2010年-世界发展银行全球_Financing_Pricing_and_Utilization_of_Pharmaceuticals_in_China___The_Road_to_Reform_70页_1mb

Summary of Financing, Pricing, and Utilization of Pharmaceuticals in China: The Road to Reform

Core Content

This document provides an in-depth analysis of the pharmaceutical system in China, focusing on financing, pricing, and utilization within the broader context of national health reform. It outlines the challenges and opportunities for reform, particularly in the areas of essential medicines, cost control, and the structural issues within the healthcare system that influence drug use and pricing.

Main Points

1. Chinese Pharmaceutical Market Overview

• Growth and Global Position: The pharmaceutical market in China has grown rapidly since the 1980s, becoming the 9th largest in the world by 2004. Annual sales growth in the mid-2000s was 28%, significantly higher than the global average of 9%.
• Domestic Industry: By 2007, the pharmaceutical industry's gross value reached RMB 600 billion, accounting for 2.71% of GDP. Domestic manufacturers dominate the market, with 70.3% of sales value.
• Import and Export Trends: Pharmaceutical imports increased 350-fold from 1978 to 2007, while exports grew 86 times over the same period.
• Cost Trends: In 2006, pharmaceutical expenditures reached RMB 448.6 billion, accounting for over 40% of total health expenditure, which is much higher than the OECD average of 15-25%.

2. Essential Medicines in China

• Origins and Development: The concept of essential medicines was introduced in the mid-1980s by WHO. China started developing its own essential drug list in 1992, aligned with urban medical insurance reforms.
• Impact and Challenges: Despite the list's existence, essential medicines have had limited impact due to:
  • Unrealistically low government-set prices that discourage production.
  • Preference for brand drugs among hospitals to maintain revenue.
  • Lack of clinical guidelines for their use.
• Availability and Pricing: In the mid-2000s, essential medicines were often understocked in public hospitals and pharmacies, with procurement prices significantly higher than international reference prices.

3. Managing Pharmaceutical Costs

• Government Price Controls: Price controls have been implemented through multiple stages, including the 23 price reductions from 1996 to 2007. However, these efforts have been largely ineffective due to:
  • Limited scope of price-controlled drugs.
  • Hospitals restricting availability of controlled drugs.
  • Physicians substituting non-controlled drugs for controlled ones.
• Alternative Approaches: New strategies include:
  • Bulk purchasing: To reduce costs by pooling demand and increasing negotiation leverage.
  • Zero markup policy: Eliminating additional profit margins on drug sales, which has shown some success in community health centers.
  • Payment system reforms: Moving from fee-for-service to global budgeting and DRG-based reimbursement.

4. Irrational Drug Use

• Definition and Scope: Irrational drug use refers to overuse, inappropriate use, or inefficient use, often driven by financial incentives rather than medical necessity.
• Common Practices: Include overuse of intravenous injections, prescribing multiple drugs when fewer are needed, and preference for brand-name over generic drugs.
• Government Response: The Ministry of Health introduced 112 clinical pathways in 2009 to guide appropriate drug use, though challenges remain in implementation and changing physician behavior.

5. Refining the Path to Reform

• Key Recommendations:
  • Essential Medicines System: Dynamically revise the list, align with health insurance benefits, and ensure affordability.
  • Generic Drugs: Encourage production and use through subsidies, GMP compliance, and standardized naming.
  • Pricing Reforms: Use pharmacoeconomic evaluations, categorize drug pricing, and reduce government control.
  • Zero Markup Policy: Support with budgetary measures and separate drug revenue and expenditure accounts.
  • Pooled Purchasing: Improve transparency and fairness in procurement systems.
  • International Experience: Learn from global best practices in essential medicines, procurement, and reimbursement.
  • Structural Reforms: View pharmaceutical reform as part of a broader health system transformation, emphasizing universal coverage and sustainable drug security.

Key Information

• Exchange Rate: 6.82 RMB = 1 USD (May 1, 2010).
• Government Role: The Ministry of Health, NDRC, and other agencies have been central to reform efforts.
• Reform Timeline: Major reforms were launched in 2009, building on earlier initiatives from 2006.
• Financial Dependency: Hospitals rely heavily on pharmaceutical revenues to offset operating deficits, creating a misalignment with public health goals.

Conclusion

The document highlights the urgent need for structural and policy reforms to address the high cost and irrational use of pharmaceuticals in China. It emphasizes the importance of aligning drug pricing and utilization with broader health reform objectives, ensuring affordability, and promoting the use of generic medicines. The reforms are seen as part of a long-term strategy to move toward a more sustainable and equitable pharmaceutical system.