医疗机构补偿与药品价格联动机制研究
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摘要
上世纪90年代以来,药品费用过快增长让各国医疗卫生费用持续快速增长,不仅挤占了大量政府财政预算,也让各国财政背负了沉重的经济负担,更让普通患者感到“看病难、看病贵”问题越发严重。如何破解“看病难、看病贵”这一问题,令广大专家和学者头痛不已。本文通过深入研究我国医疗机构补偿机制现状,发现当前医疗机构由于财政补偿不足,被迫通过药品收入和医疗服务收入弥补政策性经营亏损。在中国历次医疗卫生改革中,由于缺乏公平、有效的医疗补偿制度和严格、合理的药品定价制度,致使药品费用始终处于加速上涨态势,这同时也让中国卫生经费持续走高。
随着我国“新医改”逐步推进,医疗卫生制度改革已进入攻坚阶段——改革面临着在有限医疗费用制约下,如何实现全民统一医疗保险和消除城乡二元结构后实现城乡居民医疗统一的世纪难题。我们应充分认识现阶段医疗机构补偿和药品价格面临的诸多问题和矛盾,认识到将补偿与药品价格联动考虑的必要性、重要性和紧迫性,这对实现我国“新医改”承诺的目标具有举足轻重的意义。
本文运用文献研究、调查问卷、重点人员深度访谈、案例分析等方法,重点研究了中国医疗机构补偿体系和药品定价体系。运用层次分析法、数理逻辑推导法和数学模型建模分析法,揭示出中国医疗机构扭曲的补偿现状,运用信号模型分析法和竞争者博弈分析法,得出解决中国药品价格屡降不降的本质原因；提出将药品定价与医疗机构补偿机制联动考虑的新型医疗机构补偿机制和药品定价机制的模型和措施。
文中,首先从宏观和微观两个层面分析了医疗保障制度与医疗机构补偿机制,发现了医疗机构因财政补偿不足,被迫以药品收入和医疗服务收入弥补亏空的严峻现实。其次,从微观角度,对我国现行的三种药品定价政策逐一做了数学推理分析,在此基础上提出改进三种药品定价的政策建议；运用竞争者博弈理论对医疗机构补偿和药品价值链进行了经济学分析；通过对药品价值链重要环节有关人员深度访谈和药品价值链过程实证分析,剖析了我国药品价值链存在的问题,并提出改进建议。
最后,本文提出医疗机构补偿和药品价格联动机制的设想,并通过有关地区的试点经验和卫生经费数据,检验并论证了联动机制的必要性和紧迫性,以及实际运用的可行性。
Since the90s of last century, all countries'medical and health costs continued grow rapidly for the excessive growth of drug cost, which not only occupied a lot of government budgets, but also put a heavy financial burden on the countries'economy. To ordinary patients, excessive growth of drug cost let them feel "it's too difficult and expensive to see a doctor". This problem becomes more and more seriously in recent years. While, how to crack the problem gives the major experts and scholars a headache. In this paper, through deeply studying present situation of China's medical institutions compensation mechanism, we discover that medical institutions are forced to increase revenue due to the lack of full financial compensation for policy-related losses. China's previous health-care reforms are failed due to lacking of a fair and effective medical compensation system and strictly rational drug pricing system. The fail reforms result in accelerating drug costs rising trend, which also spur China's health expenses continued rise.
Now China's "new medical reform" goes ahead step by step and the medical and health system reform has entered in a crucial stage, the reform faces the problem how to universally achieve health insurance and how to universally achieve urban and rural residents medical insurance after eliminating urban-rural dual structure in limited medical costs, which is a huge century problems. We should fully understand the challenge that the linkage between medical institutions compensation and drug price is facing at this stage. We also should fully understand the necessity, importance and urgency of the linkage between medical institutions compensation and drug price. Well linkage between medical institutions and drug price drug price model design will contribute to realize China's "new medical reform" pledged targets.
In this paper, we focus on China medical institutions'compensation system and drug pricing system, through literature research, questionnaires, key personnel depth interviews, case studies and other methods. We use AHP, mathematical logic and mathematical derivation method to reveal China medical institutions distortion compensation Present Situation. Using signal model analysis and competitor game analysis method to find the essential reason for strong drug price after too many times drug price adjustment. We proposed new medical institutions compensation mechanism and drug pricing mechanism by linking the medical institution compensation and drug pricing mechanism.
First,we analyze the health care system and medical institutions compensation mechanism in macro and micro levels.The analyze report reveals that medical institutions are forced to use drugs and medical services revenue to make up for deficit because of lacking of enough financial compensation.Second,we use mathematical reasoning analysis method analyze the main three drug price policy so that we can give advice to each drug pricing policy.Then we analyze China drug value chain problems by using Competitors game theory in medical institution compensation,drug value chain economic analysis and depth relevant person interviews.
