医药分开在我国现状下可行策略研究
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摘要
医药卫生行业是与人民群众身体健康息息相关的重要行业,具有巨大的开发潜力和产业发展前景,一直以来都是我国重点发展行业之一。而国内巨大的药品消费市场,也造就了国内大量涉药企业的出现。
随着中国市场化改革步伐的不断迈进,许多公共服务领域引进了市场化供给机制,医疗卫生体制改革在市场化供给机制的大背景下进行着。改革在提高了公共医疗服务效率的同时也带来了不利的发展趋势,由于市场化改革进程,医疗机构在很大程度上成为自负盈亏的市场主体,参与市场竞争。长期的财政补偿和医疗收入不足,致使医疗成本严重匮乏。面临此种状况,我国政策允许医疗机构将药品加成收入作为其收入的来源之一,这在一定程度上缓解了我国医疗机构运营资金有限的问题,但同时也直接导致了我国“以药养医”的医药卫生体制现状。
医药不正当利益纽带是医药体系的各个环节互动的结果,涉及“以药养医”机制、医院药房垄断销售、医保第三方制约缺失以及药品价格管制失灵等诸多因素。这些因素就个体而言,并不能直接导致医药不正当利益纽带的形成,而一旦诸多因素汇总起来,就形成了我国特定背景下医药之间产生直接的经济利益,这也是患者“看病难、看病贵”的一个主要原因。
自建国以来,我国医疗卫生体制一直是计划经济体制下的医药不分开的模式。近10年来,随着改革开放的深入,我国社会主义市场经济体制的确立,党和政府提出了“医疗保险制度改革、医疗卫生体制改革、医药流通体制改革”三项改革思路。而对“以药养医”体制进行改革,实施“医药分开”,早在9年前的国务院文件上就已明确提出来了。2002年,在社会各界努力下,国家发改委曾启动“医药分开”试点,但因政策不配套、主管领导调离,“试点”没能继续下去。“医药分开”作为改革目标、指导思想一直写在文件上,但没能落到实处。
十七大报告及新医改报告重提医药分开,说明了我国医药卫生体制改革政策其目标的连续性和稳定性。与国办(2000)16号文件相比较,医药分开改革的基本目标相同,都是为了切断医院运行和药品销售之间的直接经济利益关系。所不同的只是医药分开的具体实施方式和实现方式。国办(2000)16号文件强调的是门诊药房脱离医院,形成社会零售药店与医院门诊药房之间的公平竞争。十七大报告并未具体说明医药分开的含义,但卫生部在提到医药分开时强调不主张医药在机构上分开,也不主张医药在管理上分开,主张医药在经济上分开。如果这一主张最终成为医改政策导向,那么新一轮的医药分开改革将由过去注重形式转变成注重内容。建立基本药物制度,实施优良的公立机构采购供应规范,形成完善的药品流通供应链服务体系、可持续的采购资金筹集渠道和健全的信用体系,将成为新一轮医药分开改革的主要任务。
本文通过对医药分开的内涵、意义、国际发展状况、国内发展历程及发展模式等方面掌握与分析,重点讨论医药分开可能对我国医疗卫生体制改革带来的影响及其在我国现状下施行可能会存在的问题,通过对国内几种“医药分开”试点实行的经验总结,以及与国际各国成功范例的对比与借鉴进行分析研究,总结过往改革的不足之处,并试图寻找出“医药分开”在我国切实可行的策略,希望可以为我国“医药分开”政策的实施提供一些有参考价值的借鉴和启示,并最终能够建立一个具有中国特色的“医药分开”模式。
Medical and health industry is closely related to people's health as an important industry, with great development potential and prospects of industrial development, it has always been one of the major developing industries in China.A huge domestic consumer market of drugs led to a large number of domestic drug-related enterprises.
With the pace of reform of the Chinese market continues to progress, many areas of public services to introduce the market mechanism of supply, health care reform in the market mechanism of supply of the large background. As a result of market-oriented reform process, the medical institutions to a large extent become self-financing market participants to participate in market competition. Long-term financial compensation and medical shortage of revenue, resulted in a serious shortage of health care costs. In this situation, China's policy to allow medical institutions to drug addition income as one of the sources of their income, which to some extent alleviate the medical institutions operating in our country the problem of limited funds, but also a direct result of our country "Over-reliance of the doctors" in the medical and health field.
Medicine is improperly linked the interests of all aspects of system interaction, involving the "Over-reliance of the doctors" mechanism, the hospital pharmacy monopoly sales, lack of health insurance, as well as third-party constraints failure to control drug prices and many other factors. If These factors are all alone, the medicine does not constitute an improper bond interest. Once the factors get together to form the context of our specific interests of Medicine improper ties to become patients problems.
