Drug Procurement Research Articles

Evaluation of E-Catalogue Drug Procurement with E-Purchasing and Non-E-Purchasing Methods at RSUD Dekai, Yahukimo Regency, Papua Pegunungan Province, Year 2022

Background: In the healthcare service system in the era of health insurance coverage (JKN), the government implemented the drug procurement process based on an electronic catalogue (E-Catalogue) through e-purchasing and non-purchasing methods. The implementation of this system will affect the efficiency of procurement and availability of drugs, which can be assessed through the perception of pharmacists and the implementation of procurement. This study aims to evaluate human resources, budget, regulations, facilities and infrastructure; drug needs planning, drug ordering, contract agreements, delivery or distribution, and the level of drug availability after the implementation of drug procurement with e-purchasing and non-purchasing methods. Methods: This study was conducted at Dekai Regional General Hospital (RSUD), Yahukimo Regency, from January to February 2023. A qualitative case study was conducted by interviewing five informants as respondents. The informant selection was performed using purposive sampling. The data were analyzed using interactive analysis through data collection and conclusion drawing. Result: The results of this study show that human resources in terms of quantity are still insufficient, the budget is sufficient, but there is still unused funding, the regulations regarding e-purchasing procurement have been understood and implemented, and the facilities and infrastructure regarding internet networks are unstable. Drug needs planning using consumption methods and does not have an Integrated Drug Planning Team, drug ordering takes a long time to be respondent to by suppliers, drug distribution takes a long time from suppliers and the expiration dates do not match the contract, resulting in a shortage of certain drugs at RSUD Dekai. The availability of drugs is not in accordance with the indicators set by the Directorate General of Pharmacy and Medical Devices. In response to this condition, the Yahukimo Regency Government, represented by the Head of RSUD Dekai, decided to use the non-purchasing method for E-Catalogue drug procurement. Conclusion: In conclusion, the study reveals several challenges and issues in the implementation of drug procurement using e-purchasing and non-e-purchasing methods at RSUD Dekai, Yahukimo Regency. This includes a shortage of human resources, unused funding in the budget, unstable facilities and infrastructure, suboptimal drug needs planning, delays in drug ordering and distribution, a shortage of certain drugs, and insufficient drug availability. Keywords: Evaluation of drug procurement, e-catalogue, e-purchasing, non-e-purchasing

Effect of a national antibiotic stewardship intervention in China targeting carbapenem overuse: An interrupted time-series analysis

To assess trends and patterns of carbapenem use and to evaluate the effects of a nationwide antibiotic stewardship policy to reduce carbapenem overuse. In this quasi-experimental study, using longitudinal data from the national drug procurement database and interrupted time-series analyses with carbapenems as the intervention group and possible carbapenem substitutes as the comparison group, we evaluated the effects of a national stewardship policy on carbapenem consumption and expenditures, by region and types of healthcare institutions. The carbapenem procurement volume declined by -28.8% (95% CI -35.0 to -22.6) (-334.4 thousand defined daily doses [DDDs] per month), and carbapenem expenditures showed a relative reduction of -38.1% (-43.9 to -32.2). The gap between the use of carbapenems and each drug in the comparison group narrowed after the policy intervention, with an increase in tigecycline use (14.9 thousand DDDs [10.8-18.9]) and a slower decrease in use of certain third-generation cephalosporin combinations (-85.7 [-143.0 to -28.4]), penicillin combinations (-200.9 [-421.4-19.6]), and fourth-generation cephalosporins (-116.9 [-219.8 to -14.0]). Consumption was highest during the pre-policy period, and declines were largest following the intervention in the eastern region (-32.1%, -39.8 to -24.4) and among tertiary hospitals (-266.2 [-339.5 to -192.9] thousand DDDs per month). This population-level drug utilization research represents the first comprehensive evaluation of the effectiveness of China's nationwide carbapenem stewardship. The national policy targeting carbapenem prescribing has led to a sustained reduction in carbapenem use with limited substitution. Effects varied geographically and were concentrated in tertiary and secondary hospitals.

