IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v19y2022i7p4285-d786387.html
   My bibliography  Save this article

Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China

Author

Listed:
  • Qian Xing

    (Department of Public Administration, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China
    Department of Pharmacoeconomics, Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing 211198, China)

  • Wenxi Tang

    (Department of Public Administration, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China
    Department of Pharmacoeconomics, Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing 211198, China)

  • Mingyang Li

    (Department of Public Administration, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China
    Department of Pharmacoeconomics, Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing 211198, China)

  • Shuailong Li

    (Department of Public Administration, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, China
    Department of Pharmacoeconomics, Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing 211198, China)

Abstract

Volume-based drug purchasing by China’s health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.

Suggested Citation

  • Qian Xing & Wenxi Tang & Mingyang Li & Shuailong Li, 2022. "Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China," IJERPH, MDPI, vol. 19(7), pages 1-22, April.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:7:p:4285-:d:786387
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/19/7/4285/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/19/7/4285/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Ying Wang & Yulei Zhu & Hang Shi & Xiaoluan Sun & Na Chen & Xin Li, 2019. "The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China," IJERPH, MDPI, vol. 16(22), pages 1-14, November.
    2. Casanova-Juanes, Julieta & Mestre-Ferrandiz, Jorge & Espín-Balbino, Jaime, 2018. "Competition in the off-patent medicine market in Spain: The national reference pricing system versus the regional system of tendering for outpatient prescription medicines in Andalusia," Health Policy, Elsevier, vol. 122(12), pages 1310-1315.
    3. Kwon, Hye-Young & Bae, Seungjin & Choi, Sang-eun & Park, Sylvia & Lee, Eui-Kyung & Park, Sungmin & Kim, Jinhyun, 2019. "Easy cuts, easy rebound: Drug expenditures with massive price cuts in Korea," Health Policy, Elsevier, vol. 123(4), pages 388-392.
    4. Lei Chen & Ying Yang & Mi Luo & Borui Hu & Shicheng Yin & Zongfu Mao, 2020. "The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China," IJERPH, MDPI, vol. 17(24), pages 1-11, December.
    5. Dylst, Pieter & Vulto, Arnold & Simoens, Steven, 2011. "Tendering for outpatient prescription pharmaceuticals: What can be learned from current practices in Europe?," Health Policy, Elsevier, vol. 101(2), pages 146-152, July.
    6. Claudiu Morgovan & Smaranda Adina Cosma & Madalina Valeanu & Anca Maria Juncan & Luca Liviu Rus & Felicia Gabriela Gligor & Anca Butuca & Delia Mirela Tit & Simona Bungau & Steliana Ghibu, 2020. "An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System," IJERPH, MDPI, vol. 17(12), pages 1-16, June.
    7. Mills, Mackenzie & Kanavos, Panos, 2020. "Do pharmaceutical budgets deliver financial sustainability in healthcare? Evidence from Europe," Health Policy, Elsevier, vol. 124(3), pages 239-251.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Chih-Hsiung Chang & Wu-Hua Chang & Yi-Yu Shih, 2022. "Is Financial Institution Management Effective to Reduce Problems Related to Information Asymmetry in Taiwan?," Bulletin of Applied Economics, Risk Market Journals, vol. 9(2), pages 37-58.
    2. Shu Yan & Lizi Pan & Yan Lu & Juan Chen & Ting Zhang & Dongzi Xu & Zhaolian Ouyang, 2023. "Towards Sustainable Drug Supply in China: A Bibliometric Analysis of Drug Reform Policies," Sustainability, MDPI, vol. 15(13), pages 1-20, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lei Chen & Ying Yang & Mi Luo & Borui Hu & Shicheng Yin & Zongfu Mao, 2020. "The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China," IJERPH, MDPI, vol. 17(24), pages 1-11, December.
    2. Christensen, Elisabeth & Hirsch, Niels Christian & Andersen, Jonas Valbjørn & Ehlers, Lars Holger, 2022. "The analogue substitution model: Introducing competition in the absence of generic substitution in Danish hospitals," Health Policy, Elsevier, vol. 126(9), pages 844-852.
