以重庆为例的短缺药品国家定点生产试点政策的实效分析

目的:分析我国短缺药定点生产试点政策的实施效果。方法:以重庆市2012年9月-2018年9月6年间确定的2批共7个定点生产药品为例,分析国家定点生产药品的总体供应情况(以医疗机构订单平均满足率为指标)、国家定点生产政策实施前后(包括定点生产期间和非定点生产期间)供应情况(订单平均满足率)的变化,并按医疗机构等级和医疗机构订购量(分为小、适中、大3个区间)进行分类分析;同时,电话访谈相关药品生产企业的相关商务人员,了解并归纳出目前这些药品存在的供应问题的原因。结果:除1个定点生产药品的订单平均满足率为0外,其余6个药品的订单满足率为58.05%～92.31%;定点生产期间订单满足率相比非定点生产期间订单满足率提升明显,但在药品定点生产到期后,订单满足率多有所下降,有的药品甚至低于定点生产前的订单满足率;三级医疗机构的订单平均满足率高于二级、一级及其他基层医疗机构,定点生产期间定点生产企业对各级医疗机构的订单平均满足率高于非定点生产期间和非定点生产企业。定点生产及相同品规药品存在的供应问题的原因经归纳主要为限价低于成本、原料原因停产、企业原因停产、医保支付价远低于供应价、医院需求量小等5种。结论:药品定点生产试点政策对于短缺药品供应发挥了明显的改善作用,但还需要通过建立定点生产药品范围、价格、期限的动态调整机制进行完善。

Effectiveness Analysis of the National Designated Production Pilot Policy for Drug in Shortage:Taking Chongqing as an Example

OBJECTIVE:To analyze the effect of the national designated production pilot policy for drug in shortage in China.METHODS:Taking 2 batches of drugs from 7 designated production manufacturers in Chongqing from Sept.2012 to Sept.2018 as an example,the overall supply situation of designated production(using the average satisfaction rate of medical institution’s order as index),the changes of drug supply(average satisfaction rate of order)before and after the implementation of national designated production policy(during designated production period and non-designated production period)were all analyzed.According to the level of medical institutions and the order quantity of medical institutions(three sections:small amount,suitable,big amount),the classification analysis was carried out.At the same time,telephone interview was conducted among the business personnel of related pharmaceutical production enterprises to understand and summarize the reasons for the supply problems of these drugs.RESULTS:Except for the average satisfaction rate of drug order was 0 in one designated production manufacturers,the satisfaction rate of drug order in the other 6 designated production manufacturers ranged from 58.05%to 92.31%.During the designated production period,the satisfaction rate of drug order was increased significantly,compared with non-designated production period.However,after the expiration of the designated production of drugs,the order satisfaction rate mostly declined,and satisfaction rate of some drug orders were even lower than that before designated production.Average satisfaction rate of drug order in third level medical institution was higher than those of second level,first level or primary medical institutions.During designated production period,the average satisfaction rate of drug order in designated production manufacturers to medical institutions at all levels was higher than during non-designated production period or in non-designated production enterprises.There are 5 kinds of reasons for supply problem of designated production and drug with same specification:the limited price is lower than the cost;the production is stopped due to raw material;the production is stopped because of enterprise;the medical insurance payment price is far lower than the supply price;the hospital demand is small.CONCLUSIONS:The designated production pilot policy has played a significant role in improving the shortage of drug supply,but it still needs to be improved by establishing a dynamic adjustment mechanism for the scope,price and duration of designated drug production.