Cost-effectiveness analysis of ceftazidime avibactam versus colistin in carbapenem-resistant enterobacteriaceae in Iran

IntroductionCeftazidime avibactam (CA) is an effective treatment against carbapenem-resistant Enterobacteriaceae (CRE), but its cost-effectiveness is unclear. This study was performed to evaluate the cost-effectiveness of CA against the best available treatment colistin (Col) for patients with CRE-related infections in Iran.MethodologyA model of a decision tree was designed to evaluate the cost-effectiveness of CA in CRE patients over a period of 5 years. The Iran health system was the perspective of the study, and the discount rates of 5.8% and 3% were considered for the data of cost and utility, respectively. The clinical inputs were obtained from a prospective observational study. We established the costs of medical services and medical tariffs of Iran’s health system, and obtained the rate of medical service resources used by patients from specialists. The results of this model included the quality-adjusted life years (QALYs), increasing costs, and incremental cost-utility ratio (ICUR). We also performed the deterministic and probabilistic sensitivity analyses.ResultsCA reduced the burden of related to treatment failure and the need for treatment of nephrotoxicity and chronic failure, whereas, the costs related to drug procurement and long-term care (due to longer survival) increased. Treatment with CA versus Col resulted in a 53% increase in QALYs and $425 in costs, leading to an ICUR equal to 798 $/QALYs. Sensitivity analyses proved the model’s strength and indicated that the cost-effectiveness of CA can reach 88% when paying 1111 $/QALY. Budget impact analysis estimated CA regimen will increase the health system costs by $1,270,462 in 5 years.ConclusionIn Iranian settings, CA can significantly increase the quality of life and patients’ survival; therefore, in comparison to the Col drug regimen, CA is a cost-effective strategy.

Sensible Factors that Need Strategic Change to Improve the Medical Drug Availability across Healthcare Institutions in Sri Lanka

Abstract : Access to medicines remains a major obstacle for people across the world to maintain their health at a desired level. Ensuring an adequate supply of safe and effective drugs of acceptable quality is an integral part of the health policy of Sri Lanka. The medical supplies division is the sole organization responsible for providing all pharmaceuticals, surgical items, laboratory items, radioactive items, and printed materials for government sector healthcare institutions. The establishment of an independent drug regulation authority, the Declaration of a national essential drug list, the establishment of a separate drug procurement entity, Pooled procurement, digitalization of drug management, and expansion of drug storage capacity are key strategies that have been implemented by the Ministry of Health to minimize the drug shortages across the healthcare institutions of Sri Lanka. Despite the implemented strategies drug shortage continue to evolve from time to time as a public outcry in the media. This case study describes the critical issues that need to look at more strategically to improve drug availability.

Influenza transmission during COVID-19 measures downscaling in Greece, August 2022: evidence for the need of continuous integrated surveillance of respiratory viruses.

After the near absence of influenza and other respiratory viruses during the first 2 years of the COVID-19 pandemic, an increased activity of mainly influenza A(H3N2) was detected at the beginning of August 2022 in Greece on three islands. Of 33 cases with respiratory symptoms testing negative for SARS-CoV-2 with rapid antigen tests, 24 were positive for influenza: 20 as A(H3N2) subtype and four as A(H1N1)pdm09 subtype. Phylogenetic analysis of selected samples from both subtypes was performed and they fell into clusters within subclades that included the 2022/23 vaccine strains. Our data suggest that influenza can be transmitted even in the presence of another highly infectious pathogen, such as SARS-CoV-2, with a similar transmission mode. We highlight the need for implementing changes in the current influenza surveillance and suggest a move from seasonal to continuous surveillance, especially in areas with a high number of tourists. Year-round surveillance would allow for a timelier start of vaccination campaigns and antiviral drugs procurement processes.