    3. Zhigang Guo & Lin Bai & Zhenhuan Luo & Mengyuan Fu & Liguang Zheng & Xiaodong Guan & Luwen Shi, 2021. "Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China," IJERPH, MDPI, vol. 18(22), pages 1-10, November.
    4. Sabine Vogler & Valérie Paris & Alessandra Ferrario & Veronika J. Wirtz & Kees Joncheere & Peter Schneider & Hanne Bak Pedersen & Guillaume Dedet & Zaheer-Ud-Din Babar, 2017. "How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries," Applied Health Economics and Health Policy, Springer, vol. 15(3), pages 307-321, June.
    5. Joo Hanne Poulsen & Lotte Stig Nørgaard & Peter Dieckmann & Marianne Hald Clemmensen, 2021. "Time spent by hospital personnel on drug changes: A time and motion study from an in-and outpatient hospital setting," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-16, February.
    6. Jiae Shin & Dongwoo Ham & Hee Young Paik & Sangah Shin & Hyojee Joung, 2021. "Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients," IJERPH, MDPI, vol. 18(3), pages 1-13, January.
    7. Livio Garattini & Alessandro Curto & Katelijne Vooren, 2015. "Western European markets for biosimilar and generic drugs: worth differentiating," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(7), pages 683-687, September.
    8. Wouters, Olivier J. & Sandberg, Dale M. & Pillay, Anban & Kanavos, Panos G., 2019. "The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period," Social Science & Medicine, Elsevier, vol. 220(C), pages 362-370.
    9. Vogler, Sabine & Zimmermann, Nina & de Joncheere, Kees, 2016. "Policy interventions related to medicines: Survey of measures taken in European countries during 2010–2015," Health Policy, Elsevier, vol. 120(12), pages 1363-1377.
    10. Claude Montmarquette & Stéphanie Boulenger & Joanne Castonguay, 2014. "Les risques liés à la création de PHARMA-QUEBEC," CIRANO Project Reports 2014rp-05, CIRANO.
    11. Zhao, Jie & Zheng, Jianzhong, 2024. "Effective policy research of county and township health sector integration in China: Empirical evidence from the difference-in-differences model," Social Science & Medicine, Elsevier, vol. 348(C).
    12. Gerald J. Pruckner & Thomas Schober, 2018. "Hospitals and the generic versus brand‐name prescription decision in the outpatient sector," Health Economics, John Wiley & Sons, Ltd., vol. 27(8), pages 1264-1283, August.
    13. Wouters, Olivier J. & Sandberg, Dale M. & Pillay, Anban & Kanavos, Panos, 2018. "The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period," LSE Research Online Documents on Economics 90828, London School of Economics and Political Science, LSE Library.
    14. Kastanioti, Catherine & Kontodimopoulos, Nick & Stasinopoulos, Dionysis & Kapetaneas, Nikolaos & Polyzos, Nikolaos, 2013. "Public procurement of health technologies in Greece in an era of economic crisis," Health Policy, Elsevier, vol. 109(1), pages 7-13.
    15. Sabine Vogler & Guillaume Dedet & Hanne Bak Pedersen, 2019. "Financial Burden of Prescribed Medicines Included in Outpatient Benefits Package Schemes: Comparative Analysis of Co-Payments for Reimbursable Medicines in European Countries," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 803-816, December.
    16. Venetia Qendri & Johannes A. Bogaards & Johannes Berkhof, 2019. "Pricing of HPV vaccines in European tender-based settings," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 271-280, March.
    17. Amarawan Pentrakan & Cheng-Chia Yang & Wing-Keung Wong, 2021. "How Well Does a Sequential Minimal Optimization Model Perform in Predicting Medicine Prices for Procurement System?," IJERPH, MDPI, vol. 18(11), pages 1-17, May.
    18. Sabine Vogler & Eveli Bauer & Katharina Habimana, 2022. "Centralised Pharmaceutical Procurement: Learnings from Six European Countries," Applied Health Economics and Health Policy, Springer, vol. 20(5), pages 637-650, September.
    19. Cornelia Bala & Adriana Rusu & Dana Ciobanu & Gabriela Roman, 2022. "Length of Hospital Stay, Hospitalization Costs, and Their Drivers in Adults with Diabetes in the Romanian Public Hospital System," IJERPH, MDPI, vol. 19(16), pages 1-13, August.
    20. Casanova-Juanes, Julieta & Mestre-Ferrandiz, Jorge & Espín-Balbino, Jaime, 2018. "Competition in the off-patent medicine market in Spain: The national reference pricing system versus the regional system of tendering for outpatient prescription medicines in Andalusia," Health Policy, Elsevier, vol. 122(12), pages 1310-1315.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:19:y:2022:i:7:p:4285-:d:786387. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.