中国药品价格管制机理研究
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摘要
药品价格问题关系到千家万户的生活与健康,药品价格管制的目的是控制药品费用的过快增长,以保证药品价格合理和药品供给的公平性。本文通过对中外药品价格管制的主要内容、管制效果的比较,结合中国医药卫生体制改革的实际,从定性分析与定量分析的结合上对中国药品价格形成机制、药品费用控制机制、药品价格管制下医疗服务机构激励机制进行了系统研究,并相应地对中国药品价格管制提出了政策建议。全文主要研究内容如下：
(1)文章在分析了药品价格影响因素、形成环节及利益分布的基础上,建立了药品成本加成定价模型、特征向量价格模型及三方信息博弈模型,指出药品价格的形成受供方、需方和政策导向等因素的影响,形成了多方利益主体的利益分配格局。并重点论述了信息博弈模型中药品价格形成是监管者、医药利益集团和政府三方博弈的结果。
(2)文章设计了药品费用控制机制基本模型,论述了供需双方控制机制、医院控制机制,以及实现这些机制的有效措施。通过分析得出需求方的健康边际收益等于其自付比例,因此自付比例成为需求方过度消费的约束；医生的单位补偿与供给方的劳动边际效果成正比,单位补偿越高,供给方愿意付出劳动就越多。个人在消费药品数量时不仅要考虑实际消费的药品数量,而且需要考虑个人需要承担的比例,而这两个方面的问题又是相互影响的。
(3)文章结合国内外实际,讨论了医药分家或医药不分家两种管理体制问题。说明医药分家并不是控制药品价格和药品费用的充分必要条件。在对医生行为进行分析并建立了医生行为基准模型的基础上,论证了医药费用上涨与药品价格管制的理论模型,分析了在完全竞争与管制下出现高价格的条件下,药品价格与医疗服务价格对社会的总福利的影响及中国实施药品价格管制的效果,并且论证J’即使在医药不分家的情况下,只要制定合理的药品价格与医疗服务价格,同样也能使社会总福利水平达到最大化。
(4)针对中国政府药品价格管制中存在的问题,从综合运用政府管理与市场机制、建立健全药品定价体系、推进相关领域配套改革等方面提出了改善药品价格管制的政策建议。
药品价格管制是一个复杂的系统工程,本文的研究旨在为改革药品管制机制提供辅助决策思路,而一个科学的医药管控体系的建立仍有待各个领域共同做出不懈的努力。
Medicine prices are related to life and health of thousands of millions of families. Medicine price regulation is intended to control fast increase of medical expenses, keep medicine price reasonable and to keep medicine supply fair. Through comparing main contents and effectiveness of medicine price regulation in China and other countries, in connection of Chinese medical system reforms, the thesis studies Chinese medicine price forming mechanism, medicine price controlling mechanism and incentive mechanism to medical service organizations under price regulation. Finally, it suggests some policies of related price regulation.
(1) Medicine prices are affected by R&D expenses, market development expenses, manufacturing costs, treatment progressiveness, market competitiveness, medical insurance as well as national situations and other factors. The thesis discusses medicine cost-plus pricing model, feature vector price model and trilateral information game model, among which it concludes that in the information game model, the medical prices are results from gaming between supervisors, interest groups and the government.
(2) On the basis of analyzing factors affecting medicine prices, pricing links as well as interest distribution, the thesis designs the basic medicine expenses controlling model, supplier-demander bilateral controlling mechanism, hospital controlling mechanism, as well as effective measures to realize the mechanisms. Through analysis, it concludes that demanders'health marginal return equals to his copayment ratio and accordingly the copayment ratio becomes restrainer for his over-consumption. A doctor's organizational compensation is proportionate to supplier's labor marginal effects, that is, the more he is compensated by his organization, the more labor the supplier is willing to pay. Therefore, an individual must consider not only the necessary medicine consumption amount, but also the copayment ratio, which are influencing each other.
(3) Medicine-hospital separation is not the necessary and sufficient conditions to control medicine price and costs. The thesis analyzes and establishes doctors' behavioral standardizing model. Then, it demonstrates a theoretical model of medical expense increase and medicine price regulation. It discusses the influences of high medicine prices on total social welfare under perfect competition and price regulation. It proves that even under non-separation of medicine and hospital, if medicine and services are priced reasonably, the total social welfare will be optimized.
(4) The government's price regulation is ineffectual. Prices set by government are dropping considerably while prices of medicines not set by government or those so-called "new medicines" are not dropping or even rising. It is medicine structure and amount instead of medicine prices that contribute more to medicine expense rise.
