健康发展与政策研究2025，Vol.28Issue(5)：517-523,539,8.DOI:10.12458/HDPR.202410053
基于中断时间序列模型评估湖北省中成药集采对公立医疗机构中成药采购结构的影响
The impact of centralized volume-based procurement of Chinese patent medicine on the procurement structure of these medicines in public medical institutions of Hubei Province:an interrupted time series analysis
摘要
Abstract
Objective To analyze the impact of the first round of centralized volume-based procurement of Chinese patent medicine on the procurement structure of these medicines in public medical institutions of Hubei Province,and to provide a reference for improving this policy.Methods Obtain the procurement data of traditional Chinese patent medicines and simple preparations for public medical institutions in Hubei Province from 2021 to 2022 through the centralized procurement platform for drugs and medical devices in Hubei Province,setting April 2022 as the time point of policy implementation.An interrupted time series(ITS)model was used to analyze the changes in the defined daily doses(DDDs),procurement amount and defined daily dose costs(DDDc)of selected and non-selected products in different levels of public healthcare institutions before and after the collection.Results 1)Overall,the DDDs of the selected products in the centralized procurement increased by 89.82%,the procurement amount increased by 24.02%,and the DDDc decreased by 34.66%.And the DDDs of non-selected products decreased by 53.26%;their procurement amount decreased by 74.24%;and their DDDc decreased by 44.89%.2)The DDDs of selected products in second and third level hospitals increased by 34.30%and 36.48%respectively,the procurement amount increased by 21.76%and 3.04%respectively;and the DDDs decreased by 28.05%and 36.94%respectively.Specifically,in primary healthcare institutions,the DDDs and procurement amounts for selected products increased by 777.29%and 658.89%,respectively,while DDDc decreased by 29.13%.Meanwhile,the DDDs of non-selected products in second and third level hospitals decreased by 79.94%and 75.69%respectively,the procurement amount decreased by 87.09%and 87.66%respectively,and the DDDc changed by 1.26%and-4.58%respectively.In primary care institutions,the DDDs and procurement amounts for non-selected products,increased by 561.85%and 1 007.74%,respectively,while the DDDc decreased by 2.58%.3)The ITS immediate effect showed a significant increase in DDDs for the selected products(β2=52.376,P=0.016)and a significant decrease in their DDDc(β2=-3.796,P=0.001).For non-selected products,however,the effects showed a decrease in DDDs(β2=-9.790,P=0.060),but not statistically significant,and a significant decrease in DDDc(β2=-3.357,P=0.024).The ITS short-term effects showed a decreased DDDs(β3=-4.301,P=0.054)for the selected products,but not statistically significant and a remarkable increase their DDDc(β3=0.620,P＜0.001);for the non-selected products,a significant decrease in DDDs(β3=-2.002,P＜0.001)and a slight increase in DDDc but not statistically significant(β3=0.059,P=0.590)were identified.Conclusions The purchasing behavior of the selected Chinese patent medicines shows a'rebound'trend over time,with DDDs rising promptly and then falling after policy implementation,accompanied by a rise in DDDc.This may be related to the change in the procurement composition ratio of products with different specifications.The primary medical institutions procurement behavior differs from that of the secondary and tertiary hospitals,mainly reflected in immediate procurement of a large number of non-selected products after the policy implementation,and tend to choose products with higher DDDc.Therefore,supervision should be strengthened to guide rational procurement,stabilize corporate expectations,and embody the principle of quantity-price trade-off.关键词
国家集采/中成药集中带量采购/中断时间序列模型Key words
national centralized volume-based procurement/centralized volume-based procurement of Chinese patent medicine/interrupted time series model分类
预防医学引用本文复制引用
安舒涵,刘韵绪,蔡梦娜,程子玮,崔丹..基于中断时间序列模型评估湖北省中成药集采对公立医疗机构中成药采购结构的影响[J].健康发展与政策研究,2025,28(5):517-523,539,8.基金项目
国家自然科学基金青年科学基金项目(72404098) （72404098）
