Objective: The paper attempts to explore the features, difficulties and policy progress of centralized purchasing of biological drugs with target quantity.Methods: Using the methods of literature review, the characteristics and difficulties of centralized purchasing of biological drugs were comprehensively analyzed, and the policy frame of the centralized purchasing of biological drugs were analyzed and elaborated.Results: Centralized purchasing of biological drugs with target quantity faces three major obstacles, i.e. clinical substitutability, the difficulty of natural extrapolation of indications and supply capacity problems. The insulin-specialized centralized procurement has conducted useful explorations and accumulated experience.Conclusion: Policies of the centralized purchasing of biological drugs should be scientifically and rationally designed and implemented based on the characteristics of biological drugs.

Tianjin is at the forefront of China in the volume-based procurement of high-value medical consumables. Up to now, Tianjin has taken the lead in carrying out multiple batches of national and alliance procurement projects, including products of intraocular lens, coronary stent, coronary dilatation balloon and joint prosthesis, achieving remarkable procurement results and continuous innovation and breakthroughs in procurement rules. This paper illustrates the practice of volume-based procurement of high-value medical consumables in Tianjin, analyzes the rules of previous procurement projects from the confirmation of intended procurement, grouping rules, selection rules, volume allocation rules and supply guarantee, summarizes the law and practical experience, including respect of clinical choice, increasing proportion of volume-based purchase, proper combination of groups, rational selection rules, consideration of implementation in advance and carrying out alliance procurement. Meanwhile, the paper offers suggestions from two perspectives of rule design and implementation, taking into account of price, quality and efficiency, etc. Also, the construction of platform should be improved, and the regional data and achievements of procurement should be shared. The paper provides reference for other regions of the country to carry out volume-based procurement of high-value medical consumables.

With the completion of the first batch of centralized volume-based drug procurement (CVDP) in Hubei Province, relevant assessments have been completed. Based on the cases of a Level III A hospital, this article analyzes the impact of CVDP on relevant stakeholders to give suggestions to public hospitals on the better implementation of volume-based drug procurement policies.

Objective: The paper attempts to evaluate the impact of previous national centralized drug procurement policies on the use of drugs in hospitals.Methods: The outpatient and emergency treatment data is retrieved from a tertiary comprehensive hospital in Beijing from June to August 2018 (before the VBP, volume-based procurement), June to August 2019 (after the first batch of VBP), June to August 2020 (after the second batch of VBP), January to March 2021 (after the third batch of VBP) and June to August 2021 (after the fourth batch of VBP), and EXCEL is applied to the data analysis.Results: With the implementation of the previous centralized procurement policies, the proportion of users of successful bidders has increased year by year, reaching a maximum of 21.36%. The total cost of medicines of winning bids and the same ingredients has achieved a cumulative decrease of RMB 25151300, a decrease of 60.27%.Conclusion: The policy of centralized drug procurement and use promotes the use of winning products and reduces the burden of drug costs.

Objective: The paper attempts to explore the awareness and satisfaction of patients in Peixian County on the centralized drug procurement, depending on whether its implementation can reduce the economic pressure of patients.Methods: 1350 outpatients in Peixian County, Jiangsu Province from January 2020 to August 2020 were selected as the research objects. Questionnaires were distributed to collect data. The patients' awareness and satisfaction with the policy was analyzed by univariate analysis and multivariate binary logistic regression analysis.Results: The results of univariate analysis showed that age, income, place of residence, educational background, working status and medical background were the influencing factors of patients' cognition of the policy. The results of multivariate analysis showed that income, educational background and medical background were the independent influencing factors of patients' awareness of the policy. The results of univariate analysis showed that age, medical background and policy cognition were the influencing factors of patients' satisfaction with the policy. The results of multivariate analysis showed that medical background and policy cognition were the independent influencing factors of patients' satisfaction with the policy.Conclusion: Strengthening publicity and improving patients' awareness and satisfaction with the policy is conducive to expanding the scope of application and benign impact of the policy.

Guided by policies and actual regulatory requirements as well as the idea of closed-loop management, Shenzhen Medicine Trading Platform has built a PDCA whole process monitoring system for centralized drug procurement with big data empowerment. Through big data analysis, closed-loop monitoring technology is realized, monitoring efficiency is improved, and the national centralized procurement task is effectively implemented.

Subsequent procurement after the expiration of the agreement is an important part of the national volume-based procurement (VBP). Based on the Guangdong and the Yangtze River Delta alliance's subsequent procurement, this paper makes a multi-dimensional analysis on the rules and results, summarizes the experience and puts forward suggestions.

