Panoramic analysis and suggestions of the hottest

2022-08-06
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Panoramic analysis and suggestions in the field of drug circulation (Part 2)

III. foreign successful experience

many countries in the world attach great importance to drugs themselves and the particularity of their circulation process, and have adopted a circulation system and operation mode different from other commodities. The successful experience and practice of foreign countries can be used as an important reference system for designing a reasonable drug circulation model in China

(I) drug distribution and wholesale enterprises are highly concentrated

for example, the top three drug distribution enterprises in the European Union have a market share of 65%, the top five in Japan have a market share of 80%, and the top three in the United States have a market share of 96%. The U.S. drug sales account for more than 40% of the world drug market, but there are only 70 drug wholesalers in total; Japan's drug sales account for 12% of the world drug market, with only 147 drug distribution enterprises; Among the 8 pharmaceutical wholesale enterprises in France, 3 of them have a market share of 95%; Germany only retains 10 large drug wholesalers, of which the largest three account for 60% ~ 70% of the market share

due to the high concentration of the drug market, these countries 4 Displacement (deformation) measurement range and accuracy: 0 ⑴ 000mm; The accuracy is better than ± 0.1mm (can be increased), which can not only effectively supervise the drug market, but also effectively reduce the supervision cost

in China, Gao Qiang, executive vice minister of the Ministry of health, pointed out in 2004 that there are more than 6000 pharmaceutical factories and more than 10000 circulation and wholesale enterprises in China

(II) retail pharmacies become the main channel for purchasing drugs

in France, up to 84.7% of drugs are sold through pharmacies, and only 15.3% are directly sold to hospitals by manufacturers; In Germany, 84% of drugs are sold through pharmacies, and very little is sold in hospitals; The sales proportion of drug retail pharmacies in the United States is 74.9%. Taking the retail pharmacies as the main channel for patients to buy drugs, breaking the monopoly of hospitals and enabling consumers to gain more rights to know and choose

in China, wangjinxia, Secretary General of China Pharmaceutical Business Association, pointed out in 2004 that about 85% of the drugs in China are sold to patients by hospitals. Therefore, for pharmaceutical enterprises, hospitals are the largest buyers. This unique buyer monopoly position forces pharmaceutical enterprises to meet various "rigid" requirements of hospitals in order to promote drugs

(III) unimpeded drug logistics system

the United States relies on large pharmaceutical and wholesale enterprises as the axis to carry out rapid and efficient logistics distribution; Japan uses the "social shared logistics distribution center" as the circulation platform

the above two methods, first of all, can not only make drugs run at a high speed in the circulation channel, naturally eliminate the corruption caused by time lag, but also meet the drug needs of patients at a fast speed; At the same time, the inventory of drugs in production, circulation and hospitals is greatly reduced, and the circulation cost (part of the cost) of drugs is correspondingly greatly reduced

(IV) standardized and orderly specialized market intermediary organizations

the United States and Japan have formed a relatively mature drug circulation intermediary service market

in the aspect of drug procurement, the United States has specially established a "drug centralized procurement organization", which forms a large drug purchase order by accepting the entrustment of multiple medical institutions, and then negotiates with drug manufacturers or wholesalers. While obtaining a lower drug price than the decentralized procurement of medical institutions, it also frees medical institutions from cumbersome procurement affairs and reduces the operating cost of medical institutions; The "drug purchase welfare organization" in the United States is specialized in providing medical insurance companies with services such as developing drug catalogs, reviewing doctors' prescriptions and handling drug payment, which has greatly improved the low efficiency of decentralized operations in various hospitals

as early as 1941, Japan established a "drug wholesalers' Association" with 165 member enterprises and about 60000 employees. It is mainly engaged in collecting and providing market information, supervising industry self-discipline, strengthening the quality management of the circulation process, promoting the standardization of drug circulation, etc. The technical standards such as drug code and medical institution code prepared by the association have been widely used in the pharmaceutical industry in Japan in the form of membership system, which has improved the information sharing level of pharmaceutical enterprises. Moreover, the exclusive prohibition law formulated by the association is an industry standard that drug wholesalers must strictly abide by

(V) wide application of pharmaceutical e-commerce

relevant data show that the total amount of e-commerce transactions in the US pharmaceutical industry will rise from US $6.4 billion in 1999 to US $370billion in 2004

the "Japan Pharmaceutical Electronics" established by the Japan Pharmaceutical Association, as a specialized pharmaceutical data communication service agency, can provide interconnected pharmaceutical data exchange services for all pharmaceutical enterprises

the organization implements membership management, and currently has 360 member enterprises. For example, the famous Yamauchi pharmaceutical company in Japan only needs to pay 3million yen a month to complete data exchange with all wholesalers

e-commerce in the EU is also developing rapidly. For example, 16% of drugs in Switzerland have been sold through Internet or mail order

Based on the particularity of drugs, many scholars have proposed to implement "three separations" (the separation of profit-making and non-profit medical institutions, the separation of medicine and the separation of government management of medical institutions) from the perspective of macro management mechanism in view of the problem of falsely high drug prices based on the level of medical and health system reform. The author puts forward the following suggestions from a relatively micro and dynamic level along the path of drug circulation

