【作者】 王健；

【导师】 钟仁耀；

【作者基本信息】 华东师范大学 ， 公共管理硕士（专业学位）， 2022， 硕士

【摘要】 看病贵一直是我国民生问题中的热点话题,而导致看病贵的主要原因则在于药品价格的高昂,国家政府一直致力于解决老百姓看不起病、吃不起药的问题。2015年3月27日,上海市人力资源社会保障局等四部门联合制定并印发了《关于做好本市医保药品带量采购有关工作的通知》(沪人社医发[2015]13号),上海市药品带量采购政策正式开始实施,该政策对部分临床用量大,价格高,且生产企业较多的基本药品和非专利药品进行了试点带量采购,在保证药品采购量的基础上,大幅度降低了药品的价格,达到了以量换价的目的,既保证了药品生产企业的生存,又真正惠及了老百姓。且药品带量采购政策不断改革,品种不断扩大,为解决老百姓看病贵的问题起到了至关重要的作用。但该政策毕竟还是在试点摸索阶段,在执行过程中还是有一些问题暴露出来,需要完善和改进。通过对国内外文献的研究发现,国内外学者对于药品采购的模式也在不断探索,在量价挂钩、采购形式等方面都做了大量的研究。国内学者对于药品集中采购的研究较多,而对于带量采购的研究相对缺乏。本文从公立医院的角度出发,以药品带量采购政策为切入点,通过比较带量采购变革的进程,明确现阶段上海市药品带量采购的执行现状,并找出政策所带来的成效。本文基于上海市药品带量采购政策在公立医院中的实施为背景,以上海市A医院为例,通过问卷调查法和访谈法对带量采购政策各利益相关群体进行研究,得出该政策在执行过程中所产生的问题,包括约定采购周期逾期严重、医疗机构回款不及时、部分药品供应不稳定、临床医师参与积极性低、患者用药产生矛盾等。并分析产生以上问题的原因,主要为医疗机构政策执行体制不完善,部分药品临床使用不及预期,医疗机构利益格局被打破,医保资金垫付给医院减轻压力,药品配送企业供应链不稳定,企业供货积极性不强,临床可替代药品品种受限,中标药企放弃带金销售模式,医疗机构缺乏激励制度,药品医保支付标准不合理,患者对国产仿制药的不信任态度等。对提升上海市药品带量采购政策的执行成效提出了一些建议。包括优化平台,改进评价反馈系统;完善制度,保证政策执行稳定;部门协同,有效加强执行监管这三个方面。而具体需从优化带量采购平台数据测算系统,构建带量采购药品评价反馈机制,完善带量采购中标药品的价格保护制度,完善药品带量采购政策激励约束制度,完善带量采购中标药品退出制度,严格把控带量采购药品资金流转过程,完善药品的支付标准,加强药品的生产监管,加大对国产仿制药一致性评价的宣传力度等着手。希望这些建议能为药品带量采购政策在上海市公立医院中的贯彻落实起到一些帮助。更多还原

【Abstract】 The high cost of medical treatment has always been a hot topic in the problems of people’s livelihood in China,and the main reason for the high cost of medical treatment is the high price of drugs,and the national government has been committed to solving the problem that the people look down on the disease and cannot afford to eat medicine.On March 27,2015,the Shanghai Municipal Human Resources and Social Security Bureau and other four departments jointly formulated and issued the Notice on Doing a Good Job in the Procurement of Medical Insurance Drugs in Shanghai(Hu ren she yi fa [2015] 13).Shanghai Municipal Drug Procurement Policy officially began to implement,the policy for some clinical use of large,high prices,and more production enterprises of basic drugs and non-patented drugs carried out pilot procurement,on the basis of ensuring the purchase of drugs,greatly reduced the price of drugs,to achieve the purpose of exchanging prices for quantity,not only to ensure the survival of drug manufacturers,but also to truly benefit the people.Moreover,the policy of drug procurement with quantity has been continuously reformed and the variety has been expanding,which has played a vital role in solving the problem of expensive medical treatment for the people.However,after all,the policy is still in the pilot exploration stage,and there are still some problems exposed in the implementation process,which need to be improved and improved.Through the research of domestic and foreign literature,it is found that scholars at home and abroad are constantly exploring the mode of drug procurement,and have done a lot of research on volume-price linkage and procurement forms.Domestic scholars have more research on centralized procurement of drugs,while there is a relative lack of research on procurement with quantity.From the perspective of public hospitals,this paper takes the drug procurement policy as the starting point,and compares the process of change in the quantity procurement,clarifies the implementation status of the drug procurement in Shanghai at this stage,and finds out the results brought by the policy.Based on the background of the implementation of shanghai drug procurement policy in public hospitals,taking Shanghai A Hospital as an example,this paper conducts research on various stakeholder groups of the volume procurement policy through questionnaire survey method and interview method,and draws the problems caused by the implementation of the policy,including serious overdue procurement cycle,untimely collection of payment by medical institutions,unstable supply of some drugs,low enthusiasm of clinicians,and contradictions in patient medication.And analyze the causes of the above problems,mainly for the imperfect policy implementation system of medical institutions,the clinical use of some drugs is not as expected,the interest pattern of medical institutions has been broken,the medical insurance funds are advanced to the hospital to reduce the pressure,the supply chain of drug distribution enterprises is unstable,the enthusiasm of enterprises to supply is not strong,the varieties of clinically replaceable drugs are limited,the winning pharmaceutical companies abandon the sales model with gold,the medical institutions lack incentive systems,and the payment standards for drug medical insurance are unreasonable,patients’ distrust of domestic generic drugs,etc.Some suggestions were put forward for improving the implementation of Shanghai’s drug procurement policy.Including optimizing the platform,improving the evaluation feedback system,improving the system to ensure the stability of policy implementation,and coordinating departments to effectively strengthen the implementation of supervision.Specifically,it is necessary to optimize the data measurement system of the procurement platform with quantity,build a feedback mechanism for the evaluation of drugs with quantity procurement,improve the price protection system for the winning drugs in the purchase of the amount,improve the incentive and constraint system of the drug procurement policy,and improve the withdrawal system of the winning drugs with the amount of procurement Strictly control the process of capital circulation of drug procurement,improve the payment standards for drugs,strengthen the production supervision of drugs,and increase the publicity of the consistency evaluation of domestic generic drugs.It is hoped that these suggestions will help the implementation of the drug procurement policy in Shanghai public hospitals.更多还原