动机制优势,纵向施力,横向聚力,内外借力,主抓关键环节,紧盯重点药品,强化应对处置,全力做好药品供应保障。纵向施力抓能力提升强监测应对善用实地调研、培训指导、数据分析和提醒通报,压实主体责任,强化短缺药品监测应对的及时性和有效性。高位推动短缺药品供应保障工作。自治区分管副主席多次就短缺药品供应保障工作作出重要批示,强调要不断健全完善工作机制,     

辽宁 多维预警防范短缺药“断货”

正2017年,辽宁省通过建立短缺药品监测预警和供应保障系统,完善相应制度,从药品生产企业、药品经营企业和医疗卫生机构3个维度开展全方位的信息采集、监测预警,纵向上实行省、市、县三级响应、分级应对、联动保障的监测预警和供应保障工作机制;横向上建立了由辽宁省卫生计生委等部门组成的辽宁省短缺药品     

基本药物政策问题的新制度经济学分析

运用新制度经济学合约、租值消散、交易费用等相关理论,将医生视为医生—医院—药商利益集团的主导者,从医生租值的角度分析了基本药物短缺等问题的经济学根源及供求机制。指出由于政府对医生服务价格的管制造成其租值损失,在各方寻租过程中,处于优势地位的医生选择通过药品销售对其服务租值进行弥补,进而导致医生对高租值药品的诱导使用和市场交易费用高企,最终造成上述政策问题。相应提出了医保总额预付、处方外配销售、使用决策规范等市场机制竞争性平抑药品租值等应对策略。     

基层医疗卫生机构药品供应现状及短缺因素分析——以安徽省为例

目的:以安徽省为例,了解基层医疗卫生机构的药品供应现状及药品短缺因素。方法:以安徽省基层医疗卫生机构为主要调查对象,通过分层随机抽样在皖北、皖中、皖南三个地区共抽取106家基层医疗卫生机构;并同时以方便抽样的方式抽取54家药品生产企业和62家药品经营企业;发放问卷了解基层医疗卫生机构的药品供应现状及造成药品短缺的主要原因和解决方法。结果:样本地区仍有13%的基层医疗卫生机构存在药品供应严重不足的现象;各个单位的药品配送率存在较大差异,有19%的基层医疗卫生机构药品配送率在70%以下;调查范围内的全部基层医疗卫生机构存在或者经历过药品短缺。导致药品短缺的主要原因有药品需求不稳定(19.20%)、药品有新的且利润较高替代品(15.94%)等;药品短缺的解决措施包括完善国家基本药物目录(12.78%),适当提高疗效确切、价格低廉品种价格(12.03%)等。结论:基层医疗卫生机构存在药品短缺现象,原因较为复杂;政府应继续推行相关政策,全面改善基层医疗卫生机构药品供应现状,防范药品短缺。     

Essential drugs policy in Bolivia

Since the publication of the WHO list of essential drugs 10years ago, there has been a growing volume of literature onthe topic. This paper on the experience of essential drugs policyin Bolivia is written in the belief that reports on attemptsto implement drugs policies in individual countries are oneof the most instructive sources of information. Coming intopower in 1982, the democratic Bolivian government set up a centrally-controlledagency to be responsible for the procurement and distributionof drugs, with a view to making basic drugs available throughoutthe country. Despite limited technical and institutional resources,the policy proved administratively and organizationally practical.However problems arose at the political level both because theinterests of the industry and pharmacists were threatened andbecause there was disagreement within the government as to whetherdrugs should be seen as commercial goods or health aids. Theagency set up to implement the drug policy was abolished withintwo months of the neo-liberal government resuming power in 1985- emphasizing the symbolic importance of the agency in the overallhealth policy. Only when those concerned with drug policy atan international level concentrate on the political and culturalobstacles to essential drugs policies, and stop giving priorityto the practical issues of procurement and distribution, willtheir policies gain the credibility which is a prerequisitefor success.     

药品带量采购和一致性评价对利益相关者的影响

摘 要 为缓解抗癌药品的短缺情况,减轻癌症患者的购药压力和经济负担。文章基于抗癌药品视角,运用利益相关者理论分析药品带量采购和仿制药一致性评价双重政策的实施对主要利益相关者的影响,发现癌症患者、政府、医院和仿制生产企业各利益相关者的合法性、权力性、紧迫性、损益及立场均有所不同。针对政府、医院、仿制药生产企业提出以下建议,政府应探索药品合理的定价机制和采购数量、及时公开信息、构建多国联盟的仿制药信息平台、严格监督市场;医院应积极响应政府号召、主动深化改革、探索激励机制;仿制药生产企业应抓住政策机遇、加强人才储备、注重科技进步。     

