In the face of clinical demand from infected patients and the tug of war over antibiotic resistance control, the National Health Insurance Administration (NHI) has adopted a two-pronged approach of incentives and controls to maintain the diversity of antibiotic drugs in the country. In addition, in order to encourage the development of new antibiotics, NHI has switched to pricing by reference to international drug prices, instead of using the therapeutic dose ratio method.

In the past, new antibiotics were priced with reference to the prices of old antibiotics. However, antibiotics are old drugs and their prices are low after the patent period, so if new drugs are priced on this basis, it will not reflect the value of new drugs and is not conducive to research and development.

"We hope to make the drugs developed in China more competitive and to obtain good prices both at home and abroad. Li added that after preliminary calculations, if the drug is subjected to a certain scale of clinical trials and pharmacoeconomic studies in China, the maximum health insurance premium can be increased by 10 per cent; if the drug is more effective, safer, more convenient and developed for children than the reference drug, the maximum health insurance premium can be increased by 15 per cent.

On the other hand, the retention of existing antibiotics is also a challenge. The first antibiotic to be discovered, penicillin, has been widely used and has developed resistance.

NHI's main goal is to provide the best possible service to its customers, and to provide them with the best possible service. When adjusting the prices of covered drugs, the Health Insurance will not only take into account the market price, but also the reasonable cost of the drugs, and will not adjust a certain percentage of the prices, and will provide a lower price limit and an overall price adjustment to ensure the quality and reasonable pricing of drugs for the public.

In terms of control, according to the trend of quality monitoring results, the rate of outpatient antibiotic use from 2017 to 2012 dropped from 10.03% to 9.52%, with the rate of use of commonly used antibiotics such as quinolones and aminoglycosides in primary clinics also dropping from 0.82% to 0.58%, indicating that the overall use of outpatient antibiotics is well controlled.

The use of antibiotics for simple hernia, thyroid surgery and mastectomy, which are not susceptible to infection during surgery, is in principle exempted, but in the past two years, the rate of post-operative antibiotics for these types of clean-up surgeries for more than three days has increased considerably.

The current requirement to administer first-line antibiotics for seventy-two hours has led to calls from clinical infectologists to downgrade the use of antibiotics to reduce resistance, to give broad-acting antibiotics first when a patient has an infection, to switch to narrow-acting antibiotics when the corresponding bacteria are detected, and to switch from multi-drug to single-drug use. The relevant medical societies should consolidate their consensus and propose treatment guidelines as soon as possible to facilitate follow-up discussions.