Chinese medicine price regulation is being improved, which is a large systematical engineering. Thus, a single price regulation will never result in effectively controlling medical expenses, which needs other supporting policies and favorable market conditions, such as perfect medical security system, the national basic medicine system, reasonable compensating mechanism for medical institutions, and so on. Or the medicine price regulation will surely result in governmental failure, ending in vain.
(1)文章在分析了药品价格影响因素、形成环节及利益分布的基础上,建立了药品成本加成定价模型、特征向量价格模型及三方信息博弈模型,指出药品价格的形成受供方、需方和政策导向等因素的影响,形成了多方利益主体的利益分配格局。并重点论述了信息博弈模型中药品价格形成是监管者、医药利益集团和政府三方博弈的结果。
(2)文章设计了药品费用控制机制基本模型,论述了供需双方控制机制、医院控制机制,以及实现这些机制的有效措施。通过分析得出需求方的健康边际收益等于其自付比例,因此自付比例成为需求方过度消费的约束；医生的单位补偿与供给方的劳动边际效果成正比,单位补偿越高,供给方愿意付出劳动就越多。个人在消费药品数量时不仅要考虑实际消费的药品数量,而且需要考虑个人需要承担的比例,而这两个方面的问题又是相互影响的。
(3)文章结合国内外实际,讨论了医药分家或医药不分家两种管理体制问题。说明医药分家并不是控制药品价格和药品费用的充分必要条件。在对医生行为进行分析并建立了医生行为基准模型的基础上,论证了医药费用上涨与药品价格管制的理论模型,分析了在完全竞争与管制下出现高价格的条件下,药品价格与医疗服务价格对社会的总福利的影响及中国实施药品价格管制的效果,并且论证J’即使在医药不分家的情况下,只要制定合理的药品价格与医疗服务价格,同样也能使社会总福利水平达到最大化。
(4)针对中国政府药品价格管制中存在的问题,从综合运用政府管理与市场机制、建立健全药品定价体系、推进相关领域配套改革等方面提出了改善药品价格管制的政策建议。
药品价格管制是一个复杂的系统工程,本文的研究旨在为改革药品管制机制提供辅助决策思路,而一个科学的医药管控体系的建立仍有待各个领域共同做出不懈的努力。
Medicine prices are related to life and health of thousands of millions of families. Medicine price regulation is intended to control fast increase of medical expenses, keep medicine price reasonable and to keep medicine supply fair. Through comparing main contents and effectiveness of medicine price regulation in China and other countries, in connection of Chinese medical system reforms, the thesis studies Chinese medicine price forming mechanism, medicine price controlling mechanism and incentive mechanism to medical service organizations under price regulation. Finally, it suggests some policies of related price regulation.
(1) Medicine prices are affected by R&D expenses, market development expenses, manufacturing costs, treatment progressiveness, market competitiveness, medical insurance as well as national situations and other factors. The thesis discusses medicine cost-plus pricing model, feature vector price model and trilateral information game model, among which it concludes that in the information game model, the medical prices are results from gaming between supervisors, interest groups and the government.
(2) On the basis of analyzing factors affecting medicine prices, pricing links as well as interest distribution, the thesis designs the basic medicine expenses controlling model, supplier-demander bilateral controlling mechanism, hospital controlling mechanism, as well as effective measures to realize the mechanisms. Through analysis, it concludes that demanders'health marginal return equals to his copayment ratio and accordingly the copayment ratio becomes restrainer for his over-consumption. A doctor's organizational compensation is proportionate to supplier's labor marginal effects, that is, the more he is compensated by his organization, the more labor the supplier is willing to pay. Therefore, an individual must consider not only the necessary medicine consumption amount, but also the copayment ratio, which are influencing each other.
(3) Medicine-hospital separation is not the necessary and sufficient conditions to control medicine price and costs. The thesis analyzes and establishes doctors' behavioral standardizing model. Then, it demonstrates a theoretical model of medical expense increase and medicine price regulation. It discusses the influences of high medicine prices on total social welfare under perfect competition and price regulation. It proves that even under non-separation of medicine and hospital, if medicine and services are priced reasonably, the total social welfare will be optimized.
(4) The government's price regulation is ineffectual. Prices set by government are dropping considerably while prices of medicines not set by government or those so-called "new medicines" are not dropping or even rising. It is medicine structure and amount instead of medicine prices that contribute more to medicine expense rise.
Chinese medicine price regulation is being improved, which is a large systematical engineering. Thus, a single price regulation will never result in effectively controlling medical expenses, which needs other supporting policies and favorable market conditions, such as perfect medical security system, the national basic medicine system, reasonable compensating mechanism for medical institutions, and so on. Or the medicine price regulation will surely result in governmental failure, ending in vain.
引文
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