MEDICINES PLANNING AND PROCUREMENT MANAGEMENT AN ACADEMIC HOSPITAL IN YOGYAKARTA, INDONESIA: A QUALITATIVE STUDY

Inventory management remains a critical issue for hospital pharmacies. Thus, there is a need for pharmaceuticals to meet economic resources. Moreover, the decision to make drug requests available should be considered, and the complexity of the problem lies in the random nature of and the various constraints that must be considered in any decision. This study aimed to analyze drug management during the planning and procurement stages of medicine in a teaching hospital in Yogyakarta. The qualitative method was used to his type of research is descriptive-analytical with a case study design of one of the public, academic hospitals in the Yogyakarta area. Data collection was conducted through interviews using a content analysis approach. The analysis technique was carried out by reducing data, analyzing data, identifying themes, and extracting data interpretation with the help of NVIVO 12 software. Overall, interviews were conducted with six participants to obtain information on drug management during the planning and procurement stages in the hospital, following the standards of home pharmacy services. The stages also included budget allocation by volume of services, increasing the competence of human resources, which supports the improvement of drug management performance, implementation of e-prescribing to facilitate monitoring evaluation, and availability of complete standard operating procedures. However, the accuracy of drug planning still needs to be improved so that an integrated management information system can support optimal drug management in a teaching hospital pharmacy installation. Keywords: Drug management, drug planning, drug procurement, public academic hospital

Literature Review: Pengelolaan Manajemen Logistik Dalam Pengadaan Obat Di Rumah Sakit Di Jabodetabek

The background of this Literature Review is based on stagnant events and stockouts of certain drugs at health care facilities in Jabodetabek which have had a detrimental impact on the location concerned. This study is used to analyze the management of drug logistics management in health care facilities in Jabodetabek. The Literature Review method uses 7 article sources from Google Scholar using the keywords drug procurement, logistics management, and hospital. The results obtained were that in several research locations there were several problems such as drug reserves, drug distribution, to the withdrawal and destruction of drugs which were directly related to the implementation of logistics management. The conclusion that can be drawn is that the management of logistics management of medicines in health care facilities in Jabodetabek is one of the conditions that must be carried out by every health service and is useful in providing good quality health services. If logistics management is carried out properly, this can increase the effectiveness and efficiency of services in health facilities and special attention is needed from various sectors to carry out logistics management of medicines in health care facilities according to existing standards.

Global application of National Comprehensive Cancer Network resource-stratified guidelines for systemic treatment of colon cancer: a population-based, customisable model for cost, demand, and procurement.

Resource-stratified guidelines (RSGs) can inform systemic treatment decisions in the face of limited resources. The objective of this study was to develop a customisable modelling tool to predict the demand, cost, and drug procurement needs of delivering National Comprehensive Cancer Network (NCCN) RSG-based systemic treatment for colon cancer. We developed decision trees for first-course systemic therapy for colon cancer based on the NCCN RSGs. Decision trees were merged with data from the Surveillance, Epidemiology, and End Results programme, the International Agency for Research on Cancer's GLOBOCAN 2020 national estimates for colon cancer incidence, country-level income data, and data on drug costs from Redbook (USA), the Pharmaceutical Benefits Scheme (Australia), and the Management Sciences for Health 2015 International Medical Products price guide to estimate global treatment needs and costs, and forecast drug procurement. Simulations and sensitivity analyses were used to explore the effect of scaling up services globally and the effect of alternative stage distributions on treatment demand and cost. We generated a customisable model, in which estimates can be tailored to local incidence, epidemiological, and costing data. First-course systemic therapy is indicated in 608 314 (53·6%) of 1 135 864 colon cancer diagnoses in 2020. Indications for first-course systemic therapy are projected to rise to 926 653 in 2040; the indications in 2020 might be as high as 826 123 (72·7%), depending on stage distribution assumptions. Adhering to NCCN RSGs, patients with colon cancer in low-income and middle income countries (LMICs) would constitute 329 098 (54·1%) of 608 314 global systemic therapy demands, but only 10% of global expenditure on systemic therapies. The total cost of NCCN RSG-based first-course systemic therapy for colon cancer in 2020 would be between about US$4·2 and about $4·6 billion, depending on stage distribution. If all patients with colon cancer in 2020 were treated according to maximal resources, global expenditure on systemic therapy for colon cancer would rise to around $8·3 billion. We have developed a customisable model that can be applied at global, national, and subnational levels to estimate systemic treatment needs, forecast drug procurement, and calculate expected drug costs on the basis of local data. This tool can be used to plan resource allocation for colon cancer globally. None.