Objective: The paper aims to construct the evaluation index system for the construction and operation of provincial medical consumables centralized procurement platform, so as to provide reference for further evaluating the effect of centralized procurement-related policies. Methods: the evaluation index system of medical consumables centralized procurement platform was preliminarily constructed by the method of policy content analysis; 19 experts in medical insurance, medicine, medical treatment and other related fields were invited and Delphi method was applied to collect experts' opinions and suggestions on the establishment of an operation index system for the construction of a centralized procurement platform for medical consumables. Results: the recovery rate of expert consultation reached 100%, and the degree of expert authority was ≥ 0.75. Through expert consultation, the construction and operation evaluation index system of medical consumables centralized procurement platform by 4 primary indicators, 13 secondary indicators and 48 tertiary indicators was finally determined. The mean value of each index importance is 4.11-4.89, the standard deviation is 0.32-0.77, and the coefficient of variation is 0.06-0.18, which meets the design requirements. Conclusion: the evaluation index system established by Delphi method has high reliability, and is significant for improving the service capacity of medical consumables centralized procurement platform and promoting the implementation of relevant policies.

The balance retention policy is to encourage and guide medical institutions and doctors to use the selected drugs of national centralized procurement. This article analyzes the influencing factors of the balance by the research of national, provincial, and municipal balance retention policy, and provides some suggestions for decision-making.

Since 2019, Nanjing Healthcare Security Bureau has actively implemented centralized procurement, and deeply participated in the two procurement modes of provincial alliance and Nanjing alliance to lower the price of medical consumables through "the volume-price exchange". This paper introduces the two procurement modes of Nanjing and analyzes the practice, efficacy and problem of each procurement. Finally, it is suggested that Nanjing should regulate the gradient price reduction of non-selected products, explore diversified negotiation rules and accelerate the formulation of unified grouping standard, so as to provide the reference for other provinces and cities to carry out the purchase of medical consumables.

The centralized procurement of in-vitro diagnostic reagents is an important part of the strategic purchase and centralized medical procurement management in the field of medical reform in China. At present, various procurement work modes have both advantages and disadvantages and need to be improved. This paper introduces, compares and analyzes four current main procurement work modes, including hospital-level independent non-centralized procurement, prefectural-level centralized bidding procurement, provincial-level centralized online procurement, and provincial-level centralized procurement with volume, and puts forward policy suggestions.

The centralized purchase of drugs in quantity has been normalized, institutionalized in China, but there are still problems to be solved in the management of the centralized purchase of drugs. On the basis of studying the development process of drug centralized purchasing in China, this paper introduces the practice of drug centralized purchasing management in a tertiary hospital in Jilin Province, shares the thoughts on the actual management work of the hospital, so as to provide reference for the further development of drug centralized purchasing policy in China

Objective: The paper is to establish a complete evaluation index system and model for the effect of centralized drug procurement policy. Methods: Literature research, expert consultation and Delphi method were used to establish the evaluation index system of the implementation effect of centralized drug procurement policy, and fuzzy analytic hierarchy process (AHP) and comparative analysis were used to establish the evaluation model, taking data of Yunnan Province as an example to conduct empirical research. Results: The evaluation index system contains 4 first-level indicators, 11 second-level indicators and 30 tertiary indicators. Among the first-level indicators, drug accessibility and drug effects weight coefficient is relatively high. Conclusion: The index system and evaluation model follow the principle of comprehensiveness, systematicness, scientificity, operability and principal component, which can provide guidance for evaluating the effect of centralized drug procurement policy in other regions.

Objective: Based on the cost data of a tertiary specialized hospital in Xiamen, the paper is to analyze the effect of centralized purchase policy of medical consumables and put forward targeted policy suggestions. Methods: Two independent samples t-test and nonparametric rank sum test were used to analyze the differences in total hospitalization cost, the cost of sanitary materials, consumable cost of centralized purchase and medical service structure before and after the implementation of the pooling policy. Results: After the implementation of the policy, the total hospitalization cost, the cost of sanitary materials and consumable cost of centralized purchase decreased. The proportion of the cost of sanitary materials and consumable cost of centralized purchase decreased, while the proportion of medical service income increased. The medical service structure has been continuously optimized, and the policy has achieved remarkable results. Conclusion: It is suggested to scientifically analyze and determine the purchase quantity to ensure the "quantity price linkage", improve the mechanism for guaranteeing policies and promote their implementation.