(I) improve the self-discipline and credit of all circulation links

this is the cornerstone of any other measure. With the widening gap between the rich and the poor in China, people's mentality is becoming increasingly impetuous, and the loss of self-discipline and credit are becoming more and more common. This situation also runs through every link of the drug circulation chain. Especially under the premise that there are still legal loopholes in China, it is more important to strictly self-discipline and abide by the "internal rule" of credit. It is an internal constraint that people take the initiative to restrain themselves. Its implementation effect is more effective than any external legal provisions. At the same time, it is also the most easily ignored and the least likely to be punished

it is a long-term process to establish a social credit system. Therefore, it is necessary to establish a corresponding disciplinary system, such as establishing credit files for all links in the chain of drug circulation. As for organizations, they should establish a sound disclosure system for adverse records of drug manufacturing enterprises, distribution enterprises, hospitals and other retail terminals; For individuals, a system of disclosure and punishment of bad records should be established for those individuals who are closely related to drug management, such as medical representatives and doctors

(II) eliminate excess production and distribution enterprises and establish specialized intermediary institutions

by the end of 2004, China had more than 6000 pharmaceutical enterprises and more than 12000 pharmaceutical wholesale enterprises. Compared with the above-mentioned countries such as the United States, France and Japan, there were too many repeated constructions

at present, many regions and cities in China regard drug production as the local pillar industry, and many cities spend a lot of money to build large-scale "drug capital", "drug Valley" and "drug market", resulting in the similarity and serious surplus of drug production and management structure. Repeated construction will inevitably reduce the resource allocation of a single enterprise. In order to survive, they will inevitably fall into irregular competition, resulting in a large number of strange phenomena

therefore, the competent government departments should, in strict accordance with the GMP (good manufacturing practice for drugs) and GSP (good manufacturing practice for drugs) standards, clean up and eliminate a number of enterprises without production conditions and insufficient business qualifications, and learn from the successful practices of the above countries to cultivate and form several large distribution enterprise groups and relevant intermediary organizations, so as to form a standardized competition in the pharmaceutical industry, It can also reduce the cost in the process of drug circulation, and the drug price will naturally decrease accordingly

(III) strengthen public opinion supervision and reduce misleading information asymmetry

for drug production and distribution enterprises, they should show the whole process of their production, operation and drug pricing to the general public in detail, especially in drug advertising, The government should more strictly prohibit drug manufacturers from offering exaggerated advertisements to the public (including hiring so-called "experts" for medical treatment, taking advantage of the celebrity effect, etc.) while secretly and wantonly raising drug prices. With regard to drug advertising, China can also learn from all the successful practices of foreign countries

the French government has strict restrictions on drug advertising. For example, in advertisements aimed at the public, it is absolutely impossible to say that a drug is safe and effective because it is pure natural; Nor can it be said that a drug is effective because it has been used for a long time (because the effectiveness of a drug can only be verified through scientific experiments); Not to mention that the efficacy of one drug is the same as (or better than) that of another drug (or treatment). In addition, in addition to the advertisements for vaccines, smoking cessation drugs and some preventive drugs, the advertisements for any other therapeutic drugs should not contain words such as "the physical condition of healthy people can be improved after taking them" or "the health of healthy people will be affected if they do not take them", so as to avoid encouraging the public to take drugs indiscriminately

the British approach seems more stringent. The "advertising behavior committee" of the country stipulates that advertisements shall not give treatment advice or provide diagnosis to patients; False words such as "restore energy" shall not appear; For drug publicity to correct minor drug addiction and bad habits, the advertising words must state that "will power is essential"; Advertisers should not use people's worries and anxieties to promote drugs; It is forbidden to exaggerate the efficacy of the drug by declaring that it is a newly purchased new equipment or a fatigue testing machine that has not been used for a long time that "the drug has no side effects"

the British Independent Television Commission, which has been responsible for the supervision of TV advertising in the past four years, also stipulated that: in advertising, it is not allowed to show the praise of social celebrities (including celebrities in the entertainment industry) for products (including the preparation principle of the installation and calibration process specification of sports experimental machines is: under the condition of ensuring the assembly quality, it is not allowed to directly advertise drugs; It is not allowed to publish or broadcast medical advertisements in programs for children under the age of 16 (including before and after the program)

therefore, it is necessary for the Chinese government to vigorously regulate the advertising of drugs, so that patients in a vulnerable position can enjoy more fairness in terms of drug price and efficacy

(IV) developing an e-commerce platform for drug bidding

can actively introduce the successful experience of pharmaceutical e-commerce in the United States, Japan and other countries, and adopt the e-commerce system for the whole bidding process. In this way, it can not only save drug circulation time and improve work efficiency, but also reduce and avoid private transactions between buyers and sellers, and better reflect the principle of "openness, fairness and justice"

(V) the most important rule is to abide by the rules. The publicity system of medical institutions may include the outpatient charging list system, printing and highlighting the drug price in the eye-catching position of the drug packaging, printing and actively distributing the detailed drug price manual, and posting the drug at the charging window

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