Establishing the basic drug system is an important part of realizing the basic medical and health system in China. Determining the catalogue and varieties of essential drugs, organizing planned production, sales, circulation and use, and establishing a national essential drug policy are important institutional guarantees. Essential drugs are produced by the government, purchased by the government or reimbursed by medical insurance, and their differential pricing will eventually increase the total profits of pharmaceutical companies.
The purchase of essential drugs is monopolized by the government. This is a buyer's monopoly. In this case, the price of essential drugs is mainly determined by demand. The demand for essential drugs is not only the quantity purchased by the government, but more importantly, doctors and people should be willing to accept and use it. In practice, doctors should be trained to use basic drugs in coordination with clinical diagnosis and treatment routines and medication routines. At the same time, it is necessary to publicize and educate the masses on essential drugs and "induce" the demand for essential drugs. The policy basis of essential drugs is stable price mechanism and ensuring that pharmaceutical companies have certain profits and returns. State and politics
The government buys essential drugs in bulk, which makes the production have economic scale effect. When organizing the production and bulk purchase of essential drugs, the state should also give play to the market competition mechanism, reduce the price of essential drugs, make the price of essential drugs close to the marginal cost of drugs, and maximize social welfare. Coverage of national essential drug system
The national essential drug system should cover the relevant policies and strategies of national essential drugs, including the selection, production, procurement and distribution, pricing, financing, use and quality supervision of essential drugs, so as to ensure that the masses can obtain high-quality and low-priced essential drugs and solve the current livelihood problems of "difficult to use drugs" and "expensive to use drugs". So far, China does not have a complete national essential drug system, and it is necessary to establish a series of policies and measures for the production, circulation, supply, use and supervision of essential drugs, which are led by the government, driven by the market and based on the law. Establishing the national essential drug system is a fundamental system to rectify and standardize the order of drug production and circulation, control inflated prices, effectively curb commercial bribery, promote rational drug use and reduce the drug burden of the masses.
The establishment of a national essential drug system needs to meet the following four conditions: First, it needs to meet the basic medical needs of the whole people. The second is to consider the social and economic endurance. The third is to achieve social fairness, justice and transparency. Fourth, it should be conducive to the development of medical and health undertakings and promote social progress.
Establishing the basic drug system is a reasonable adjustment to the interests of the government, enterprises, hospitals and citizens. The key is to solve the hospital's compensation mechanism, ensure the legitimate profits of pharmaceutical companies, and compensate for the payment of medical insurance expenses, that is, the coordination of the three policies of "medicine, medicine and insurance".
Supporting reform measures for the basic drug system
The choice of essential drugs should be based on six factors: efficacy, safety, disease needs, quality, cost-effectiveness and low price. Essential drugs are mostly generic drugs that have passed the patent period, and expensive innovative drugs should not be included in the list of essential drugs. Due to the great regional differences in China's economic development, residents' income and consumption level, and the characteristics of Chinese patent medicines and ethnic medicines, the selection of varieties can be considered more relaxed than the World Health Organization's demonstration catalogue, and 400 ~ 600 varieties are appropriate. The limited amount of drugs necessary for the treatment of diseases with definite curative effect and low price are regarded as the basic drugs in the core list, and the expenses are completely paid by the state (provided free of charge or paid by the medical insurance system). Moreover, each province can add a part of drugs to the supplementary list of essential drugs according to the economic conditions of the region, and the cost of this part of drugs needs to be paid by individuals.
