我国药品流通业模式创新与价格监管改革研究

发布时间：2018-06-26 12:02

本文选题：药品价格虚高 + 药品流通业　；参考：《南开大学》2014年博士论文

【摘要】：药品是关系人民生命健康的特殊商品,重构药品生产流通秩序事关国计民生、人民幸福,既必要又紧迫。我国药品流通业发展取得巨大成就,但药品生产流通秩序混乱现象始终没有得到很好解决,药品价格虚高尚未根治,而且药品集中招标采购推行以来又出现了一些新问题,规范和整顿药品生产流通秩序已经成为我国医药卫生体制改革中的重大课题之一。为此,在2013年开年之际中华人民共和国卫生部推出了我国医疗卫生系统综合改革的路线图,该路线图包含了五大改革领域,一是医疗保障制度建设和改革,二是医疗服务体系的改革,三是公共卫生体制改革的突破,四是药品供应的新模式,五是政府监管体制的改革和完善。本文所研究的问题将涉及后两大改革领域。本文在明确药品流通内涵和特性,梳理药品流通理论、政府规制理论以及药品流通模式创新、药品流通政府监管制度等相关文献综述的基础上,重点研究了以下几个主要问题：首先,在把握全球药品市场发展特点和药品现代流通共同特征的前提下,从实行医药分开、推进标准化建设、提高药品市场集中度、规范企业经营行为、发展社会中介组织、建立现代信息系统等多个视角,分析了我国药品流通领域改革的问题,并对中国药品流通政府监管的五阶段制度变迁进行了详细的梳理；第二,对我国药品流通业的参与主体以及药品流通的全流程框架进行了系统提炼,将药品生产到药品销售的整个流程分为药品招标制度改进拍卖机制、缩减药品流通渠道、建构药品流通网络、改革药品流通终端四个模块,进行了全面的理论阐述和模型分析；第三,在充分把握我国药品流通业政府监管现状及问题成因的条件下,总结了发达国家药品流通业政府监管特征及经验启示,建立了药品流通全流程价格监管理论模型,进行了药品流通价格监管的机理分析,分析了药品流通政府监管的实际效果,并从完善药品监管的法律体系、建立统一独立的药品监管体制、健全标准体系并建立长效监督机制、完善药品价格形成机制、加强药品使用环节的监管等方面,提出我国药品流通全程价格监管的对策体系。相对于已有文献,本文以解决药品流通领域价格不合理问题为导向,其主要贡献体现在以下几个方面：首先,对我国药品流通业的相关主体、相关环节的内在联系进行逻辑判断,从企业与政府两个主体出发,沿着企业模式创新和政府科学监管两条主线,系统的建立起能够抓住药品价格虚高等问题本质的分析框架；其次,利用拍卖机制模型证明了我国目前“双信封”采购招标机制的制度性缺陷,针对其存在的弊端提出了第二价格密封拍卖机制的修正方案,以有效处理集中采购招标环节的激励机制问题,并分为四个模块对药品流通全程的模式创新进行了系统化的研究；第三,在信息不对称条件下,建立了药品流通源头控制的有条件价格监管模型、考虑市场范围影响的含有距离参数的中间环节价格监管模型、提出了针对医疗机构和零售机构两类药品流通终端的政府分类监管的基本思路。
[Abstract]:In 2013 , the Ministry of Health of the People ' s Republic of China launched a road map for the reform of the health system in our country .

On the basis of clarifying the connotation and characteristics of drug circulation , combing drug circulation theory , government regulation theory and drug circulation pattern innovation and drug circulation government regulation system , this paper mainly focuses on the following major problems : first , under the premise of grasping the characteristics of global drug market development and the common characteristics of modern medicine circulation , the article analyzes the problems of reform in the field of medicine circulation in China , and makes a detailed analysis on the five - stage institutional change of Chinese medicine circulation government regulation .
Second , the whole process framework of drug circulation in our country is systematically refined , and the whole process of drug sales is divided into drug bidding system to improve the auction mechanism , reduce the flow channel of drugs , construct the drug circulation network , reform the four modules of the drug circulation terminal , and carry out comprehensive theoretical exposition and model analysis ;
Third , under the condition of fully grasping the current situation and causes of the administration of drug circulation industry in our country , this paper summarizes the regulatory characteristics and experiences of drug circulation price supervision in developed countries , establishes the theory model of drug circulation price supervision , analyzes the practical effect of drug circulation price regulation , establishes a unified independent medicine supervision system , perfects the standard system and establishes long - term supervision mechanism , perfects the mechanism of drug price formation , strengthens the supervision of drug use link , and puts forward the countermeasure system of the whole course price supervision of drug circulation in China .

Compared with the existing literatures , this paper aims to solve the problem of unreasonable price in the field of medicine circulation . The main contributions of this paper are as follows : Firstly , the author makes a logical judgment on the relationship between the relevant subjects and relevant links of the pharmaceutical flow industry in China . From the two subjects of the enterprise and the government , the paper puts forward two main lines : the innovation of the enterprise model and the regulation of the government science , and the establishment of the system can grasp the analytical framework of the essence of the problem of the deficiency of medicine price and the like ;
Secondly , using the auction mechanism model to prove the institutional weakness of the bidding mechanism of " double envelopes " in our country , the paper puts forward the amendment scheme of the second price seal auction mechanism aiming at the shortcomings of the present " double envelope " procurement bidding mechanism , so as to effectively deal with the incentive mechanism problem of the centralized procurement bidding process , and divides into four modules to systematically study the mode innovation of the whole process of drug circulation ;
Thirdly , under the condition of asymmetric information , a conditional price regulation model controlled by the source of drug circulation is established , and the price regulation model of the intermediate link with distance parameter is considered , and the basic idea of the government classification supervision for the two types of drug circulation terminals in medical institutions and retail establishments is put forward .
【学位授予单位】：南开大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R95;F726

【参考文献】