我国药品价格虚高问题的成因及对策研究
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摘要
近年来,“看病难,看病贵”已经成为社会热点问题。我国卫生总费用逐年大幅增加,卫生总费用占GDP的比例也呈上升趋势。虽然近年来随着新农合医疗体系与各种城镇医疗保险的普及,我国各种形式的医疗保障覆盖率达80%,但总体来讲,报销比例偏低,医疗费用支出的半数以上部分仍由个人支付,医疗费用支出的增长速度超过了个人经济收入增长的速度,“看病贵、看病难”问题严重。在门诊病人和出院病人医疗总费用中,药品费用的支出比重高达40%-60%。经济合作与发展组织国家为5%一20%,日本为20%左右,都大大低于我国的情况。我国医疗费用过高的一个关键因素就是医疗过程中药品费用过高。
我国目前存在着药价虚高的现象,即药品价格长期严重偏离生产成本,因此若能有效地控制药价就可以极大地缓解看病贵的问题,从而大大减轻居民的医疗负担。药品是一种直接关系到人民身心健康特殊商品,药价虚高不仅增加了人民群众的经济负担,加重看病难的现象,还严重影响和破坏了制药企业的正常生产经营秩序,导致了商业贿赂等社会腐败现象,助长了不正之风的蔓延,给整个社会的和谐发展造成了极大威胁。因此,要达到促进医药领域合理药品价格秩序的形成、促进医药行业健康发展、促进公众健康福利提高这一宏伟目标,解决药价虚高问题是关键。
药价虚高是一个综合性病症,其根源在于我国医药体制上的种种弊病,药品生产经营企业、医疗机构、政府部门都有责任,包括药品生产流通体制、医院的“双垄断”的经营体制、医疗机构“以药养医”的经济补偿机制、医疗机构的薪酬制度、药价管制模式、现有的医疗保险制度,药品定价模式不合理、药品注册销售过程中的寻租现象等。本文参照发达国家药品费用控制的成功经验,提出了一些政策建议。对药品的生产经营企业,提高市场准入条件,促进规模化经营,减少流通环节。对于医疗机构,打破其“双垄断”的特殊地位与“以药养医”的不合理经济补偿模式,从根本上消除医药间的直接经济联系。同时改革医疗机构薪资制度,加强医德医风建设。对于政府来说,应加大对卫生事业的投入,完善“双G”认证标准,改革药品定价机制,完善药品招投标制度、医疗保险制度等相关体制的改革等。解决药价虚高问题是一项综合性工程,需要从以上各个方面全面推进我国医药体制改革,形成治理合力。
In recent years, "expensive medical bills and difficult access to quality medical services " has become a hot social issue. With years of significant increase in total health expenditure, the proportion of the expenditure in GDP is rising too. Although in recent years, with the establishment of a new rural cooperative medical care system and the rising popularity of a variety of urban health insurances, our various forms of medical care have achieved a coverage of 80%, reimbursement rate is generally low. People still pay a large proportion of medical costs, and health care costs grow faster than personal income. "Expensive medical bills and difficult access to quality medical services" is a serious problem. In the total medical costs that discharged patients and outpatients have paid for, the proportion of drug expense takes up to 40%-60% while the percentage is 5% to 20% in the member countries of Organization for Economic Cooperation and Development (OECD),20% in Japan, which are significantly lower than that in China. The high drug cost in the medical process is an important and direct contributor to the high cost of health care in our country.
The prices of medicines are unreasonably high currently, which means the drug prices are drastically higher than the production cost. Therefore, drug price control can greatly ease the problem of expensive medical treatment, and greatly reduce the medical burden of ordinary people. Drug is a special commodity which is directly related to people's physical and mental health. Formidable price not only increases people's financial burden, making medical treatment more unaccessible, but also seriously affects and disturbs the normal pharmaceutical production and operation, causing commercial bribery and other social corruption, fueling the spread of unhealthy practices, bringing long-term instability to the entire community and a great threat to the harmonious development. Therefore, solving the problem of high medicine prices is very important. It can promote the establishment of a reasonable order of drug prices, the healthy development of the medicine industry, and the improvement of the public health and welfare.