Objective: The paper evaluates the implementation effect of centralized procurement of psychotropic drugs to provide reference for promoting, improving centralized procurement of psychotropic drugs. Methods: The use of selected drugs of a psychiatric hospital from December2019to August2022were collected, compared, analyzed, including the number of selected products, the amount of use, the sales amount, the agreed task amount, average cost per time of selected key varieties of psychiatric category, the amount of prescriptions, DDDs, the average drug cost per outpatient/inpatient, adverse drug reactions, other indicators. Results: The tasks of each batch of centralized purchase were overfulfilled, the sales volume of centralized purchase varieties increased significantly, with the highest increase of1269.71%. Compared with the same period of the previous year, the total sales amount of non-selected drugs with the same generic name decreased significantly, with a maximum decrease of254.19%. The maximum ratio of prescription quantity of selected varieties/non-selected varieties was30.88. The average drug cost per outpatient/inpatient decreased gradually. The average drug cost of the selected varieties of psychiatric products decreased significantly compared with that before centralized purchase, with the maximum decrease of84.07%. Conclusion: The centralized purchase of psychotropic drugs reduces the drug costs for patients with mental diseases, improves the efficiency of medical insurance funds

Objective: The paper attempts to explore the effect of collaborative drug management in a tertiary hospital in Beijing, to provide suggestions for promoting rational drug use, improving drug management in hospitals. Methods: Excel software was used to explore the drug purchase data of the hospital from2017to2021by comparative analysis. Results: After collaborative management, the proportion of centralized procurement, national negotiation drugs in the total drug catalog of the hospital increased4.35times, the proportion of selected centralized procurement drugs quantity increased4.59times, the frequency of national negotiation drug procurement increased6.21times, the total amount of drug procurement decreased50million yuan. Conclusion: The coordinated drug management of centralized purchase, national negotiation can improve the availability of drugs, the efficiency of medical insurance funds, promote rational drug use in hospitals, optimize the drug purchase, supply management in hospitals

Objective: The paper provides ideas for the design of price formula for centralized procurement of drugs with quantity using comprehensive scoring method. Methods: We summarize the use of price formulas in local drug centralized procurement practice, clarify the connotation of different price formulas, interpret the characteristics, risks of different formulas from five dimensions. Results: At present, the commonly used price formulas can be summarized into five categories, different formulas can meet different policy objectives. Conclusion: The choice of price formula should suit the actual work, make the formula simple, clear, reasonably select the value, quantity of relative number, pay attention to the risk of price weight degradation, etc., strive to scientifically, comprehensively transform the price factors into price scores

The paper analyzes the functions, tasks, challenges of the current centralized purchase platform for drugs, medical consumables in China, puts forward suggestions based on the summary of Chongqing's experience. Under the guidance of the new development concept, the healthcare security department can innovate the social governance model, adapt to the requirements of the normalization, institutionalization of centralized procurement in quantity under the new situation by purchasing third-party professional services, empower the high-quality development of centralized procurement, support the reform, management of medical service, medicine prices, achieve the combination of a promising government, an effective market

With the normalization of the national centralized drug procurement, some of the first four batches of drugs have expired, and follow-up procurement of the first and the third batch have been carried out. This paper attempts to analyze the first and third batch of follow-up mode, refine and analyze the follow-up modes of different regions and alliances, analyze the effects of the first and third batches in some regions and the changes in the follow-up environment and policy requirements of the second and fourth batches, and put forward policy suggestions for the optimization of follow-up rules.

Objective: The effect of coronary stent centralized procurement on patients with coronary stent implantation was analyzed, so as to provide reference for the cost control in hospitals and departments. Methods: A retrospective study was adopted to collect data on first page of medical records before and after the implementation of coronary stent volume procurement policy, and analyze the hospitalization expenses of patients. Results: The total hospitalization cost and consumables cost (mainly coronary stent cost) of patients before and after coronary stent volume procurement decreased significantly, and the medical service fee increased (P﹤0.05). Conclusion: The centralized procurement policy of coronary stent has remarkable effect on the cost control of patients with coronary stent implantation, which can help the hospital to carry out the cost control, rationally allocate medical resources, optimize clinical pathways, and develop refined management.

Objective: The paper analyzes the influence of coronary stent national centralized procurement on disease groups of percutaneous coronary intervention. Methods: According to the first page of percutaneous coronary intervention in four hospitals, the changes of disease cost, average hospitalization days and surgical operation before and after coronary stent centralized procurement were analyzed. Results: The average hospitalization days decreased by 12.26%, the average cost of hospitalization decreased by 29.69%, the cost of materials decreased by 44.47%, the cost of drugs, examination and inspection also decreased, and the cost of medical services increased. The proportion of coronary stent implantation decreased significantly from 86.24% to 78.61% (P﹤0.05), the ratio of stent implantation decreased from 93.32% to 84.35% (P﹤0.05), and the ratio of ordinary balloon operation increased from 82.95% to 87.45% (P﹤0.05). The ratio of drug balloon operation increased slightly, but there was no significant difference. Conclusion: After coronary stent procurement, the cost of percutaneous coronary intervention has decreased significantly, and there are differences in the cost structure and operation methods among different hospitals. It is recommended that hospitals continuously optimize the cost structure of diseases under the background of DRG payment, so as to promote the healthy development of hospitals.