At the end of the paper, the writer put forward the idea of well linkage between medical institutions compensation and drug price. Then, using the pilot experience and data in certain area to test and demonstrate the necessity and urgency of the linkage mechanism as well as the feasibility of the idea.
随着我国“新医改”逐步推进,医疗卫生制度改革已进入攻坚阶段——改革面临着在有限医疗费用制约下,如何实现全民统一医疗保险和消除城乡二元结构后实现城乡居民医疗统一的世纪难题。我们应充分认识现阶段医疗机构补偿和药品价格面临的诸多问题和矛盾,认识到将补偿与药品价格联动考虑的必要性、重要性和紧迫性,这对实现我国“新医改”承诺的目标具有举足轻重的意义。
本文运用文献研究、调查问卷、重点人员深度访谈、案例分析等方法,重点研究了中国医疗机构补偿体系和药品定价体系。运用层次分析法、数理逻辑推导法和数学模型建模分析法,揭示出中国医疗机构扭曲的补偿现状,运用信号模型分析法和竞争者博弈分析法,得出解决中国药品价格屡降不降的本质原因；提出将药品定价与医疗机构补偿机制联动考虑的新型医疗机构补偿机制和药品定价机制的模型和措施。
文中,首先从宏观和微观两个层面分析了医疗保障制度与医疗机构补偿机制,发现了医疗机构因财政补偿不足,被迫以药品收入和医疗服务收入弥补亏空的严峻现实。其次,从微观角度,对我国现行的三种药品定价政策逐一做了数学推理分析,在此基础上提出改进三种药品定价的政策建议；运用竞争者博弈理论对医疗机构补偿和药品价值链进行了经济学分析；通过对药品价值链重要环节有关人员深度访谈和药品价值链过程实证分析,剖析了我国药品价值链存在的问题,并提出改进建议。
最后,本文提出医疗机构补偿和药品价格联动机制的设想,并通过有关地区的试点经验和卫生经费数据,检验并论证了联动机制的必要性和紧迫性,以及实际运用的可行性。
Since the90s of last century, all countries'medical and health costs continued grow rapidly for the excessive growth of drug cost, which not only occupied a lot of government budgets, but also put a heavy financial burden on the countries'economy. To ordinary patients, excessive growth of drug cost let them feel "it's too difficult and expensive to see a doctor". This problem becomes more and more seriously in recent years. While, how to crack the problem gives the major experts and scholars a headache. In this paper, through deeply studying present situation of China's medical institutions compensation mechanism, we discover that medical institutions are forced to increase revenue due to the lack of full financial compensation for policy-related losses. China's previous health-care reforms are failed due to lacking of a fair and effective medical compensation system and strictly rational drug pricing system. The fail reforms result in accelerating drug costs rising trend, which also spur China's health expenses continued rise.
Now China's "new medical reform" goes ahead step by step and the medical and health system reform has entered in a crucial stage, the reform faces the problem how to universally achieve health insurance and how to universally achieve urban and rural residents medical insurance after eliminating urban-rural dual structure in limited medical costs, which is a huge century problems. We should fully understand the challenge that the linkage between medical institutions compensation and drug price is facing at this stage. We also should fully understand the necessity, importance and urgency of the linkage between medical institutions compensation and drug price. Well linkage between medical institutions and drug price drug price model design will contribute to realize China's "new medical reform" pledged targets.
In this paper, we focus on China medical institutions'compensation system and drug pricing system, through literature research, questionnaires, key personnel depth interviews, case studies and other methods. We use AHP, mathematical logic and mathematical derivation method to reveal China medical institutions distortion compensation Present Situation. Using signal model analysis and competitor game analysis method to find the essential reason for strong drug price after too many times drug price adjustment. We proposed new medical institutions compensation mechanism and drug pricing mechanism by linking the medical institution compensation and drug pricing mechanism.
First,we analyze the health care system and medical institutions compensation mechanism in macro and micro levels.The analyze report reveals that medical institutions are forced to use drugs and medical services revenue to make up for deficit because of lacking of enough financial compensation.Second,we use mathematical reasoning analysis method analyze the main three drug price policy so that we can give advice to each drug pricing policy.Then we analyze China drug value chain problems by using Competitors game theory in medical institution compensation,drug value chain economic analysis and depth relevant person interviews.
At the end of the paper, the writer put forward the idea of well linkage between medical institutions compensation and drug price. Then, using the pilot experience and data in certain area to test and demonstrate the necessity and urgency of the linkage mechanism as well as the feasibility of the idea.
引文
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