Since the founding of the PRC, China's health system has been under the planned economic system of the pharmaceutical industry model together. Over the past 10 years, with the deepening of reform and opening up, China's socialist market economy, the party and the Government has proposed a "medical insurance system reform, health reform, medicine distribution system," the three reform. And reform "to drug dependent medical" system, the implementation of "separate", as early as 9 years ago, the State Council, the document had clearly come. In 2002, efforts in the community, the National Development and Reform Commission has been activated "medicine separate" pilot, but the policies are incomplete and out of competent leadership, "the pilot" did not continue. "Separate medicine" as the goal of reform, the guiding ideology has been written on paper, but failed to implement.
Medicine report 17 separate again, explains the medical and health system reform of China's policy objectives of continuity and stability. National Office (2000) compared to document on the 16th, medicine separate from the same basic goal of reform is to cut off the hospital between the drug sales operation and the direct economic interests. The difference may be the connotation of Chinese medicine and the realization of separate ways. State Office (2000) stressed on the 16th out of the hospital outpatient pharmacy, the formation of community retail pharmacies and hospital outpatient pharmacy between fair competition. 17 The report did not specify the meaning of separation of medicine, but the leadership of the Ministry of Health in Medicine separately that are not in favor of the connotation of medicine stressed on the separation of the body, do not advocate the separation of medicine in the management of, and advocate the separation of medicine in the economy. If the Ministry of Health eventually became the leading advocate of medical reform policy, then a new round of reform of medicine will be separated from the form into the past-oriented focus on the contents of a basic drug system, the implementation of quality norms in procurement and supply of public institutions, the formation of the flow of drugs to improve the supply chain service systems, sustainable procurement, fund-raising channels and a sound credit system, will become a new round of reform of medicine separate from the main task.
Based on the separation of the connotation of Chinese medicine, the significance of international development, the course of domestic development and the development of models and analysis have focused on separation of medicine may be brought about by China's medical and health system reform and its implementation in our country under the status quo may be problems through a number of domestic cities "of Chinese medicine to separate" the implementation of the pilot experience, as well as a successful example of countries with the international comparative analysis and draw on research, summed up the past, the inadequacy of the reform, and trying to find a "separate medicine" practical strategies in China, hoping for my "medicine to separate" the implementation of the policy to provide some useful reference and enlightenment, and ultimately to the establishment of a with Chinese characteristics "separate medicine" model.
随着中国市场化改革步伐的不断迈进,许多公共服务领域引进了市场化供给机制,医疗卫生体制改革在市场化供给机制的大背景下进行着。改革在提高了公共医疗服务效率的同时也带来了不利的发展趋势,由于市场化改革进程,医疗机构在很大程度上成为自负盈亏的市场主体,参与市场竞争。长期的财政补偿和医疗收入不足,致使医疗成本严重匮乏。面临此种状况,我国政策允许医疗机构将药品加成收入作为其收入的来源之一,这在一定程度上缓解了我国医疗机构运营资金有限的问题,但同时也直接导致了我国“以药养医”的医药卫生体制现状。
医药不正当利益纽带是医药体系的各个环节互动的结果,涉及“以药养医”机制、医院药房垄断销售、医保第三方制约缺失以及药品价格管制失灵等诸多因素。这些因素就个体而言,并不能直接导致医药不正当利益纽带的形成,而一旦诸多因素汇总起来,就形成了我国特定背景下医药之间产生直接的经济利益,这也是患者“看病难、看病贵”的一个主要原因。
自建国以来,我国医疗卫生体制一直是计划经济体制下的医药不分开的模式。近10年来,随着改革开放的深入,我国社会主义市场经济体制的确立,党和政府提出了“医疗保险制度改革、医疗卫生体制改革、医药流通体制改革”三项改革思路。而对“以药养医”体制进行改革,实施“医药分开”,早在9年前的国务院文件上就已明确提出来了。2002年,在社会各界努力下,国家发改委曾启动“医药分开”试点,但因政策不配套、主管领导调离,“试点”没能继续下去。“医药分开”作为改革目标、指导思想一直写在文件上,但没能落到实处。
十七大报告及新医改报告重提医药分开,说明了我国医药卫生体制改革政策其目标的连续性和稳定性。与国办(2000)16号文件相比较,医药分开改革的基本目标相同,都是为了切断医院运行和药品销售之间的直接经济利益关系。所不同的只是医药分开的具体实施方式和实现方式。国办(2000)16号文件强调的是门诊药房脱离医院,形成社会零售药店与医院门诊药房之间的公平竞争。十七大报告并未具体说明医药分开的含义,但卫生部在提到医药分开时强调不主张医药在机构上分开,也不主张医药在管理上分开,主张医药在经济上分开。如果这一主张最终成为医改政策导向,那么新一轮的医药分开改革将由过去注重形式转变成注重内容。建立基本药物制度,实施优良的公立机构采购供应规范,形成完善的药品流通供应链服务体系、可持续的采购资金筹集渠道和健全的信用体系,将成为新一轮医药分开改革的主要任务。
本文通过对医药分开的内涵、意义、国际发展状况、国内发展历程及发展模式等方面掌握与分析,重点讨论医药分开可能对我国医疗卫生体制改革带来的影响及其在我国现状下施行可能会存在的问题,通过对国内几种“医药分开”试点实行的经验总结,以及与国际各国成功范例的对比与借鉴进行分析研究,总结过往改革的不足之处,并试图寻找出“医药分开”在我国切实可行的策略,希望可以为我国“医药分开”政策的实施提供一些有参考价值的借鉴和启示,并最终能够建立一个具有中国特色的“医药分开”模式。
Medical and health industry is closely related to people's health as an important industry, with great development potential and prospects of industrial development, it has always been one of the major developing industries in China.A huge domestic consumer market of drugs led to a large number of domestic drug-related enterprises.
