我国药品回扣问题成因及对策分析
发布时间：2018-11-07 11:22
【摘要】：自从上世纪80年代以来,我国药品市场进入迅速发展时期,药品回扣现象也随之产生。近三十年来,药品回扣一直以来都是社会关注的焦点之一,它不仅阻碍了药品市场的健康发展,还侵害了国家和患者的合法利益,诱使一部分医务工作者走向违法犯罪的道路。本文首先简要介绍了药品回扣的概念、产生与发展,提出药品回扣与医药代表联系密切。简单介绍了国内药品价格虚高现象严重,药品生产成本与定价严重不符。然后简单分析药品回扣产生的危害:它严重扰乱了药品市场秩序,使假冒伪劣药品充斥市场,危害患者的生命健康;药品生产成本与定价不符,造成国家税收的严重流失;药价虚高加重患者的医疗负担,许多患者因病致贫;药品回扣造成医患之间信用缺失,医患矛盾激化,不利于构建和谐的医患关系。然后分别从以下几个方面分析药品回扣产生的原因:医药产业结构不合理,小企业占多数,难以形成核心竞争力,产品严重供大于求;政府监管不力,药品定价机制不合理,政府工作人员缺乏医学知识背景;医疗机构运行体制存在缺陷,政府财政补偿不到位,医生的合法收入偏低,难以抵抗高回扣的诱惑;医院在药品购销领域处于双垄断地位,患者处于弱势地位;立法不完善,回扣定性不明确,民事赔偿相关法律缺失等。为了规制药品回扣,本文针对以上原因,提出下面几点意见,有些已经在实行,有些还需完善,也有些新方法期待能够被采纳。整顿药品市场秩序,制定规范科学的药品定价体系;实行医药分开,如进行药房托管;打破“以药养医”的机制,加大医院的政府资金投入,提高医院药事服务费,尊重医生的劳动价值;鼓励民营医院的发展,形成强大的医疗服务网络;健全药品采购管理体系,加强各级采购人员相互之间的监督管理;优化集中招标采购制度,并提出新见解,建议对现有的集中招标采购制度加以修改,允许医院和药品生产企业进行二次议价;完善基本药物制度,增加药物品种,保持药物的及时供应;用法律手段严惩药品回扣行为,分不同情况,分别定为受贿罪和非国家工作人员受贿罪,并且建议立法机关明确相应的民事赔偿;加强医务人员的法制教育,以实际案例警戒医务人员;加强医务人员医德教育,培养高尚的职业道德,从自身开始拒绝药品回扣。通过以上几个方面的分析,希望对规制我国的药品回扣有所帮助。
[Abstract]:Since 1980's, China's drug market has entered a period of rapid development, drug rebate phenomenon also emerged. In the past 30 years, drug rebate has been one of the focus of social attention. It not only hinders the healthy development of the drug market, but also infringes the legitimate interests of the country and patients, and induces some medical workers to the road of illegal crime. This paper first introduces the concept of drug rebate, its emergence and development, and points out that drug rebate is closely related to pharmaceutical representatives. This paper briefly introduces the phenomenon of false high drug price in China and the serious discrepancy between drug production cost and pricing. Then it analyzes the harm caused by drug rebate: it seriously disturbs the order of drug market, makes fake and inferior drugs flood the market, endangers patients' life and health, and the cost of drug production does not accord with pricing, which results in the serious loss of state tax; The deficiency of drug price increases the medical burden of patients, many patients become poor because of illness; the rebate of drugs leads to the lack of credit between doctors and patients, the contradiction between doctors and patients intensifies, which is not conducive to the construction of a harmonious relationship between doctors and patients. Then analyze the reasons of drug rebate from the following aspects: the structure of pharmaceutical industry is unreasonable, small enterprises account for the majority, it is difficult to form the core competitiveness, and the product supply exceeds the demand seriously; Government supervision is weak, drug pricing mechanism is unreasonable, government staff lack of medical knowledge background, the operating system of medical institutions has defects, the government financial compensation is not in place, the legal income of doctors is low, it is difficult to resist the temptation of high rebate; The hospital is in the double monopoly position in the field of drug purchase and sale, the patient is in the weak position; the legislation is not perfect, the rebate quality is not clear, the civil compensation related law is missing and so on. In order to regulate drug rebates, this paper puts forward the following suggestions for the above reasons: some are already in practice, some still need to be perfected, and some new methods are expected to be adopted. To rectify the order of the drug market, to establish a standardized and scientific drug pricing system, to separate medicine from medicine, for example, to conduct pharmacy custody; To break the mechanism of "nourishing medicine with medicine", to increase the investment of government funds, to raise the service charge of pharmacy, to respect the labor value of doctors, to encourage the development of private hospitals, and to form a strong medical service network. To improve the drug procurement management system and strengthen the supervision and management among procurement personnel at all levels; To optimize the centralized bidding procurement system and put forward new ideas, it is suggested that the existing centralized bidding procurement system should be revised to allow hospitals and pharmaceutical manufacturing enterprises to carry out second price bargaining; Improve the system of essential drugs, increase the variety of drugs, and maintain the timely supply of drugs; Using legal means to severely punish drug rebates, according to different circumstances, respectively as bribery crime and non-state staff bribery crime, and suggested that the legislature clear the corresponding civil compensation; Strengthen the legal education of medical personnel, alert medical personnel with actual cases, strengthen medical moral education of medical personnel, cultivate noble professional ethics, and refuse drug rebates from their own point of view. Through the above several aspects of analysis, I hope to regulate the rebate of drugs in China.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F203
