【作者】 林薇；

【导师】 阳义南；

【作者基本信息】 华南理工大学 ， 公共管理（专业学位）， 2020， 硕士

【摘要】 为充分保障药品供应,减轻患者用药负担,杜绝药品生产销售由来已久的商业腐败问题,2000年起我国正式制定实施药品集中采购制度。近20年以来,药品集中采购制度在控制药品费用、降低药品价格、保障药品供应、促进用药安全、改善药品流通环境等方面发挥了重要作用,取得了巨大的社会效益和经济效益。我国药品集中采购制度发展至今,制度数量多、结构复杂,对其运行绩效进行实证研究比较困难。而药品可及性提供了具有可操作性的视角,降低了评价复杂度。本文通过文献研究,在梳理国内外研究成果、介绍我国药品集中采购制度运行现状,分析我国药品可及性现实问题的基础上,通过将药品集中采购制度的基本任务与药品可及性内涵进行“耦合”,明确了评价的基本维度。通过问卷和访谈,在确定评价维度的基础上,通过专家打分及可行性分析筛选指标;通过层次分析法、CRITIC方法进行主、客观赋权,形成了指标体系。通过实证研究,将全国层面公布的权威性数据带入评价体系分析发现:2015至2018年,我国药费比重稳定下降,但企业销售费用逐年上升,说明人民群众用药负担不断减轻,但药品费用的下降空间仍然较大;药品购销交易效率低,安全用药问题突出,说明药品购销交易周期长、配送环节多、履约质量差,药品集中采购制度对确保药品质量安全、促进合理用药的保障力度不足;医药产业和药品购销市场规模逐年扩大,但买方、卖方垄断风险并存,对降药价、保供应均造成风险隐患。依据实证研究结果,提出进一步完善我国药品集中采购制度的策略:一是继续坚持公共利益为主、兼顾市场利益的制度发展导向。二是要继续推动降低药品费用,坚持带量采购,创新药品集中采购做法,探索医疗保障部门直接参与药品集中采购,以扩大制度边际效益,确保药品价格长期处于合理区间。三是加强药品质量管理,一方面要“截流”,把好药品质量遴选关,另一方面要“拓源”加快一致性评价,让更多合格药品进入采购名录;四是在降低交易成本、提高药品交易效率的同时利用制度杠杆调节市场资源配置,提高药品供给水平。五是加强市场管理和服务,打击药品购销环节违法行为,保障买卖双方的合法权益。更多还原

【Abstract】 In order to fully ensure drug supply,reduce the burden of drug use on patients,and put an end to the long-standing problem of commercial corruption in drug production and hospitals,China formally formulated and implemented the centralized drug procurement system since 2000.In the past 20 years,the centralized drug procurement system has played an important role in controlling drug costs,reducing drug prices,ensuring drug supply,promoting drug safety,and improving drug circulation environment.It is difficult to make an empirical study on the performance of centralized drug procurement system in China due to its large number and complex structure.Drug accessibility provides an operational perspective and reduces the complexity of evaluation.On the basis of literature research,domestic and foreign research results,the status quo of China’s centralized drug procurement system,and the analysis of the practical problems of drug accessibility in China,this paper "coupled" the system of centralized drug procurement with the connotation of drug accessibility,and clarified the basic dimensions of evaluation.Through questionnaires and interviews,on the basis of determining the evaluation dimensions,the indicators were selected through expert scoring and feasibility analysis.Through the analytic hierarchy process(AHP)and CRITIC method,subjective and objective weighting is carried out,and the indicator system is formed.Through empirical research,the authoritative data published by National Administrative Bureau of the State Owned Property of the People’s Republic of China(NABS)were brought into the evaluation system,and it was found that: from 2015 to 2018,the proportion of drug expenses in China declined steadily,but the sales expenses of enterprises increased year by year,indicating that the burden of drug use of the people was constantly reduced,but there was still large space for drug expenses to fall.The low efficiency of drug purchase and sale transaction and the prominent problem of safe drug use indicate that the drug purchase and sale transaction cycle is long,poor system performance,and the centralized drug purchase system is insufficient to ensure the quality and safety of drugs and promote rational drug use.The scale of the pharmaceutical industry and the purchase and sale market has been expanding year by year,but there is monopoly risks in the market.Based on the results of the empirical study,the paper puts forward some strategies to further improve the centralized drug procurement system in China.First,continue to adhere to the correct system development orientation.Second,we will continue to reduce drug costs,continue to purchase drugs in large quantities,innovate in the practice of centralized drugprocurement,expand the marginal benefits of the system,and ensure that drug prices remain within a reasonable range in the long run.Third,we need to strengthen drug quality management.On the one hand,we need to "intercept the flow" and make sure that the quality of drugs is properly selected.The fourth is to reduce the transaction cost and improve the efficiency of drug transaction,and at the same time to use institutional leverage to adjust the allocation of market resources and improve the level of drug supply.Fifth,we will strengthen market management and services,crack down on illegal drug purchases and sales,and protect the legitimate rights and interests of both buyers and sellers.更多还原