摘要
发展医药共同物流体系是解决医药流通环节费用过高、信息不透明、药品无法追溯等问题的有效途径,能够有效推动医药物流产业良性发展。研究医药共同物流管理机制,有助于进一步探寻医药共同物流发展的内在规律和管理要求,推动医药共同物流理论向实践应用转化,有利于落实“新医改”、保障人民群众医药卫生安全,具有重要的现实意义。
首先分析了医药共同物流体系各参与主体的利益诉求,探讨医药共同物流体系演化路径,即从一体化集成到要素集聚,最终实现系统集群,并提出医药共同物流体系管理机制框架：信任机制、决策机制、利益机制和风险机制。
信任机制是医药共同物流体系运行的基础机制。首先分析个人信任与组织信任行为的区别,讨论医药共同物流的组织信任基础。考虑单边道德风险及风险中性,建立线性信任契约与非线性信任契约模型,均实现帕累托优化。考虑双边道德风险下,信息对称条件可实现帕累托最优；信息不对称条件下,通过调整利益收益的相关参数,可实现帕累托优化,并符合整体利益。在离散需求情况下,建立完全信任模型可实现了帕累托最优。研究结果表明：系统化信任制度设计是医药共同物流信任机制的根本保障；企业声誉和社会舆论是产生医药共同物流信任机制的必要条件；利益是医药共同物流信任机制的“稳定器”；合作风险既是医药共同物流信任机制的价值衡量标准,也是信任机制的重要变量,能够从根本上影响信任机制的运行质量。
决策机制是医药共同物流体系管理机制的重要组成部分。首先就医药共同物流体系决策机制内涵和主要内容进行分析,提出医药共同物流决策机制主要由系统内部决策机制和政府监管决策机制构成。分析医药物流企业与医药制造流通联盟的博弈过程,医药物流企业败诉概率、败诉惩罚度、应诉成本、利益比例和隐藏信息成本系数均将影响决策结果。在不完全信息下,医药物流企业应对索赔的成本、医院的担保激励力度、利益分享比例、隐藏信息成本将影响影响决策博弈均衡结果,通过双方合作并建立较高的索赔成本,提供更大的激励,才能达到经济理性。政府通过一系列积极的宏观政策,将实现社会总福利的帕累托优化。比较不同的政府监管决策方案,应同时强调增加处罚模式的监管力度和处罚额度,保证奖励制度的公平性；强化问责制度监管的的问责力度。
医药共同物流利益机制是合作稳健性的保证、合作驱动力的源泉和合作效率的推动器。设计三种医药共同物流体系合作利益分享模型,即多因素综合利益机制、基于Shapley值的利益机制、基于改进型核仁法的利益机制。针对Shapley值法“核”不存在、一般核心法解集空间不相交等相关缺陷,引入一个具有正负变化功能的松弛变量,对Shapley值法和一般核心法进行改进。改进型核仁法的医药共同物流利益机制,较为顺利地解决了Shapley值法和一般“核心法”失效的问题。通过建立医药共同物流公益金制度,实现了合作利益合理分享。
医药共同物流涉及主体多、运作环节多、各成员之间关系复杂,风险机制是医药共同物流的重要保障。根据专家意见法,提出医药共同物流风险的主要形式为：道德风险,管理风险,运作风险和信用风险,风险的主要原因是合作方式、利益分配、信息共享、治理机制等四个方面。运用支持向量机SVM方法对医药共同物流风险水平进行预测,达到了很高的拟合度,说明该方法有较强的可信度。最后,探讨了医药共同物流体系风险预警机制和风险治理对策：从完善联盟机制、健全声誉机制、优化利益分配机制三方面着手,建立联合应对策略。
通过对医药共同物流管理机制的系统研究,丰富和发展了医药物流相关理论,探寻了医药共同物流内部运作规律,对于保证医药共同物流系统稳定运行,有重要的理论指导意义。
The pharmaceutical joint logistics system is an effective way to solve problem of high cost of medicine circulation, information opacity, drugs monitoring difficulties, to effectively promote development of pharmaceutical logistics industry. Research on management mechanisms of pharmaceutical joint logistics system has important practical significance, can contribute to explore the inherent law and management requirements of pharmaceutical joint logistics system, promote the transformation of pharmaceutical joint logistics theory to practical application, is conducive to the implementation of the new health care reform, to protect the health and safety of people.