Evidence-based cost estimation of essential medicines for pediatric cancer care in Peru.

e18533 Background: Inequitable access to essential medicines is a large contributor to the inferior outcomes experienced by children with cancer living in low-and-middle-income countries. In collaboration with the Peruvian Ministry of Health and the Pan American Health Organization, we aimed to predict annual aggregate drug costs as well as primary cost drivers for treating Peruvian children with cancer to inform more accurate and efficient drug procurement. Methods: FORxECAST is a pediatric cancer-specific model that projects required drug quantity and cost for 18 common pediatric cancers, drawing on internationally adopted standard treatment protocols. It is customizable to geographic region, local cancer incidence, stage distribution, and domestic drug prices. To estimate aggregate costs utilizing FORxECAST, Peruvian incidence, stage at diagnosis, and per-unit drug prices were provided by local stakeholders. FORxECAST-embedded standardized data for country-specific age, sex, and BSA sourced by the World Health Organization and the Global Childhood Cancer Microsimulation Model were used. To provide comparative analyses, aggregate costs adapted for Peruvian incidence were calculated utilizing reference drug prices available through the Management Sciences for Health (MSH) International Medical Products Price Guide. Results: FORxECAST projected Peruvian aggregate drug costs to be USD$1,672,795.47 annually, which was 47% less than expected by median MSH prices and represents 4% of the total Peruvian cancer care budget. 19 of 22 medicines were cheaper on a per-unit basis relative to MSH. Dactinomycin was the costliest per-unit agent but contributes to less than 2% of the overall budget due to low aggregate demand. Primary cost drivers were 6-mercaptopurine, intravenous methotrexate, and asparaginase, due to the large quantities needed for treatment of Peru’s most common pediatric cancer: acute lymphoblastic leukemia. However, because of their low per-unit prices, sensitivity analyses showed that the annual drug budget would remain lower than predicted by MSH, even if the per-unit price for these 3 agents increased by 50% (USD$2,431,550.71 vs. USD$3,099,401.31). Conclusions: The cost of procuring accurate quantities of essential pediatric cancer medicines to meet population-level need is a small percentage of the total cancer budget for the Peruvian healthcare system. Given the potential impact that improved drug access could have on pediatric cancer survival, these data can justify health systemic efforts to effectively earmark funds for pediatric cancer care and minimize risks of stockout. Our analyses also demonstrate the importance of incorporating context-specific drug prices when estimating domestic budget impact. Next steps include comparative analyses with neighboring health systems in Latin America to assess regional price variation and inform opportunities for pooled procurement.

Trends and duration of antibacterial drug supply chain issues in the United States, January 2017–June 2022

Background: Drug manufacturing and distribution is a complex, global process. The global drug supply chain is prone to disruptions associated with geopolitical issues, trade, civil unrest, severe weather, and pandemics, all of which have the potential to affect medication supply and result in drug shortages. To our knowledge, the extent to which the supply of antimicrobials is threated due to disruptions in the drug supply chain in the United States is unknown. We examined trends and duration of disruptions to the drug supply chain for antimicrobials. Methods: Manufacturer reports of supply disruptions were extracted from the Food and Drug Administration (FDA) and the American Society for Health-Systems Pharmacists (ASHP) websites and merged on the agent-formulation level. For each month of the study period, a drug was considered to have an active supply chain issue if an FDA or ASHP shortage or recall report overlapped with that month for ≥15 days, or if a discontinuation had occurred within the previous 3 months. Total months of supply chain issues were summed for antimicrobials overall, at the agent formulation , and class levels. A Mann-Kendall test was used to determine the significance of trends in supply-chain issues. Results: Of 105 antimicrobials purchased in the United States, 74 (70%) had a supply-chain issue for ≥1 month from January 15, 2017, to June 30, 2022. Combined, the 74 agents had 1,611 total months of supply-chain issues over the 66-month study period. Agents from the penicillin class were most frequently affected (ie, 80% of penicillins had supply-chain issues for 206 months), but cephalosporins had supply-chain issues for the longest duration (66% of cephalosporins for 653 months). From 2017–2021, supply-chain issues decreased significantly for penicillins and quinolones (tests of trend, P = .01 and .02, respectively). No trend was identified for the other classes or antimicrobials overall. Interestingly, supply-chain issues for most classes did not increase with seasonal increases in antimicrobial use. Also, supply-chain issues affected 33 antimicrobial agents for at least half of the study period, and supply-chain issues affected ampicillin-sulbactam, cefotaxime, ceftazidime, cefotetan, cefepime, clindamycin, vancomycin for 100% of the study period. Conclusions: Drug supply-chain issues commonly affect antimicrobials and are not improving for most classes. Drug supply-chain issues cause significant strain on healthcare, including drug procurement, access to optimal therapy, and poses challenges to prescribing and antimicrobial stewardship. To decrease the threat to the antibacterial drug supply, action should be taken to strengthen the drug supply chain to ensure access to these essential medicines.Disclosures: None