With the pace of reform of the Chinese market continues to progress, many areas of public services to introduce the market mechanism of supply, health care reform in the market mechanism of supply of the large background. As a result of market-oriented reform process, the medical institutions to a large extent become self-financing market participants to participate in market competition. Long-term financial compensation and medical shortage of revenue, resulted in a serious shortage of health care costs. In this situation, China's policy to allow medical institutions to drug addition income as one of the sources of their income, which to some extent alleviate the medical institutions operating in our country the problem of limited funds, but also a direct result of our country "Over-reliance of the doctors" in the medical and health field.
Medicine is improperly linked the interests of all aspects of system interaction, involving the "Over-reliance of the doctors" mechanism, the hospital pharmacy monopoly sales, lack of health insurance, as well as third-party constraints failure to control drug prices and many other factors. If These factors are all alone, the medicine does not constitute an improper bond interest. Once the factors get together to form the context of our specific interests of Medicine improper ties to become patients problems.
Since the founding of the PRC, China's health system has been under the planned economic system of the pharmaceutical industry model together. Over the past 10 years, with the deepening of reform and opening up, China's socialist market economy, the party and the Government has proposed a "medical insurance system reform, health reform, medicine distribution system," the three reform. And reform "to drug dependent medical" system, the implementation of "separate", as early as 9 years ago, the State Council, the document had clearly come. In 2002, efforts in the community, the National Development and Reform Commission has been activated "medicine separate" pilot, but the policies are incomplete and out of competent leadership, "the pilot" did not continue. "Separate medicine" as the goal of reform, the guiding ideology has been written on paper, but failed to implement.
Medicine report 17 separate again, explains the medical and health system reform of China's policy objectives of continuity and stability. National Office (2000) compared to document on the 16th, medicine separate from the same basic goal of reform is to cut off the hospital between the drug sales operation and the direct economic interests. The difference may be the connotation of Chinese medicine and the realization of separate ways. State Office (2000) stressed on the 16th out of the hospital outpatient pharmacy, the formation of community retail pharmacies and hospital outpatient pharmacy between fair competition. 17 The report did not specify the meaning of separation of medicine, but the leadership of the Ministry of Health in Medicine separately that are not in favor of the connotation of medicine stressed on the separation of the body, do not advocate the separation of medicine in the management of, and advocate the separation of medicine in the economy. If the Ministry of Health eventually became the leading advocate of medical reform policy, then a new round of reform of medicine will be separated from the form into the past-oriented focus on the contents of a basic drug system, the implementation of quality norms in procurement and supply of public institutions, the formation of the flow of drugs to improve the supply chain service systems, sustainable procurement, fund-raising channels and a sound credit system, will become a new round of reform of medicine separate from the main task.
Based on the separation of the connotation of Chinese medicine, the significance of international development, the course of domestic development and the development of models and analysis have focused on separation of medicine may be brought about by China's medical and health system reform and its implementation in our country under the status quo may be problems through a number of domestic cities "of Chinese medicine to separate" the implementation of the pilot experience, as well as a successful example of countries with the international comparative analysis and draw on research, summed up the past, the inadequacy of the reform, and trying to find a "separate medicine" practical strategies in China, hoping for my "medicine to separate" the implementation of the policy to provide some useful reference and enlightenment, and ultimately to the establishment of a with Chinese characteristics "separate medicine" model.
引文
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