浙江省基层医疗机构实施基本药物制度的补偿机制研究

目的:了解基层医疗卫生机构补偿机制中存在的困难和问题,并提出关于建立医疗机构合理补偿机制的意见和建议。方法:对样本县基本药物制度实施前后财务收支状况进行分析以及开展专题访谈。结果:财政补助收入金额和比例都有很大幅度的提高,药品收入占业务收入比例下降,药品加成率明显下降。补偿渠道较为单一,补偿缺乏刚性。结论:应通过强化政府责任,完善经常性收支差额核定办法,建立健全多渠道的补偿机制和构建基层医疗机构间的激励分配机制等措施来建立科学合理的补偿机制。     

The financial impacts of the nursing shortage

This article examines the multiple factors leading to the nursing shortage and the financial impact of the nursing shortage on hospitals and health care providers, the government, society and educational institutions. Nursing shortages have occurred in this country throughout history, however, the current shortage is especially grappling due to the financial condition of the health care system, Health Insurance Portability and Accountability Act, the Balanced Budget Act, the compounding conditions that have led up to the shortage and the forecasted health care needs. Many solutions have been proposed to improve the nursing shortage. This article provides recommendations to problem solving methods and discusses some current policy alternatives, including recently enacted "nurse-patient ratio" regulation, demonstrated by California state policy and the "Magnet Certification" program developed by American Nursing Credential Center (ANCC). This article further examines the financial impacts on nursing shortage problem.     

US Propofol Drug Shortages: A Review of the Problem and Stakeholder Analysis

Background

Drug shortages have increased in recent years in the United States, with a majority involving sterile injectable drugs. Propofol, a sterile injectable drug, is frequently used as a sedative, thanks to its rapid onset of action and a short recovery period. However, propofol is complicated and expensive to manufacture, and recent events involving major manufacturers have led to shortages of the drug in the United States.

Objectives

To review the events leading to the shortage of propofol and to discuss how the shortage is affecting various healthcare stakeholders, as an example of the systemwide problem of drug shortages in the United States.

Discussion

Manufacturers currently have little economic incentive to produce propofol, a generic drug whose production is costly and carries a high liability. The enforcement of good manufacturing practices by the US Food and Drug Administration is beneficial for the safety of US citizens, but it can inherently lead to a sudden halt in the manufacturers'' production of drugs. Hospitals are affected because they must develop a plan to address current and potential shortages, including restricting the use of medications that have a shortage and shifting to alternative agents.

Conclusion

The shortage of propofol significantly impacted the delivery of care in the United States in 2009, and various stakeholders are working to increase the existing supply of propofol and to investigate the use of alternative medications when the supply runs short. The case of propofol presented in this article is used to illustrate a systemwide view of the impact of drug shortages on the US healthcare system.In recent years, drug shortages have become a common occurrence in hospital and retail settings, with a record high of 267 drug shortages reported in 2011.1 Julie A. Golembiewski, PharmD, Clinical Associate Professor, Departments of Pharmacy Practice and Anesthesiology, University of Illinois at Chicago, defines a drug shortage as “a situation in which the total supply of all clinically interchangeable versions of an FDA [US Food and Drug Administration]-regulated drug is inadequate to meet the current or projected demand at the user level.”1 The impact and prevalence of such drug shortages were illustrated by a 2011 American Hospital Association survey of community hospitals.2 Nearly 50% of the responding hospitals reported ≥21 drug shortages within the first 6 months of 2011, and more than 99% of hospitals reported at least 1 drug shortage.2Approximately 80% of drug shortages involve sterile injectable drugs, such as anesthesia agents and chemotherapy drugs.1 These drugs can be difficult and expensive to manufacture, thereby forcing companies to operate on slim profit margins and leading to other companies exiting the market altogether.3 Currently, 3 pharmaceutical companies account for 70% of the sterile injectable products manufactured in the United States.1 The FDA maintains a useful website on drugs (www.fda.gov/Drugs/DrugSafety/DrugShortages) that provides notifications regarding drug shortages, guidelines on shortage management, and the agency''s actions to address specific shortages.Propofol, one of the sterile injectable drugs that is currently experiencing a shortage, is a phenolic derivative with sedative and hypnotic properties that is frequently used in intensive care units.4 It is formulated as an oil-in-water emulsion for intravenous use, which makes it highly lipophilic and allows it to rapidly cross the blood-brain barrier.4 Propofol is also quickly redistributed into peripheral tissues and is metabolized, resulting in a rapid onset of action, as well as a rapid emergence from sedation, making it the preferred choice for many anesthetists.4

KEY POINTS

• ▸ Drug shortages are common in hospitals and retail settings across the United States with serious impact to all healthcare stakeholders.
• ▸ The majority of drug shortages involve sterile injectable agents.
• ▸ Propofol is often used as a sedative and is undersupplied for the demand in the United States; manufacturers of this drug need greater financial incentives to produce it.
• ▸ The FDA can help to resolve drug shortages by enforcing good manufacturing practices and by designating alternate suppliers.
• ▸ Hospitals must develop plans to address shortages, including restrictions on drug use and using alternate agents.
• ▸ The propofol shortage had implications for various stakeholders, including patients, providers, payers, and drug manufacturers. This case is a good example of the impact of drug shortages overall on the US healthcare delivery system as a whole.