Enhancing colon cancer care in restricted-resource settings.

Colon cancer ranks third among the most frequently diagnosed cancers worldwide and was projected to claim more than 900 000 lives in 2020, according to the International Agency for Research on Cancer's GLOBOCAN data. 1 Sung H Ferlay J Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71: 209-249 Crossref PubMed Scopus (30514) Google Scholar The overall survival rate for colon cancer varies on the basis of clinical and pathological factors, such as staging, performance status, and geographical location. Despite the lower incidence, survival of colon cancer in low-income and middle-income countries (LMICs) is considerably reduced compared with high-income and very-high-income countries, which is probably attributable to disparities in diagnostic and treatment access. Considering expected increases in colon cancer incidence due to demographic and dietary changes, there is an urgent and unmet need to enhance cancer care in LMICs through better resource allocation and cost-effective interventions to achieve optimal value for money and reduce health inequalities. 2 Khan SZ Lengyel CG Challenges in the management of colorectal cancer in low- and middle-income countries. Cancer Treat Res Commun. 2023; (published online April 6.)https://doi.org/10.1016/j.ctarc.2023.100705 Crossref Scopus (0) Google Scholar Global application of National Comprehensive Cancer Network resource-stratified guidelines for systemic treatment of colon cancer: a population-based, customisable model for cost, demand, and procurementWe have developed a customisable model that can be applied at global, national, and subnational levels to estimate systemic treatment needs, forecast drug procurement, and calculate expected drug costs on the basis of local data. This tool can be used to plan resource allocation for colon cancer globally. Full-Text PDF

Does China's centralized volume-based drug procurement policy facilitate the transition from imitation to innovation for listed pharmaceutical companies? Empirical tests based on double difference model.

Introduction: The normalized implementation of the centralized volume-based procurement policy for pharmaceuticals is a concerted push for supply-side structural reform of the pharmaceutical industry in China. The impact of the centralized drug procurement policy on pharmaceutical companies' transition from imitation to innovation is investigated to test whether a positive effect occurs in the innovation landscape of the pharmaceutical market. Methods: The double difference method and a series of robustness tests were used based on data from a sample of listed pharmaceutical companies in Shanghai and Shenzhen A-shares between 2015 and 2021. Results: The study found that the centralized drug procurement policy significantly contributed to the increased intensity of innovation input in the Chinese pharmaceutical industry. In terms of regional and firm nature heterogeneity, it was found that firms in the seven provinces belonging to the three economic regions had a better increase in innovation input intensity than other regions. Firms of state-owned nature had a better increase in innovation input intensity than private companies. The mechanism test found a partial mediating effect of nearly 10% for the cost of sales rate on the innovation input intensity of listed companies and a negative mediating effect on corporate operating profit. Discussion: Further research found that the effect of centralized drug procurement policy on the improvement of innovation quality of listed pharmaceutical companies was evident. The innovation development of Chinese pharmaceutical companies no longer focused on the accumulation of innovation quantity.