On the basis of existing research results, this dissertation analyzes the participating interest demands of pharmaceutical joint logistics system, explores the evolution path of pharmaceutical joint logistics system, from integration to factor concentration, and ultimately system clusters, management mechanism framework:trust mechanism, decision-making mechanism, interest mechanism and risk mechanism.
The trust mechanism is underlying mechanisms of pharmaceutical joint logistics system. Discussed by analyzing the difference between behavior of personal trust and organizational trust, pharmaceutical joint logistics system organizational trust is based on the interests, reputation, and risk. Consider unilateral moral hazard, the trust contract pharmaceutical manufacturing and circulation Union. This dissertation establish a linear trust deed and nonlinear trust contract model firstly, taking into account bilateral moral hazard, information symmetry under asymmetric information flow of pharmaceutical manufacturing alliance trust contract design and Pareto optimization. Secondly, in the case of discrete demand, pharmaceutical manufacturers and pharmaceutical distribution of the balance of the trust deed, results show that:a systematic trust system is the fundamental guarantee of pharmaceutical joint logistics system trust mechanism; corporate reputation and public opinion is to produce pharmaceutical joint logistics system necessary condition; interests is "stabilizer" of pharmaceutical joint logistics system trust mechanism; risk is a pharmaceutical joint logistics system trust mechanism measure of value, the important variables can fundamentally affect the quality of the operation of the trust mechanism.
Decision-making mechanism is an important part of the pharmaceutical joint logistics system management mechanisms. Analysis main content of decision-making mechanism of pharmaceutical joint logistics system, decision-making mechanism is mainly constituted by system internal decision-making mechanisms and government regulatory decision-making mechanism. From the the game process of pharmaceutical logistics companies and pharmaceutical manufacturing and circulation Union, pharmaceutical logistics enterprises probability of losing, losing the degree of punishment, the respondent costs, the proportion of interest and hidden cost factor will influence decision-making results. Incomplete information, pharmaceutical logistics enterprises to cope with the cost of claims, hospitals guarantee incentives, the proportion of benefit-sharing, hidden information costs will affect the impact of the decision-making game equilibrium results through cooperation and the establishment of higher claims costs, providing greater incentives, in order to achieve economic rationality. The Government adopted a series of positive macroeconomic policy, will significantly reduce the transaction costs of cooperation of the pharmaceutical logistics companies, pharmaceutical manufacturing and circulation Union and hospitals, social welfare Pareto optimization. Finally, three different government regulatory decision-making program, penalty system, reward system and accountability systems. In the regulatory decision-making mode of penalties should be also stressed increased supervision and penalty amount; regulated in reward system mode, pay attention to the fairness; pharmaceutical services provider identified in the regulatory decision-making mode of the accountability system, to strengthen the accountability efforts.
The pharmaceutical joint logistics system mechanism of interest is guarantee of co-operation, source of driving force and efficiency pusher of cooperation. Designed three pharmaceutical joint logistics system co-benefit-sharing model:multifactor comprehensive benefit mechanism, interest mechanism based on Shapley value, based on improved nucleolus interest mechanism. As Shapley Value and core method to solve less than defects, introduct slack variables to improve the general core. Pharmaceutical joint logistics system based on improved nucleolus law pharmaceutical interest mechanism successfully solve the difficult issues of Shapley Value, establish Community Chest of pharmaceutical joint logistics system, and equitable sharing of cooperation interests to solve the key issues of pharmaceutical joint logistics system stability.
There are many participants involved in pharmaceutical joint logistics system, complex relationships among the members; so, the risk mechanism is an important guarantee of pharmaceutical joint logistics system. Based on expert opinion, pharmaceutical joint logistics system risk major forms:moral risk, management risk, operational risk and credit risk, the main reasons is cooperative manner, distribution of benefits, information sharing, governance mechanism. This dissertation used the support vector machine method to predict risks level of pharmaceutical joint logistics system, reached a very high fit credibility. Finally, explore risk early warning mechanisms and risk Countermeasures of pharmaceutical joint logistics system:perfect alliance mechanism, improve reputation mechanism, and optimize benefits distribution mechanism, establishment of a joint response strategy.
In summary, this dissertation enriched and developed the theory of the pharmaceutical logistics; explored the inner operation regularity of pharmaceutical joint logistics system. This reseach result is valuable and worth popularizing for pharmaceutical joint logistics system.
引文
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