Two major problems led to a recent shortage of propofol in 2010. After an outbreak of hepatitis C resulting from the inappropriate, unsanitary use of propofol, a verdict was issued against Teva Pharmaceuticals, which held 40% of the US market share at the time.3 As part of this ruling, Teva was ordered to pay $356 million to 1 man who developed hepatitis C, and their partner, Baxter International, was ordered to pay $144 million.3 The precedent set by this ruling discourages companies from making drugs with a high liability risk, especially when the court system unfairly holds pharmaceutical manufacturers responsible for the misuse of their products.3 It should be noted that the manufacturers'' marketing of oversized vials may have contributed to a hepatitis C outbreak, because the practice of reusing such vials inherently poses a risk of infectious contamination.The second major problem deals with noncompliance with the FDA''s good manufacturing practices. In 2010, Hospira, Inc, voluntarily closed its manufacturing plant in North Carolina to address quality assurance and regulatory issues that had been identified during inspections by the FDA.1 This plant has remained closed for most of the past 2 years, focusing its efforts on becoming FDA compliant.1An additional factor that has affected propofol availability was a voluntary recall of select lots of propofol that were manufactured by Hospira.5 The recall was issued as a result of possible contamination with particulate matter on March 31, 2010, and was extended nationwide on May 27, 2010, resulting in a shortage of propofol between April 1, 2010, and June 30, 2010.5 As manufacturers continue to merge, fewer companies provide a larger portion of a drug''s supply. Problems with one of these companies, such as the recall by Hospira, can lead to a sudden shortage of a drug.In critical care, drugs are chosen for a certain condition based on their efficacy, pharmacodynamics, pharmacokinetics, bioavailability, or actions on distinct receptors.6 However, in recent years, with the epidemic of drug shortages, medications are sometimes chosen simply because they are the only ones available.6 Drug shortages, including that of propofol, can alter how the pharmacy dispenses or prepares medications, as well as affect government regulation of pharmaceutical manufacturers and patient care, especially when alternative medications must be used in place of the preferred drug.     

Trend in geographic distribution of physicians in Japan

Background  

Since the late 1980s, the policy of the Japanese government regarding physician manpower has been to decrease the number of medical students. However, the shortage of doctors in Japan has become a social problem in recent years. The aim of this study was to compare the numbers of physicians in Japan between 1996 and 2006 and the trends in distribution of physicians.     

Occupational health research priorities in Malaysia: a Delphi study

OBJECTIVES—As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia.
METHODS—Participation was sought from government ministries, industry, and professional organisations, and university departments with an interest in occupational and public health. Two rounds of questionnaires resulted in a final list of priorities, with noticeable differences between participants depending on whether they worked in industry or were from government organisations.
RESULTS—The participation rate of 71% (55 of 78) was obtained for the first questionnaire and 76% (72 of 95) for the second questionnaire. The participants identified occupational health problems for specific groups and industries as the top research priority area (ranked as top priority by 25% of participants). Ministry of Health participants placed emphasis on healthcare workers (52% ranking it as top priority), whereas those from industry identified construction and plantation workers as groups, which should be accorded the highest priority. Evaluation of research and services was given a low priority.
CONCLUSIONS—The priorities for occupational health determined with the Delphi approach showed differences between Malaysia, a developing country, and findings from similar European studies. This may be expected, as differences exist in stages of economic development, types of industries, occupational activities, and cultural attitudes to occupational health and safety. Chemical poisonings and workplace accidents were accorded a high priority. By contrast with findings from western countries, workplace psychosocial problems and musculoskeletal injuries were deemed less important. There also seemed to be greater emphasis on adopting interventions for identified problems based on experience in other countries rather than the need to evaluate local occupational health provisions.


Keywords: occupational health; research priorities; Malaysia     

对深化上海医改的几点思考

国家医改方案已经公布,上海医改设计时必须注意处理好组建医疗联合体、管办分离、医保改革、医院补偿机制、全科医师培养、发展高端医疗服务业这六方面的问题。分析了组建医疗联合体必须克服的四个障碍;管办分离的精髓是政府卫生行政部门与医院院长间真正意义上的职责边界合理与清晰;医保改革应由医疗保险向健康保障模式转变,处理好“一卡通”与“个人帐户”问题;医院补偿机制应着重处理好政府财政、医疗服务收费与药品收入三者的关系,在核定支出前提下,医院收支结余部分上交是实现公益性回归的途径之一;社区卫生服务中心医师不必全部是全科医师;关闭公立医院开展的特需医疗服务是吸引社会资金举办高端医疗服务业的最佳途径。最后提出“三包一线”,即建立上海市公共卫生服务包、基本医疗服务包、基本药品包及个人自负封顶线的上海市医改基本思路。