The change of drug utilization in China’s public healthcare institutions under the “4 + 7” centralized drug procurement policy: Evidence from a natural experiment in China

Abstract

Background: Improving drug accessibility and rational drug use are major challenges for China’s healthcare reform. In 2018, the Chinese government introduced a novel nationwide policy of centralized drug procurement for off-patent drugs, focusing on improving drug utilization patterns of public medical institutions.Objective: To estimate the impacts of the Chinese centralized drug procurement policy (the so-called “4 + 7” policy) on drug utilization in public medical institutions.Methods: A retrospective natural experimental design and difference-in-difference method were applied using cross-region data extracted from the national procurement database. Eleven “4 + 7” pilot cities (intervention group) and eleven non-pilot provinces (control group) were matched. In addition, “4 + 7” policy-related drugs (n = 116) were selected as study samples, including 25 drugs in the 4 + 7” procurement List (“4 + 7” List drugs) and their alternative drugs (n = 91) that have not yet been covered by centralized procurement policy. Then, the “4 + 7” List drugs were divided into bid-winning and non-winning drugs according to the bidding results, and they were sorted into generic and original drugs. Defined daily dose (DDD) was used to standardize the quantity of drugs used.Results: In the 1-year procurement period, the overall completion rate of agreed procurement volume reached 191.4% in pilot cities. Owing to policy impact, the consumption increased by 405.31% in bid-winning drugs (β = 1.62, p < 0.001) and decreased by 62.28% (β = −0.98, p < 0.001) in non-winning drugs. The overall use proportion of bid-winning drugs increased from 17.03% to 73.61% with statistical significance (β = 1.48, p < 0.001), and increments were also detected in all healthcare settings, regions, and anatomical therapeutic chemical (ATC) categories (all p-values < 0.05). Generics and originators were detected with 67.53% increment (β = 0.52, p < 0.001) and 26.88% drop (β = −0.31, p = 0.006) in consume volume. The use proportion of generics increased from 59.23% to 78.44% with significance (β = 0.24, p < 0.001), as well as in tertiary hospitals (β = 0.31), secondary hospitals (β = 0.23), and primary healthcare centers (β = 0.11) (all p-values < 0.001). The use proportion of relatively quality-guaranteed drugs (i.e. bid-winning and original drugs) increased from 56.69% to 93.61% with significance (β = 0.61, p < 0.001), and similar increments were also detected in all healthcare settings, regions, and ATC categories (all p-values < 0.05).Conclusion: Healthcare providers demonstrated good compliance with the “4 + 7” policy in completing contracted procurement volume. Centralized drug procurement policy promoted drug consumption gradually concentrated on bid-winning drugs, generic drugs, and more importantly, quality-guaranteed drugs.

The impact of the national centralized drug procurement on the use of original and generic targeted anti- tumor drugs in Hohhot, China: an interrupted time-series analysis

“…In this study,our ndings indicate a signi cant increase in the use of generic targeted anti-tumor drugs following policy implementation(305.26%, 167.31%, and 347.94%), consistent with previous studies by Lu et al [20,21]. At the same time, the expenditure of the generic targeted anti-tumor drugs decreased(-81.64%, -43.45%, and − 93.10%), and the DDDc decreased(-85.54%, -85.86%, and − 84.93%), which met the requirements of the NCDP to reduce medicines cost and alleviate the drug burden of patients, which was similar to the results of previous studies [22,23].…”

Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients

“…The increased use of bid-winning drugs may be related to the significant price reduction that occurred after the implementation of the NVBP policy, and thus implied that the affordability of antihypertensive drugs increased significantly and released some unmet medication demands after drug price reduction ( Wang et al, 2020b ). Besides, to ensure the completion of the relevant policy assessment target, healthcare institutions have launched a series of incentives for doctors to prioritize recommending the bid-winning antihypertensive drugs ( Liu et al, 2021 ; Lu et al, 2022b ). As is well known, only generic drugs which have passed consistency evaluation are deemed eligible to participate in National Volume-based Procurement.…”

“…Previous studies have reported that after the implementation of the NVBP policy, non-winning generic drugs were substituted with bid-winning original and generic drugs ( Lu et al, 2022a ). The daily cost of bid-winning original and generic drugs decreased significantly, as did that of non-winning drugs ( Yang et al, 2022 ).…”

Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China

“…Of all the respondents, 54% thought that the price of medical drugs was high, which is consistent with the situation of China's drug service market ( 49 ). At the national level, expenditure on drugs has increased gradually ( 50 ). For example, in 2018, China's total drug expenditure was 1,914.89 billion yuan, accounting for 32.39% of the total health expenditure, which is far higher than the average of 17% in OECD countries ( 51 ).…”