Since the implementation of centralized drug procurement organized by the state, the calculation of surplus funds has a very important incentive effect on medical institutions. Combined with the actual work of Anhui Province, this paper simulates and calculates the relevant parameters and indicators, classifies and analyzes the different reported volume of various medical institutions, and finally obtains some suggestions. When reporting the volume, medical institutions can appropriately float up the agreed purchase volume base, and guide patients to minimize the use of non winning products or non winning drugs whose purchase price is lower than the winning price, so as to maximize the remaining funds of various varieties..

Objective: The paper analyzes the impact of the centralized procurement policy on pharmaceutical companies' drug sales and provide a theoretical basis for the improvement of the policy. Methods: The interrupted time series method was used to analyze the sales of centralized drug varieties and alternative drugs varieties by pharmaceutical companies before and after the implementation of the centralized procurement policy. Results: After the implementation of the centralized procurement policy, the procurement volume of the selected enterprises increased by 163.28% and the proportion of procurement volume in all enterprises increased from 37.45% to 86.45%, while the procurement volume of unsuccessful enterprises decreased by 75.30% and the proportion of procurement volume in all enterprises decreased from 62.55% to 13.55%. Among the selected companies, the procurement volume of centralized drug varieties of non-top 100 enterprises increased by 313.27%, while the procurement volume of centralized drug varieties of top 100 enterprises increased by only 5.76%. The interrupted time series analysis revealed that in the non-supply regions, the procurement volume of selected companies had significant immediate changes (β2=-58.727, P<0.001) and the long-term trend was downward after the policy intervention (β3=-4.550, P=0.010). Conclusion: The policy has led to significant change in market share for the selected and unsuccessful companies in centralized drug varieties, but with limited impact on alternative varieties. The procurement volume of the selected top 100 companies has seen small growth. The procurement volume of unsuccessful enterprises shows a long-term downward trend. The sales of drugs by selected enterprises in non-supply areas have significantly decreased. Government departments should pay continuous attention to the reasonable profit demands of selected enterprises, guide them to change marketing strategies, and ensure the stable supply of selected products.

Objective: The report compares the differences in the impact of VBP generic drugs and original drugs on the main clinical outcome indicators in the treatment of major diseases, and promotes the rational use of VBP drugs in the clinical practice. Methods: The main focus is on the effectiveness and safety of the second and third batches of VBP drugs in clinical diagnosis and treatment. The paper investigates a total of 29 representative medical institutions in 16 provinces and municipalities in China, covering six major categories of cardiovascular, anti-tumor, neuropsychiatric, anti-infection, metabolic and endocrinic, and digestive systems. We extract baseline information and research indicators related to drug treatment and clinical outcomes from medical record data for efficacy, safety, and economic evaluation. Statistical analysis is conducted with inter-group baseline correction and analysis method of outcome indicators. Result: There is no statistically significant difference in the effectiveness and safety between the selected generic drugs in the national centralized procurement and the original drugs, providing evidence-based basis for rational clinical medication. Conclusion: This study provides an important reference for clinical doctors in decision-making of drug use, promotes the clinical rational use of selected drugs in centralized procurement, provides evidence-based data for the implementation of national centralized procurement policies, and also provides a model and method for the implementation and effectiveness evaluation of national centralized procurement policies.

Objective: The paper evaluates the impact of national centralized volume-based procurement (NCVBP) on the renewal period in public medical institutions. Methods: Data on the procurement records of drugs from January 2018 to December 2020 were obtained from the China Drug Supply Information Platform (CDSIP). The change of purchase volume, purchase expenditure and daily cost of drugs with different winning bids in the public medical institutions from 7 pilot cities was analyzed. Interrupted time-series analysis (ITSA) with two intervention points was used in this study. Results: The DDDs level of generic drugs passing the consistency evaluation of quality and efficacy (CEQE) which won the bid during the agreement period but failed in the renewal period changed significantly during the agreement period (β₂=18713.23,p<0.001). The change in the DDDs level (β₄ =-22287.48,p=0.002) , the trend (β₅=-1943.60,p=0.022) , and the level of purchase expenditure (β₂=-21869.97,p=0.002) was significant in the renewal period. The DDDs level of drugs which failed in the bid during the agreement period but won the bid during the renewal period changed significantly during the renewal period (β₄=19442.77,p<0.001), and the change of purchase expenditure (β₄=8840.89,p<0.001) was significant. The results showed that purchase expenditure (β₂=-89005.99,p<0.001) of generic drugs which didn’t pass the CEQE in selected drugs decreased during the agreement period. The trend of purchase expenditure (β₄=2538.91,p=0.046) and its proportion (β₄=0.52,p=0.011) was upward in the renewal period. Conclusions: The daily average cost of unapproved generic drugs should be monitored, and the mechanism for listing and unlisting unapproved generic drugs should be improved. We should monitor whether there is an unreasonable increase in the daily cost of drugs failed in the agreement and renewal period, also we should adhere to the policy of centralized NCVBP and improve supporting measures.