Influence of national centralized drug procurement policy on the use of antibiotics in pediatric inpatients

ObjectiveTo explore the safety and efficacy of centrally procured antimicrobial drugs in the pediatric population, the impact of centrally procured policies on pediatric antimicrobial drug use and drug costs, and to make recommendations for hospitals to balance better the relationship between centralized procurement policies and antimicrobial drug management. MethodsThe data on the use of antimicrobial drugs and adverse reactions reported by inpatients in our hospital for half a year before and after centralized drug procurement were collected. Changes in the intensity, structure and utilization rate of antibacterial drugs, incidence of adverse reactions and drug costs, average length of stay, cure rate and improvement rate of patients before and after centralized procurement were compared. An electronic questionnaire survey was conducted on the cognition of clinical medical staff on the use of antibacterial drugs before and after centralized drug procurement. Results1. Centralized antibacterial drugs are widely used in our hospital, and there is no obvious difference in safety and effectiveness from non-centralized drugs. 2. The centralized procurement policy significantly reduces antimicrobial drug costs but increases non-antimicrobial drug costs. 3. The intensity and utilization rate of antimicrobial drugs has stayed the same after the centralized procurement policy, but the drug structure changed. ConclusionThere is still some prejudice among medical professionals and the public towards centralized antibacterial drugs, and positive guidance should be strengthened. The implementation of the centralized procurement policy needs corresponding management measures to ensure the rational use of antimicrobial drugs in clinic.

Comparative Study on Low-Carbon Strategy and Government Subsidy Model of Pharmaceutical Supply Chain

Despite the growing urgency to curb carbon emissions worldwide, the healthcare industry, particularly the pharmaceutical industry, has received little attention from the sustainability community in terms of its contribution to the global carbon footprint. This paper constructs a differential game model of the secondary pharmaceutical supply chain consisting of pharmaceutical enterprises and medical institutions in the context of centralized drug procurement policy, considering the effects of health insurance reimbursement and consumers’ low-carbon preferences, and compares and analyzes the feedback equilibrium strategies of low-carbon inputs and marketing efforts, supply chain profits, and social welfare levels under four government subsidy models and further discusses them with arithmetic examples. The results illustrated that government subsidies have a significant impact on the low-carbon investment of pharmaceutical enterprises and the low-carbon marketing of medical institutions; subsidies for pharmaceutical enterprises can significantly increase the low-carbon investment and profit level of pharmaceutical enterprises; subsidies for medical institutions can effectively promote the implementation of the “zero-rate” policy and the realization of the emission reduction target under the centralization policy of medical institutions, increase the market demand for low-carbon drugs, and thus gain higher profits; the dual-subsidy model of the government brings higher social welfare than the single-subsidy model, and under a reasonable subsidy ratio, the profit and social welfare of the whole supply chain can be maximized.

Analisis Sediaan Farmasi Di Indonesia Dalam Menunjang Sistem Kesehatan Nasional: A Systematic Review

Pharmaceutical preparations is a term that covers all forms of pharmaceutical preparations ranging from drugs, medicinal ingredients, traditional medicines to cosmetics. This term has been regulated in Government Regulation of the Republic of Indonesia Number 51 of 2009 concerning Pharmaceutical Work. Management of pharmaceutical preparations is a cycle of activities starting from the selection, scheduling needs, receiving, storage, distribution, destruction and withdrawal, control, which is necessary for pharmaceutical service activities. The method used in this study is a Systematic Literature Review (SLR) of ten national journals which were obtained using online database facilities via the Google Scholar, Refseek, and Sciencegate pages. Journals were selected based on publications published between 2018 and 2023. There were obstacles in the implementation of pharmaceutical preparations, including planning that was still conservative, from delays in drug procurement in demand and distribution, resulting in empty drug supplies. However, not all aspects are problematic. There are many other aspects of the mechanism of pharmaceutical preparation that are carefully programmed and procedurally appropriate. This matter needs to be done routinely and continuously, and with written commitments for pharmaceutical preparations in Indonesia in supporting SKN it can be categorized as quite good.