The production and circulation of essential drugs-with certain social public welfare, need the macro-control of the government and make full use of the market competition mechanism. The state organizes and guarantees the production and supply of essential drugs. Fixed-point production enterprises can be screened by the national and provincial governments for regional fixed-point production and directional distribution, and they can also introduce market competition mechanism to determine the access qualification of fixed-point enterprises, and at the same time introduce government supervision, social supervision and elimination mechanisms to ensure that fixed-point enterprises provide high-quality products. The other way is to only implement government procurement, and the government departments will put forward a list of procurement varieties and quantities, and open tenders to production enterprises to form a competitive mechanism. The basic drug circulation system can adopt the principle of parallel government underwriting and market circulation, and gradually work towards the direction of "centralized government procurement, unified distribution and zero-margin sales". Different users can adopt different methods. For example, drugs in community health service centers can be considered to be purchased by the government and distributed centrally. Centralized online bidding for bulk drugs in city hospitals can be considered; A small amount of drugs can be purchased independently by the hospital. The corresponding expenses incurred in the bidding and purchasing of essential drugs shall be borne by the government.
Fiscal and taxation system of essential drugs-The government should give different policy support to the production of essential drugs. For example, we should subsidize the price of cheap and loss-making drugs, implement a low-profit pricing policy, use project funds or low-interest loans to encourage the development of essential drugs, levy a lower value-added tax rate than other drugs, and implement tax reduction and tax rebate. At the same time, it is necessary to establish a basic drug financing system, increase the government's investment in medical expenses for key diseases and poor people, and study the drug compensation policy of medical insurance. There are many ways to raise funds for essential drugs, such as government financing, medical insurance payment, personal payment and complete personal payment.
Rational use of essential drugs-In order to guide the rational use of essential drugs in clinic, it is urgent to formulate unified guidelines for the diagnosis and treatment of common diseases and train clinicians to use drugs rationally. Under the basic drug system, it is necessary to make necessary regulations on the purchase and use of drugs in hospitals of different levels. Community health service centers, township hospitals and village clinics can only use basic drugs. In hospitals above the second level, essential drugs are the first choice for clinical services. Other non-essential drugs can be added on the basis of using essential drugs. In short, in the absence of universal coverage in the medical insurance system, the cost of essential drugs should not be borne by the government or the security system, and should be completely free. At the same time, more publicity should be done to guide the masses to choose to use essential drugs. Pricing of essential drugs-the unified national guidance price shall be implemented, but the principle of high quality and good price shall be embodied. The gross profit margin of the production and circulation of essential drugs should be higher than the average level of other drugs, and the differential pricing model should be implemented. It is suggested to establish a floating price range, which can increase the price of high-quality essential drugs by less than 20% compared with conventional drugs. The government sets the ex-factory price and differential rate, and the hospital implements zero differential rate adjustment. A small number of essential drugs that are in short supply, low unit price and small dosage, but necessary for patients, can be appropriately increased (at a profit). For clinically necessary drugs, the varieties that enterprises are unwilling to produce due to price reasons should be
The government timely adjusts to reasonable prices or price subsidies.
The cost of essential drugs should be borne by individuals, units and countries reasonably, and should not be all free. In underdeveloped areas, the government can consider providing it free of charge; In developed areas, patients have to pay a certain proportion. Under the medical insurance system, the compensation ratio of essential drugs and non-essential drugs should be different. A considerable part of the cost of essential drugs can be compensated from urban residents' medical insurance or the new rural cooperative medical system. The medical insurance system can be fully paid (compensated), and the new rural cooperative medical system can be partially paid. For the disadvantaged or difficult people, it can be solved through financial or medical assistance channels. For low-income poor people, the government can provide basic drugs free of charge.
The establishment of a basic drug system requires a variety of supporting measures. The state should formulate the health law or the basic medical security law, and stipulate the relevant connotation of the basic drug system. The government should do a good job in quality supervision and management of essential drugs and establish an information system for essential drugs. At the same time, it is necessary to strengthen the publicity and education of basic drug knowledge in the media and popularize drug knowledge. Finally, we believe that the national essential drug system should be managed by the health authorities, and the coordination and deliberation system of relevant departments should be established, and the departments of health, medical insurance, drug supervision, price, science and technology should implement unified management and coordination of the entire pharmaceutical industry.