Objective: The paper analyzes the implementation of the national centralized drug procurement in Yunnan Province, explores the problems concerned by policy stakeholders and puts forward suggestions accordingly. Methods: We conducted statistical analysis of 118 drugs of centralized procurement with a total of 3 batches, selecting the time period before and after the policy implementation for comparison. Guided by policy objectives, we analyzed policy documents and official media news, and selected four primary indicators, i.e. accessibility, impact on drugs, impact on medical treatment, and impact on medical insurance. By literature review and consulting experts, 19 secondary indicators such as affordability and average outpatient drug cost per visit were introduced. Based on the execution time of national centralized drug procurement, the first three batches of centralized drug procurement were selected as the research objects. A longitudinal analysis was conducted before and after the implementation of policies, and a horizontal analysis was conducted on the overall situation of Yunnan Province and the country. We selected some representative varieties for analysis and judgment based on indicators such as resident prevalence, medication, procurement volume, procurement completion rate, and generic drug substitution rate. Excel, spss statistics and other software were used to clean and integrate the data collected, and statistical means such as the variance analysis and Chi-square test were used to analyze the differences and trends of the data before and after the implementation of the policy. Results: After the implementation of the national centralized drug procurement policy, the proportion of drugs, the drug price and the proportion of adverse drug reactions reported decreased by 1.00%, 81.14% and 2.44%, respectively. The cost of the other 6 indicators increased, specifically, the growth rate of delivery rate was 6.00%, the average outpatient drug cost was 9.87%, the average inpatient drug cost was 2.71%, the industry concentration rate was 0.60%, the generic drug replacement sum rate was 29.03%, and the generic drug quantity replacement rate was 37.99%. Conclusions: The policy target of centralized drug procurement in Yunnan Province has been basically achieved. The drugs of national centralized drug procurement have promoted the accessibility of drugs, purified the industry conduct, gradually restructured the enterprise scale, and reduced the burden on medical insurance funds. However, the average outpatient drug costs and average inpatient drug costs are both increasing, consistent with the overall national trend. Although the national drug procurement reduced the drug price, the average outpatient drug cost per time increased instead, indicating that the control effect of centralized procurement on the total drug cost was not ideal, and the improvement effect on the concentration ratio of the industry in Yunnan Province was not obvious. It is suggested to always adhere to the leading position of the government, constantly expand the scope of national procurement, and give full play to the advantages of big data trading platform to scientifically guide the procurement and reporting work of hospitals. After the implementation of drugs, it is necessary to gradually strengthen the monitoring of drug trade, improve and implement supporting measures of policies, andcalculate of the proportion of medical insurance funds saved from centralized procurement, so as to gradually promote the progress and development of medical technology.

Since 2019, the national and local departments concerned have explored the centralized procurement of high-value medical consumables, and formed a certain degree of buyer monopoly by pooling the procurement volume of medical institutions, so as to give full play to the strategic purchase of medical insurance funds, promote the high-quality and coordinated development of medical security and medical services, and realize a win-win situtation. Based on the centralized procurement practice of the inter-provincial alliance of cardiac intervention electrophysiological medical consumables led by Fujian Province, this paper studies and analyzes the problems and countermeasures of centralized procurement of high-value medical consumables, and provides a reference and for improving the subsequent centralized band procurement of high-value medical.

Objective: The paper analyzes the effect of national centralized procurement of artificial joint through comparison of disease cost. Methods: According to the medical records of first page in 11 hospitals paid by diagnosis-related groups to hip joint replacement and knee joint replacement, the changes of case number, average hospitalization days, and disease costs were analyzed before and after national centralized procurement of artificial joints. Results: Compared with before the national centralized procurement of artificial joints (June to September 2022), after the procurement of (January to April 2022), the average hospitalization costs of hip joint replacement and knee joint replacement were significantly reduced by 22.50% (p<0.01) and 20.51% (p<0.01) respectively, in which the cost of medical consumable decreased by 41.73% (p<0.01) and 33.00% (p<0.01), but the cost of drugs increased by 16.15% and 12.98%, and the average hospitalization days were extended by 12.46% and 2.96% respectively. Conclusions: National centralized procurement of artificial joints can effectively promote the price of artificial joints to return to a reasonable level, and the hospitalization expenses of related diseases can be significantly reduced, which can effectively reduce the burden of patients. However, there are great differences in the cost structure of disease types among different hospitals. It is suggested that the medical insurance department should strengthen the supervision of centralized procurement of consumables, and medical institutions should improve the internal control assessment of centralized procurement of consumables, and strengthen the refined control of the cost of disease types.