Artificially instigated high drug price is a syndrome rooted in China's abuses of the medical system. Medicine production enterprises, medical institutions and government departments are all responsible for the problems including the drug production and distribution system, the hospital's operating system of "double monopoly", the "supporting hospital with medicine" in medical institutions, the economic compensation mechanism, the medical sector pay system, the mode of drug price regulation, the existing system of medical insurance, the unreasonable drug pricing, and the rent-seeking phenomenon in the process of drug registration. It is a comprehensive project to solve the problem of high medicine prices. Our country should comprehensively improve the medical system from the aspects mentioned above, and take advantage of governmental power. Some policy suggestions were proposed in the present thesis, based on the success of medicine price control in developed countries,
我国目前存在着药价虚高的现象,即药品价格长期严重偏离生产成本,因此若能有效地控制药价就可以极大地缓解看病贵的问题,从而大大减轻居民的医疗负担。药品是一种直接关系到人民身心健康特殊商品,药价虚高不仅增加了人民群众的经济负担,加重看病难的现象,还严重影响和破坏了制药企业的正常生产经营秩序,导致了商业贿赂等社会腐败现象,助长了不正之风的蔓延,给整个社会的和谐发展造成了极大威胁。因此,要达到促进医药领域合理药品价格秩序的形成、促进医药行业健康发展、促进公众健康福利提高这一宏伟目标,解决药价虚高问题是关键。
药价虚高是一个综合性病症,其根源在于我国医药体制上的种种弊病,药品生产经营企业、医疗机构、政府部门都有责任,包括药品生产流通体制、医院的“双垄断”的经营体制、医疗机构“以药养医”的经济补偿机制、医疗机构的薪酬制度、药价管制模式、现有的医疗保险制度,药品定价模式不合理、药品注册销售过程中的寻租现象等。本文参照发达国家药品费用控制的成功经验,提出了一些政策建议。对药品的生产经营企业,提高市场准入条件,促进规模化经营,减少流通环节。对于医疗机构,打破其“双垄断”的特殊地位与“以药养医”的不合理经济补偿模式,从根本上消除医药间的直接经济联系。同时改革医疗机构薪资制度,加强医德医风建设。对于政府来说,应加大对卫生事业的投入,完善“双G”认证标准,改革药品定价机制,完善药品招投标制度、医疗保险制度等相关体制的改革等。解决药价虚高问题是一项综合性工程,需要从以上各个方面全面推进我国医药体制改革,形成治理合力。
In recent years, "expensive medical bills and difficult access to quality medical services " has become a hot social issue. With years of significant increase in total health expenditure, the proportion of the expenditure in GDP is rising too. Although in recent years, with the establishment of a new rural cooperative medical care system and the rising popularity of a variety of urban health insurances, our various forms of medical care have achieved a coverage of 80%, reimbursement rate is generally low. People still pay a large proportion of medical costs, and health care costs grow faster than personal income. "Expensive medical bills and difficult access to quality medical services" is a serious problem. In the total medical costs that discharged patients and outpatients have paid for, the proportion of drug expense takes up to 40%-60% while the percentage is 5% to 20% in the member countries of Organization for Economic Cooperation and Development (OECD),20% in Japan, which are significantly lower than that in China. The high drug cost in the medical process is an important and direct contributor to the high cost of health care in our country.
The prices of medicines are unreasonably high currently, which means the drug prices are drastically higher than the production cost. Therefore, drug price control can greatly ease the problem of expensive medical treatment, and greatly reduce the medical burden of ordinary people. Drug is a special commodity which is directly related to people's physical and mental health. Formidable price not only increases people's financial burden, making medical treatment more unaccessible, but also seriously affects and disturbs the normal pharmaceutical production and operation, causing commercial bribery and other social corruption, fueling the spread of unhealthy practices, bringing long-term instability to the entire community and a great threat to the harmonious development. Therefore, solving the problem of high medicine prices is very important. It can promote the establishment of a reasonable order of drug prices, the healthy development of the medicine industry, and the improvement of the public health and welfare.
