1,430 research outputs found
Analysis of the influence of recent reforms in China : cardiovascular and cerebrovascular medicines as a case history to provide future direction
Background: Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. Objective: Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. Methods: Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. Results: Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. Conclusion: Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources
Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis
INTRODUCTION: The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS: Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS: Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS: Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour
Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction
Exploring the evidence base for national and regional policy interventions to combat resistance
The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions
Pharmaceutical policy, impact and health outcomes
Pharmaceutical policy is essential given increasing expenditure on medicines and only finite resources, with global expenditure on medicines estimated to reach US237 billion by 2024, and continue growing (4). This increase is driven by the increasing prevalence rates of patients with cancer alongside the increasing costs of new oncology medicines, with requested prices per life year gained for new oncology medicines rising four-fold or more during the past years after adjusting for inflation (4). This increase is exacerbated by the emotive nature of the disease area (6). These growth rates though are unsustainable leading to greater scrutiny over the cost and value of new oncology medicines, which will continue (
Healthcare Providers' accounts of influences of antibiotic-related reforms on their behaviour with respect to the use of antibiotics for children : A qualitative study in China
National Drug Policy Face-off: Some Notes Justifying the Regulations and Drug Price Control Regime in India
This is an attempt in examining and carrying out the discussion and debate on regulations and prince control in pharmaceutical industry in the Indian context. Herein the above discussion presented the perspectives of the industry and the welfare of the poor population along with alternative options. Given its critical nature in existence of human race while protecting, maintaining and restoring health of human being, regulations on pharmaceutical industry are needed to ensure safety, quality and effectiveness of drugs they develop and produce. As pharmaceutical industry involved with the phenomenon of Induced-demand and it is one of the industries where the price competition may not be prevailing, hence price controls on certain essential and life-saving drugs are needed especially in the Indian context
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Exploring the antibiotics innovation system and R&D policies in China: mission oriented innovation?
One possible response to the growing problem of Antimicrobial Resistance (AMR) in pathogenic infections is the development of new types of antibiotics. However, the pharmaceutical companies that have traditionally led such innovation face a lack of incentives at the present time due to high levels of market uncertainty and low expected returns. Mission oriented innovation with coordinated investment and market-shaping policies may offer an approach to accelerating antibiotic innovation. This paper aims to evaluate whether preCovid-19 Chinese policies concerning AMR can be seen as constituting a mission-oriented approach and whether these policies have influenced antibiotics innovation in China. It adopts a mixed method approach to deliver several insights. By using historical event analysis based on data collected from interviews, public and commercial databases as well as policy documents, the paper finds that China’s recent actions concerning AMR since 2008 comprise many elements of mission-oriented innovation policy. The National Action Plan to Contain AMR has provided a clear mission since 2016 to tackle the problem of AMR and provides the opportunity to coordinate and integrate these policies into a more coherent and evolving
mission-oriented innovation approach. Analysis of relevant research grants and publications suggest that these policies (including the 2016 National Action Plan) have drawn the scientific community towards antibiotics research and provided more support to this area. Case studies following the development of new antibiotics are used to illustrate how the established elements of mission oriented innovation policy have or have not contributed to antibiotics innovation in China. Further research is required to more comprehensively analyse R&D investments, and to understand the effects of recent policies, especially after 2016
EFFECT EVALUATION OF COMPREHENSIVE HEALTHCARE REFORM IN BEIJING, CHINA
Public hospitals in China have historically relied on profits from high markups on drug and medical consumables sales, which contributed to escalating medical expenditures and placed heavy financial burdens on patients. Aiming to contain escalating medical expenditures and reorient public hospital services more toward the public interest, Beijing implemented two rounds of healthcare reform in 2017 and 2019. The first round focused on separating drug sales from hospital revenue (reform 1), and the second round extended to included zero markup on medical consumables and price adjustments for medical services (reform 2). This study evaluated how these two rounds of reform have affected patients, physicians, and public hospitals. We determined the effects of controlling the excessive growth of medical expenditures, how medical expenditures and hospital revenue structures have changed, estimate the effect of guiding patients to go to primary healthcare facilities instead of tertiary hospitals, and determine how to control the excessive growth of expenditures in terms of changing medical service utilization. The monthly observational data for each hospital from January 2016 to December 2019, covering 354 healthcare facilities, were analyzed to estimate the effect of reform on changes in medical expenditures, medical revenue structures, and the number of outpatients and inpatients. A panel-interrupted time series model was used for analysis. Questionnaires and semi structured interviews were then conducted to assess the effectiveness of the reforms. Results showed that Beijing’s reforms restrained rising health care expenditures and reshaped hospitals’ revenue structures by reducing the proportion of drug and consumable sales and increasing the proportion of medical consultation fees that made up hospital revenues and by leading patients to seek treatment at primary care facilities. In these ways, we found that Beijing’s comprehensive healthcare reforms have been effectively implemented and are progressing as intended. This study could provide some insight into healthcare system reform. A dynamic price-adjustment mechanism for healthcare services should be established; changes in service delivery should be monitored further, and service quality should be evaluated thoroughly; a DRG-based payment method should be promoted
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