Objective: The paper systematically analyzes the four batches (including three batches of national procurement and a batch of follow-up procurement) of national high-value medical consumables centralized volume-based procurement rules and selected results, in order to reflect the trend of China's high-value medical consumables centralized volume-based procurement. Methods: By analyzing the four batches of procurement documents, the procurement rules are compared from five aspects, i.e. the proportion of intended procurement, grouping rules, quotation rules, selection rules, and volume allocation rules. Also we analyze the selected results from two aspects of selected price and selected enterprises and summarize the trend of centralized volume-based procurement of high-value medical consumables in China. Results: According to comparison of the rules, the proportion of intended procurement is increasing, grouping rules reflect homogeneous competition in the same group, the price composition becomes more detailed, selection rules tend to stabilize the clinical supply, and volume allocation rules reflect quantity-price linkage. According to the selected results, the prices of selected drugs decrease to 80%, the difference of selected price gradually narrows to less than 1.5 times, the domestic share of national varieties steadily increases, domestic substitution further strengthens, the selected rate of enterprises gradually increases and stabilizes at 90%, the leading enterprises are selected and the industry concentration further increases. Conclusion: Combining the analysis above with the current situation of the procurement, the paper summarizes the seven trends of high-value medical consumables centralized volume-based procurement in China, namely, procurement rules design is more focused on the protection of market stability, procurement scope continues to expand and almost all varieties can be selected, we form a new pattern of pharmaceutical centralized volume-based procurement with collaborative promotion, a number of initiatives support the procurement to move towards a new journey of comprehensive price management, varieties focus on low localization rate areas and domestic replacement process accelerated, centralized procurement promotes enterprise innovation and realizes the high-quality development of pharmaceutical industry, centralized procurement synergy "medical insurance-medical treatment-drugs linkage" to promote the development of pharmaceutical industry.

Objective: Through in-depth analysis of the effects and problems of the centralized procurement policy of high-value medical consumables in a first-class a hospital in Shanghai, the paper evaluates the efficiency change of medical service, and puts forward suggestions accordingly, taking the centralized procurement of intraocular lens as an example. Methods: Through the literature research, Horn-meter model, projection-after implementation comparative analysis, case study and interview, we summarize rules and methods to provide a reference for the implementation of centralized procurement policy of high-value medical consumables. Conclusion: The government should continue to promote and guarantee the implementation of centralized procurement policy. Medical institutions should actively implement the policy, strengthen the construction of compensation mechanism, optimize the price structure of medical services and ensure the diversity of clinical products. Medical insurance departments should give full play to the guiding role of medical insurance and relieve the pressure of expenditure.

Objective: The paper explores the using characteristics of antitumor drugs after the national centralized volume-based drug procurement policy and provides suggestions for monitoring of antitumor alternative drugs, as well as the optimization of the policy. Methods: Descriptive statistical methods were used to analyze the expenditures, DDDs and DDDc of antitumor drugs before and after the policy using the drug purchasing data from the National Drug Supply Security Information Platform from 2019 to 2020. Results: The expenditures and DDDc of antitumor selected varieties decreased by 31.87% and 51.55%, while the DDDs increased by 40.61%. The overall expenditures and DDDs of antitumor alternative drugs increased by 49.20% and 41.62% respectively, while the DDDc changed in small increments. Among original and generic drugs, the increase of DDDs of selected generic drugs was higher than that of original drugs, and the cost of the two kinds of drugs decreased obviously. The growth rate in expenditures and DDDs of alternative original drugs was higher than that of generic drugs. Among the drugs with different degrees of substitution, the increase of expenditures, DDDs and DDDc of certain degree of substitution drugs was much higher than that of basic substitution drugs. Conclusions: The implementation of the national centralized volume-based drug procurement policy achieved obvious effects in reducing the drug price and saving the cost in antitumor selected varieties, but the substitution effect of selected varieties to alternative varieties was insignificant. Information technology should be used to monitor the limit of expenditures and dosage of higher degree of substitution varieties, and to accelerate the substitution of expensive original drugs by generic drugs passed the consistency evaluation.

Objective: The paper analyzes and compares the differences in the contribution rate of different levels of public medical institutions to the change of drug procurement volume after the national centralized volume-based procurement (NCVBP). Methods: Data on the drug procurement records of from January 2018 to December 2020 were obtained from the China Drug Supply Information Platform (CDSIP). The contribution rate of different levels of public medical institutions on drug procurement volume and procurement expenditure from 7 pilot cities was analyzed. Results: The contribution rate of tertiary medical institutions was the highest (58.03%) during the pilot period on the increase in the purchase volume of centralized varieties, but the contribution rate of primary medical institutions was the highest (103.29%) during the continuation period. The contribution rate of primary medical institutions during the pilot period and the continuation period was the highest on the increase in the procurement volume of substitute varieties (54.87% and 72.88%). The contribution rate of primary medical institutions during the pilot period was the highest (45.62%) on the increase in the procurement expenditure of B01 antithrombotic bid-winning drug. The contribution rate of primary medical institutions during the pilot period and continuation period was the highest on the increase in the procurement volume of C08 calcium channel blocker, C09 acting on the renin-angiotensin system bid-winning drug. The contribution rate of tertiary medical institutions during the pilot period and the continuation period was the highest on the increase in the procurement volume of L01 anti-tumor bid-winning drug (89.21% and 61.85%). Conclusion: During the continuation period, the contribution rate of primary medical institutions to the increase in procurement volume increased during the continuation period. The procurement volume of some therapeutic drugs has increased, among which the contribution rate of primary medical institutions was the highest.

