RESUMEN

A perennial question for the pharmaceutical industry has been excessive drug prices. To alleviate patients' burden of expensive medical bills and increase the affordability of medicines, China adopted the Two-Invoice System (TIS) in drug procurement for public medical institutions in 2017. In this paper, we study the impact of the TIS on pharmaceutical manufacturers' selling expenses. Using a Difference-in-Differences (DID) methodology and a sample of the A-share pharmaceutical manufacturing firms listed on the Shanghai Stock Exchange and Shenzhen Stock Exchange from the years 2014 to 2020, we find that the TIS leads to a significant increase in pharmaceutical manufacturers' selling expenses but gradually weakens over time. In addition, we further explore whether the impact of the TIS on pharmaceutical manufacturers' selling expenses is affected by the pharmaceutical manufacturers' previous drug circulation mode. The results indicate that the TIS could significantly increase the pharmaceutical manufacturers' selling expenses in the agency mode group. However, there is no evidence to support the TIS having the same effect in the direct sales office model group.

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OBJECTIVE： To provide reference for promoting the implementation of “two-invoice system” for drug purchase in medical institutions. METHODS： The function of confirmation， enquiry， statistics for “two-invoice system” of drug purchase order were added into relevant module of SPD （supply processing distribution） system to realize the management of “two-invoice system” data by means of information technology. By analyzing the data of the “two-invoice system” of Shanxi dayi hospital （our hospital） from Aug. 2017 to Jun. 2018， the effects of SPD system on “two-invoice system” of drug purchase in our hospital were introduced after the application of SPD system. The effects of SPD system were evaluated in respects of work efficiency， accuracy rate and resource saving， etc. RESULTS： SPD system was used for the management of “two-invoice system” to realize the information management of invoices. The time for checking “two-invoice system” information was shortened from 1.5 min/sheet to 0.1 min/sheet； the accuracy rate was increased from 95％ to 100％， and about 40 000 sheets of paper were saved each year. CONCLUSIONS： The application of SPD system in “two-invoice system” of drug purchase can improve the work efficiency， reduce the labor cost and reduce the waste of resources， it effectively improves the level of management in our hospital.

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OBJECTIVE: To provide suggestions for the development of drug circulation enterprises under "two invoice system".METHODS: By analyzing the negative effects of "multi invoice system" on drug circulation enterprises and positive effects of "two invoice system" on drug circulation enterprises, the development direction of drug circulation enterprises was investigated under "two invoice system".RESULTS & CONCLUSIONS: The "multi invoice system" formulates the high drug price, causes high drug circulation cost and is difficult to check drug quality. The "two invoice system" standardizes the order of drug circulation field, saves medical drug source, reduce drug price and kept capital chain stable. Under "two invoice system", drug circulation enterprises should actively adapt to the transformation of medical and pharmaceutical market, and reconstruct the chain of drug circulation. The integration of medical circulation network should be established between the relevant departments and various subjects. Drug circulation subjects should promote the check of ticket, account and goods, standardize the date of back account, implement reform stably.

RESUMEN

OBJECTIVE:To provide policy suggestion for the effective implementation of"two-invoice system"policy in the field of pharmaceutical distribution in China. METHODS:By analyzing current mode and problems of pharmaceutical distribution in China,the implementation background of"two-invoice system"was understood.At the same time,main points of"two-invoice system"policy were reviewed and summarized;the effect of the policy promotion and the potential risks could be inferred,and the corresponding policy suggestions were put forward. RESULTS & CONCLUSIONS:At present,there are many problems in the field of pharmaceutical distribution in China,such as low concentration of industry,confusion of circulation order,numerous relevant parties of interest chain and endless violations. The implementation of"two-invoice system"has realized the consistency of invoice flow,logistics and cash flow,through clearly defining production enterprises,strengthening invoice management of circulation enterprises and public medical institutions,guaranteeing drug supply in remote areas, constructing information platform,compressing circulation link,integrating circulation enterprises,implementing"point to an area"completely. It is conducive to effectively improve regulatory efficiency of government departments and the concentration of pharmaceutical distribution industry,and is expected to reduce the virtual high drug price through linkage with other policies. The"two-invoice system"policy framework of provinces(regions,cities)is adjusted according to practical situation of different districts based on the national policy,corresponding practice and exploration have been carried out. The"two-invoice system"has its own adaptability in the implementation process,which may cause drug shortages,local protectionism and new interest chain. The author puts forward the countermeasures,such as timely assessment of the implementation of the"two-invoice system",taking various measures to ensure the supply of drugs,setting up appropriate policy transition period,and strengthening coordination and cooperation among relevant departments so as to response to potential risks during the implementation of the"two-invoice system"policy.