Research on the Coupling of Centralized Drug Procurement based on Blockchain Technology

Centralized drug procurement is an important measure to alleviate the high cost of drugs for the masses. However, due to the difficulties in platform interaction, low transparency, privacy disclosure and other problems of centralized drug procurement, the efficiency of drug circulation is low and violations emerge in an endless stream. Blockchain technology is characterized by decentralization, tamper-proof, autonomy, etc. Combined with the features of numerous participants in centralized drug procurement and large amount of data processing, a framework for centralized drug procurement based on super ledger is built, and identity registration chain code, price negotiation chain code, and contract performance chain code are designed to realize centralized drug procurement autonomy, openness, transparency, and traceability. It aims to improve centralized drug procurement and ensure transparency and accountability throughout the drug supply chain in order to maximize the effect of lower prices brought about by healthcare reform.

Optimalisasi Manajemen Pelayanan Gerai Sehat di Layanan Kesehatan Cuma-Cuma (LKC) Dompet Dhuafa Jawa Tengah

Free Health Service (LKC) Dompet Dhuafa Central Java is a health program that provides free health services for underprivileged communities. However, to ensure optimal service, it is necessary to optimize the service management of healthy outlets at LKC. The purpose of this study is to identify factors that influence the optimization of healthy outlet service management in LKC and design a theoretical framework that can help in improving the quality of health services in LKC. This study used a qualitative approach with data collection techniques through in-depth interviews. The results showed that the factors that affect the optimization of healthy outlet service management at LKC include: human resource management, drug and medical device procurement management, data management, and community relations management. From the results of the analysis, a theoretical framework was designed which includes six components, namely: planning, organizing, procurement, implementation, supervision, and assessment. This theoretical framework can help in improving the quality of health services in LKC by providing systematic and comprehensive guidance for LKC management. In conclusion, optimization of healthy outlet service management at LKC needs to be carried out continuously to improve the quality of health services. The theoretical framework designed can be used as a reference for LKC management in improving and developing health programs for underprivileged communities.

Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level.

Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.

Analysis of the accessibility of cancer patients to drug provision at the outpatient stage of treatment in the Russian Federation

Introduction. The outpatient stage of management of patients with malignant neoplasms does not have additional funding. Availability of patients to prescribed drugs on outpatient review of funds allocated by the Russian Federation for the purchase of drugs based upon budgets providing for benefits. In connection with the study of the problem of procurement of drugs for the treatment of patients with malignant neoplasms in outpatient treatment, an urgent task arises, the solution of which is the essence of the development of a study on the planning of drug treatment of patients. 
 Purpose is to study the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment in the Federal Districts of the Russian Federation.
 Material and methods. To study the availability of patients with malignant neoplasms, the supply of medicines for the treatment of patients with malignant neoplasms in 2019 and 2020 to hospitals purchased at the expense of the constituent entities of the Russian Federation and the federal budget in the Federal Districts was analyzed. We compared the funds spent between the subjects of the Russian Federation in terms of patients with a first diagnosis. To compare the provision of patients with drugs, we recalculated the amount of funds spent on the purchase of drugs per patient with a newly diagnosed oncological disease living in the Federal District.
 Results. Significant differences were found in the provision between the Federal Districts, reaching almost four times the size.
 Limitations. When studying the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment, purchases of all Federal Districts of the Russian Federation at the expense of both the subjects of the Russian Federation and the federal budget were analyzed, which is a sufficient reference sample.
 Conclusion. A significant difference in the amount allocated per patient both from the funds of the regional and federal budgets, with the newly diagnosed malignant neoplasm in the Federal Districts creates unequal conditions for treating patients on an outpatient basis.

Centralized Drug Procurement and asymmetric earnings management: Evidence from China

Using a difference-in-differences approach, we study the impact of Centralized Drug Procurement (CDP) on the earnings management of pharmaceutical firms in China. We find an asymmetric earnings management effect that winning firms manage earnings upward, whereas losing firms manage earnings downward. Further analyses show that upward earnings management by winning firms is stronger for firms with more analysts following, shares pledged, and strong competition, whereas downward earnings management by losing firms is more pronounced for young firms, non-state-owned enterprises, and high government subsidy firms.