Objective: The paper explores the evaluation objectives, angles and methods that can be used to quantitatively evaluate the quality of drugs in local pharmaceutical centralized volume-based procurement. In addition, based on the concept of value-based health care, a drug quality evaluation index pool is constructed to provide tools for local procurement practice. Methods: We collect local pharmaceutical centralized volume-based procurement documents, identify the indicators that can be used to evaluate the macro quality level of drugs, build a basic index pool, and build a classification index pool based on expert opinions. Results: The basic index pool for drug quality evaluation suitable for local pharmaceutical centralized procurement was established, which was divided into three categories of the recommended index pool, the caution index pool, and the non-recommended index pool. The recommended index pool contains 8 first-level indicators, 17 second-level indicators and 27 third-level indicators. The caution index pool contains 5 first-level indicators, 5 second-level indicators and 5 third-level indicators. The non-recommended index pool contains 9 first-level indicators, 25 second-level indicators and 29 third-level indicators. Conclusion: In the practice of local procurement, the indicators in the recommended index pool can be directly selected. The indicators in the caution index pool can be selected when necessary, or can be used to assist in ranking, and the indicators in the non-recommended index pool are not recommended.

Objective: The paper studies the effect of intraocular lens centralized procurement on hospitalization expenses of cataract surgery patients. Methods: According to the first page of medical records in Ningbo City, the changes of disease cost, patient structure, average hospital stay of top 10 hospitals with cataract surgery cases before and after intraocular lens centralized procurement were compared and analyzed. Results: Patients with cataract surgery aged 60-80 years old accounts for nearly 70%. After intraocular lens centralized procurement, the hospitalization expenses decreased by 7.59%, among which the cost of materials decreased by 27.79%. Medical service fees, inspection fees, and drug costs increased by varying degrees, and the average length of stay was shortened by 0.32 days. Conclusions: The effect of intraocular lens centralized procurement on disease cost control is obvious, but the cost structure of different hospitals is significantly different. It is recommended that hospitals strengthen the control of disease cost under the background of DRG payment, incorporate intraocular lens into the national centralized purchase, and further reduce the cost of patients.

Objective: The paper analyzes the impact of the centralized procurement policy on the number of patients undergoing artificial joint replacement surgery, the total cost per time, the cost of patients per time, and the proportion of medical insurance reimbursement per time, and evaluates the implementation effect of the policy. Methods: Based on the cost data of artificial joint replacement in 29 hospitals above Level II in Anyang City, the paper applies Excel to compare and analyze the effect of artificial joint replacement and the change of cost data before and after centralized purchase. Results: After the centralized procurement policy, the number of patients with artificial hip and knee replacement increased by 50% and 79.41%, respectively, the patient cost decreased by 59.99% and 46.23%, respectively, and the actual reimbursement ratio of both cases increased by 16.76% and 4.16%, respectively. Conclusion: The national centralized procurement policy has a remarkable effect in reducing the medical cost of patients and greatly reduces the medical burden of patients. Public hospitals should play an active role in internal management and promote the sustainable development of the policy.

National centralized drug procurement involves diversified drug types and wide geographical area, which provides important reference for regional alliances to carry out centralized procurement. This paper takes the expansion of “4+7” centralized procurement, the second to fifth batch of national centralized drug procurements, and the centralized drug procurement of regional alliances with official data published before December 2021 as examples. OLS regression model is used to analyze whether national centralized drug procurements would have a price transmission effect on the centralized drug procurements of regional alliances. The result shows that there is no significant price transmission effect between national centralized drug procurements and the regional ones. However, this result may not completely deny the existence of price transmission effect due to limited available data, along with few overlapping drug types, different purchase amount and selection rules among the studied drug procurements. This paper aims to enrich the understanding of the connotation and implementation of the centralized drug procurement policy. Meanwhile, it provides some reference for the following centralized drug procurements.