[Abstract]:Since 1980's, China's drug market has entered a period of rapid development, drug rebate phenomenon also emerged. In the past 30 years, drug rebate has been one of the focus of social attention. It not only hinders the healthy development of the drug market, but also infringes the legitimate interests of the country and patients, and induces some medical workers to the road of illegal crime. This paper first introduces the concept of drug rebate, its emergence and development, and points out that drug rebate is closely related to pharmaceutical representatives. This paper briefly introduces the phenomenon of false high drug price in China and the serious discrepancy between drug production cost and pricing. Then it analyzes the harm caused by drug rebate: it seriously disturbs the order of drug market, makes fake and inferior drugs flood the market, endangers patients' life and health, and the cost of drug production does not accord with pricing, which results in the serious loss of state tax; The deficiency of drug price increases the medical burden of patients, many patients become poor because of illness; the rebate of drugs leads to the lack of credit between doctors and patients, the contradiction between doctors and patients intensifies, which is not conducive to the construction of a harmonious relationship between doctors and patients. Then analyze the reasons of drug rebate from the following aspects: the structure of pharmaceutical industry is unreasonable, small enterprises account for the majority, it is difficult to form the core competitiveness, and the product supply exceeds the demand seriously; Government supervision is weak, drug pricing mechanism is unreasonable, government staff lack of medical knowledge background, the operating system of medical institutions has defects, the government financial compensation is not in place, the legal income of doctors is low, it is difficult to resist the temptation of high rebate; The hospital is in the double monopoly position in the field of drug purchase and sale, the patient is in the weak position; the legislation is not perfect, the rebate quality is not clear, the civil compensation related law is missing and so on. In order to regulate drug rebates, this paper puts forward the following suggestions for the above reasons: some are already in practice, some still need to be perfected, and some new methods are expected to be adopted. To rectify the order of the drug market, to establish a standardized and scientific drug pricing system, to separate medicine from medicine, for example, to conduct pharmacy custody; To break the mechanism of "nourishing medicine with medicine", to increase the investment of government funds, to raise the service charge of pharmacy, to respect the labor value of doctors, to encourage the development of private hospitals, and to form a strong medical service network. To improve the drug procurement management system and strengthen the supervision and management among procurement personnel at all levels; To optimize the centralized bidding procurement system and put forward new ideas, it is suggested that the existing centralized bidding procurement system should be revised to allow hospitals and pharmaceutical manufacturing enterprises to carry out second price bargaining; Improve the system of essential drugs, increase the variety of drugs, and maintain the timely supply of drugs; Using legal means to severely punish drug rebates, according to different circumstances, respectively as bribery crime and non-state staff bribery crime, and suggested that the legislature clear the corresponding civil compensation; Strengthen the legal education of medical personnel, alert medical personnel with actual cases, strengthen medical moral education of medical personnel, cultivate noble professional ethics, and refuse drug rebates from their own point of view. Through the above several aspects of analysis, I hope to regulate the rebate of drugs in China.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F203
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