药占比管制方式及其学术争议
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摘要
医疗费用的持续上涨是全球卫生系统面临的挑战,而"看病贵"也是我国新医改试图缓解的首要问题。近年来,我国政府采用药占比管制方式控制过度用药现象,试图遏制医疗费用上涨之势,但此举的控费效果存有争议。药占比管制对于医疗供给侧的"以药养医"格局,或许有短期压制之效,但对遏制过度医疗并降低医疗费用的上涨不起作用,同时还极有可能对患者福利的其他方面造成了负面影响。全球性医疗控费之道在于通过医保支付制度改革重构供方的激励结构,使之形成通过控制成本以达成收入最大化的长效机制。
The rise of health expenditure was a challenge for governments globally. Expensive health care was a severe problem that had plagued China's health care reform. In recent years, the Chinese government had published drug proportion regulation to control health expenditure. However, the effect of the policy was controversial. The drug expenditure proportion regulation might have a short-term suppression effect on the "raising healthcare by medicine", but it could not curb excessive health expenditure and have a negative impact on patients. The right way to control health expenditure globally was to reconstruct the incentive structure of the supplier through medical insurance payment system reform, so as to form a long-term mechanism for controlling the costs to match the maximization of income.
The rise of health expenditure was a challenge for governments globally. Expensive health care was a severe problem that had plagued China's health care reform. In recent years, the Chinese government had published drug proportion regulation to control health expenditure. However, the effect of the policy was controversial. The drug expenditure proportion regulation might have a short-term suppression effect on the "raising healthcare by medicine", but it could not curb excessive health expenditure and have a negative impact on patients. The right way to control health expenditure globally was to reconstruct the incentive structure of the supplier through medical insurance payment system reform, so as to form a long-term mechanism for controlling the costs to match the maximization of income.
引文
[1]中华人民共和国卫生部.医院管理评价指南[M].北京:我国法制出版社,2008.
[2]刘桦,臧巧源.门诊药占比影响因素分析[J].我国医院用药评价与分析,2012,12(6):564-566.
[3] Organization for Economic Co-operation and Development.Health at a glance 2011[R]. Paris:OECD Publishing, 2011.
[4]中华人民共和国卫生部卫生经济研究所. 2010我国卫生总费用研究报告[R].北京:卫生部卫生经济研究所,2010.
[5]周枫,傅全威.从药占比看医院管理成效[J].解放军医院管理杂志,2013,20(5):488-488.
[6]严忠文.行政干预控制药占比的实践与体会[J].医药导报,2012,31(6):830-830.
[7]于娣,姜潮. 1993-2003年辽宁省省直医院药品比例变动分析[J].中国卫生经济,2005,24(10):31-33.
[8]吴珠明,杨天才,袁海玲.临床药师在降低药占比中的药学实践及效果评价[J].实用药物与临床,2017,20(10):1193-1196.
[9]朱恒鹏.管制的内生性及其后果:以医药价格管制为例[J].世界经济,2011(7):64-90.
[10]杨学文,邱波.片面强调“药占比”让看病更难[J].中外医疗,2010,29(23):192-192.
[11]张泽洪.住院医疗费用控制的系统规制与微观治理分析[J].财经论丛,2016,206(4):98-104.
[12]陈刚.药占比管制能控制医疗费用吗?——基于县级医院的理论与实证分析[J].财经论丛,2014,184(8):87-96.
[13]郭科,顾昕.过度医疗的解决之道:管制价格,强化竞争还是改革付费?[J].广东社会科学,2017(5):176-185.
[14]顾昕.走向公共契约模式——我国新医改中的医保付费改革[J].经济社会体制比较,2012(4):21-31.
[15] PREKER A S, LIU X, VELENYI E V. Public ends, private means:strategic purchasing of health services[M]. Wahington DC.:The World Bank, 2007.
[2]刘桦,臧巧源.门诊药占比影响因素分析[J].我国医院用药评价与分析,2012,12(6):564-566.
[3] Organization for Economic Co-operation and Development.Health at a glance 2011[R]. Paris:OECD Publishing, 2011.
[4]中华人民共和国卫生部卫生经济研究所. 2010我国卫生总费用研究报告[R].北京:卫生部卫生经济研究所,2010.
[5]周枫,傅全威.从药占比看医院管理成效[J].解放军医院管理杂志,2013,20(5):488-488.
[6]严忠文.行政干预控制药占比的实践与体会[J].医药导报,2012,31(6):830-830.
[7]于娣,姜潮. 1993-2003年辽宁省省直医院药品比例变动分析[J].中国卫生经济,2005,24(10):31-33.
[8]吴珠明,杨天才,袁海玲.临床药师在降低药占比中的药学实践及效果评价[J].实用药物与临床,2017,20(10):1193-1196.
[9]朱恒鹏.管制的内生性及其后果:以医药价格管制为例[J].世界经济,2011(7):64-90.
[10]杨学文,邱波.片面强调“药占比”让看病更难[J].中外医疗,2010,29(23):192-192.
[11]张泽洪.住院医疗费用控制的系统规制与微观治理分析[J].财经论丛,2016,206(4):98-104.
[12]陈刚.药占比管制能控制医疗费用吗?——基于县级医院的理论与实证分析[J].财经论丛,2014,184(8):87-96.
[13]郭科,顾昕.过度医疗的解决之道:管制价格,强化竞争还是改革付费?[J].广东社会科学,2017(5):176-185.
[14]顾昕.走向公共契约模式——我国新医改中的医保付费改革[J].经济社会体制比较,2012(4):21-31.
[15] PREKER A S, LIU X, VELENYI E V. Public ends, private means:strategic purchasing of health services[M]. Wahington DC.:The World Bank, 2007.