Objective: The paper analyzes the influence of centralized procurement policy on drug procurement in the agreed procurement cycle and renewal period of public medical institutions at different levels. Methods: The changes of drug purchase volume, purchase expenditure and average daily cost of public medical institutions at different levels in 7 pilot cities were analyzed by interrupted time series analysis. Results: The purchase volume of centralized drug varieties increased by 15.36% and 4.61% in the pilot period and the renewal period, respectively. The growth rate of the purchase volume of alternative drug varieties in the pilot period and the renewal period was higher than that of centralize drug varieties, which was 17.30% and 5.60%, respectively. In the base period, the procurement volume of original drugs, reviewed generic drugs and unreviewed generic drugs accounted for 27.07%, 53.00% and 19.93%, respectively. The proportion of reviewed generic drugs in the pilot period and the renewal period increased by 34.71% and 0.92%, respectively. In the base period, the purchase volume of original drugs, reviewed generic drugs and unreviewed generic drugs accounted for 40.46%, 42.87% and 16.68%, respectively, while the proportion of reviewed generic drugs in the pilot period and the renewal period increased by 20.07% and 0.07%, respectively. Conclusion: The policy effect of primary medical institutions is behind schedule. The reviewed generic drug substitution effect of the centralized drug varieties was obvious, and the drug quality of primary medical institutions was improved. The DDDc of unreviewed generic drugs in the renewal period of Level-3 and Level-2 medical institutions increased abnormally.

Objective: The paper evaluates the impact of centralized procurement policies for antibiotics on perioperative prophylactic medication in obstetrics, gynecology, and pediatric orthopedics, providing reference for promoting and improving centralized procurement of antibiotics. Methods: Taking a tertiary hospital in Linyi City as an example, a retrospective method was used to collect data on drug consumption, sales amount, medication frequency (DDDs), daily cost (DDDc), and affordability for the first half of the year (January 1, 2021 to June 30, 2021) and the second half of the year (January 1, 2022 to June 30, 2022) of cefuroxime sodium for injection, which was selected in the fifth batch of national drug centralized procurement, for comparative analysis. Results: After the implementation of the centralized procurement policy, the average length of hospital stay in obstetrics and gynecology decreased from 6.98 days to 6.21 days, with a decrease of 14.29%. The average cost of drugs per case, the proportion of drugs cost per case, the average cost of cefuroxime per case, and DDDc decreased by 30.70%, 19.26%, 7.5%, and 12.43%, respectively. The average length of hospital stay in pediatric orthopedics decreased from 9.76 days to 8.50 days, with a decrease of 12.91%. The average cost per case and DDDc of cefuroxime decreased by 1.17% and 13.69%, respectively. Conclusion: The implementation of the national centralized drug procurement policy effectively lowered the price of cefuroxime sodium for injection, improved patient affordability, increased the efficiency of medical insurance funds and reduced operating costs of hospitals.

In China, the centralized volume-based procurement of drugs is a system innovation that leverages the strategic purchasing function of healthcare insurance, to reconstruct the pharmaceutical price formation mechanism, standardize the order of drug circulation, reduce the burden of patients’ drug costs, and ensure rationality and safety of drug use. This study aims to systematically review the policy connotations, operational effects, and multi-influences from the perspective of system establishment. The core mechanism includes the working mechanism of government organization, alliance procurement, and platform operation, the rule mechanism of giving priority to drug quality, guaranteeing supply and procurement based on clinical needs, as well as the operation and maintenance mechanism of centralized procurement and use. The core drug price formation mechanism includes the market exchange mechanism of “price for volume” and market contract mechanism of “four guarantees” . The implementation of the system involves 4 key links (bidding procurement, supply and delivery, distribution and use, and continuation work) and 18 core elements. After the implementation of the centralized volume-based procurement policy, there were obvious clinical substitution effects of drug use, improvement in drug accessibility, significant decrease in drug costs which mainly benefits patients, increase in drug market concentration, and gradual reshaping of the industrial pattern.

Objective: The paper evaluates the effect of centralized medical consumables procurement policy on expenses of patients undergoing knee arthroplasty and analyzes the law of cost change, providing evidence for reasonably controlling the cost of these surgeries. Methods: Based on the real-world data before and after the implementation of policy, RDD was applied to analyze the impact of centralized medical consumables procurement on the hospitalization costs of patients undergoing knee arthroplasty. Results: After the implementation of centralized medical consumables procurement policy, the hospitalization costs of patients undergoing knee arthroplasty have significantly decreased. The optimal bandwidth was approximately 57.48 days, and the average hospital expenses of patients decreased by 23311.29 yuan on April 30, 2022. The estimated results of 1/2 optimal bandwidth showed that the expenses decreased by 24923.05 yuan, and the estimated results of 2 times optimal bandwidth showed that the expenses decreased by 21547.30 yuan. The local average effect of different bandwidths is slightly different, but all shows a decreasing trend. Conclusion: The centralized medical consumables procurement policy has effectively reduced the hospital expenses of patients undergoing knee arthroplasty. Hospital managers should strictly implement the procurement policy, improve clinical pathways and standardize diagnosis and treatment behavior to reduce patients’ expenses. In addition, relevant departments should steadily expand the scope of procurement and strengthen supervision to ensure the effective implementation of policy and improve the accessibility and affordability of medical services.