Artificially instigated high drug price is a syndrome rooted in China's abuses of the medical system. Medicine production enterprises, medical institutions and government departments are all responsible for the problems including the drug production and distribution system, the hospital's operating system of "double monopoly", the "supporting hospital with medicine" in medical institutions, the economic compensation mechanism, the medical sector pay system, the mode of drug price regulation, the existing system of medical insurance, the unreasonable drug pricing, and the rent-seeking phenomenon in the process of drug registration. It is a comprehensive project to solve the problem of high medicine prices. Our country should comprehensively improve the medical system from the aspects mentioned above, and take advantage of governmental power. Some policy suggestions were proposed in the present thesis, based on the success of medicine price control in developed countries,
引文
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[3]第四次国家卫生服务调查分析报告.http://www.moh.gov.cn/publicfiles/business/htmlfiles /mohwsbwstjxxzx/s8211/201009/49165.htm
[4]朱燕刚.我国药品费用机制及其对策研究[D].[硕士学位论文].上海：第二军医大学,2007
[5]高明.药事管理与法规[M].北京：中国中医药出版社,2006
[6]马特.我国药品价格虚高成因分析及综合整治方案[D].[硕士学位论文].天津：天津大 学,2004
[7]卫生部采取多项措施控制医药费用不合理增长2010-05-28.http//www.moh.gov.cn
[8]陈绍成.我国药品价格虚高原因分析及治理对策的研究[D].[硕士学位论文].重庆：重庆大学,2007
[9]是什么造成了抗生素滥用..2010.http//www.infzm.com/content/52288
[10]齐晓涟,闫素英,王育琴.细化工作流程努力做好药物不良反应监测工作[J].山西医药杂志,2007,36(4)：373-374
[11]高鸿业.西方经济学[M].北京：中国人民大学出版社,2007
[12]刘华.对药品价格虚高问题的分析和思考[J].中国卫生资源,2006,9(4)：151-152
[13]2009年度统计年报.http://www.sfda.gov.cn/WS01/CL0108/54601.html
[14]氧氟沙星注射.http://app1.sfda.gov.cn/datasearch/face3/base.jsp?tableld=25&tableName =TABLE25&title=国产药品&bcld= 124356560303886909015737447882
[15]吴晓东. “一药多名”药品价格虚高的关系分析与[J].生产力研究,2008,2：78-80
[16]张玮. “药价虚高”的成因分析及政策建议[J].川北医学院学报,2009,24(3)：295-299
[17]朱燕刚,张鹭鹭,任益烟,等.我国药品价格虚高利益主体的利益分布及成因分析[J].中国卫生经济,2006,25(11)：15-18
[18]出厂价15.5元药品被医院卖213元利润达1300%.2010.http://news.sina.com.cn/c/sd/ 2010-05-17/085120286921.shtml
[19]陶志明.解决我国药品价格虚高问题的对策[J].经济纵横,2008,2：53-55
[20]李瑜.从药品的商品特性破解药价虚高难题[J].经济研究导刊,2010,12：27-29
[21]陈园,曹易.我国药品价格虚高的原因及应对之策[J].科技创业月刊,2010,8：58-60
[22]陈世英,陈燕波.关于药品价格虚高的感想[J].按摩与康复医学,2010,17：115-116
[23]许引旺.我国药品价格虚高问题研究[D].[硕士学位论文].厦门：厦门大学,2006
[24]梁毅,丁静.我国药品价格困境分析[J].中国药学,2006,4(5)：397-399
[25]徐金水.药品价格虚高成因剖析与对策[J].卫生经济研究,2002,10.8-9
[26]陈楚杰,潘华峰,卓著,等.药物价格虚高现状的政府责任及对策研究[J].中国卫生事业管理,2007,8：537-539
[27]药品“变脸”涨价何时休2006. http://news.nmgnews.com.cn/nmgrb/article/20061226/ 26292 1.html
[28]罗文华.药品生产质量管理[M].北京：人民卫生出版社,2009.3-5
[29]袁大峰.解决我国药品价格虚高问题的对策研究[D].[硕士学位论文].西安：西北大学,2008
[30]Pelen F. An increasingly complex system reimbursement and pricing of drugs in France[J].. HEPAC,2000,2:20
[31]郭莹,严明,郭晶,等.西方发达国家药品价格管理模式比较[J].中国药房,2005,16(1)：6-9
[32]Anon. Major product prices cut in France[J]. Scrip,1994,30:2
[33]Schulenburg JM,GramfVD. The German health care system at the crossroads[S]. Health Economics,1994,3:301
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