【作者】 陈伟国；

【导师】 蒋明新；

【作者基本信息】 西南财经大学 ， 企业管理， 2008， 博士

【摘要】 同国民经济其他行业相比,医药行业有其鲜明的特点。医疗作为一种特殊的服务,药品作为一种特殊的商品,它们在流通和使用过程中,具有准公共产品属性、不完全替代性、效用的两重性、消费的信息不对称性、需求的价格弱弹性等。同时,医药市场行业主体也有如下特殊性:1、医药相关服务具有高度的技术性和专业性,其主导权在医师和药店从业人员;2、对医药相关从业人员的职业道德有很高的要求;3、消费者的消费心态较差,大多怀有烦躁、忧郁、沮丧甚至恐惧的心态;4、组织具有多重目标性,而有的时候这些目标还有可能是相互冲突的,如我国医院大多是非营利性医院,以救死扶伤为己任,按道理财政应该足额拨款,而我国财政能力又有限,导致医院为了生存,纷纷从药品加价上获取利润,导致医院名义上是非营利性的,而实际上利润丰厚;5、医药服务具有延续性和紧密性。医药相关服务通常不能一次完成,由此频繁接触产生的依赖和亲密关系非一般行业可比;6、受相关法规约束较多。由此,医药供应链与其他产业供应链相比,具有市场竞争的不完全性,终端消费行为的特殊性、供应链管理绩效好坏与政府医药体制和政策的相关性。当前,我国医药行业正在经历深刻的变革。医药行业作为国家实施社会保障制度的重要支柱,既面临着良好的发展机遇,同时也面临着严峻的挑战。长期以来,我国公立医院在医疗卫生机构中占有很大的比重,国家在资金和技术投入、医疗机构审批、医疗保险和公费医疗、税收等政策方面大力向公立医院,特别是城市大型医院倾斜。我国医院收入来自于政府补贴、医疗服务收费、药品加成,改革开放以来,由于政府预算补助不足,医院主要靠自身经营收入(医疗服务收费和药品加成收入)加以补偿。在医疗服务收费不能体现医疗技术劳务价值时,医院只能从药品利润中获取生存和发展所需的资金。再加上我国人民群众长期以来形成了在医生指导下进行药品消费的习惯,加之我国另一药品销售终端——零售药店的自身发展水平有限、竞争层次较低,医院就一直占据着我国药品零售市场的垄断地位,并利用自己的主导优势,进行渠道和价格限制,抑制竞争对手发展;占压厂家和经销商资金,索要高额赞助费、折扣、回扣等;利用药品信息优势,给患者开大处方、滥用药、开贵重药等。同时,由于我国的药品定价机制、新药审批机制、药品招标机制、基本药物制度等方面存在着缺陷,造成了药品价格虚高,药品生产企业新药研发能力和积极性不高,“新药”主要是在原有药品基础上改头换面,药品招标制度实施效果不好、以次充好、假药泛滥等现象层出不穷。多种因素造成了我国医药市场混乱和异常,政府和人民群众都不满意。对于转轨变型时期中国医药市场中存在的种种问题,不少人从不同的角度提出了自己的看法和建议。与许多着重研究医药卫生系统中的某个环节(例如制药企业、医院、药店或连锁药店等等)、某个方面(例如政府管制、药价虚高等等)的文献不同,本文从医药供应链的角度,把医药卫生市场中的有关组织和个人视作一个既相互联系、又相互博弈的整体,力图从物流、资金流、信息流以及它们之间的相互关系方面,对供应链中各不同市场主体的行为以及他们之间的相互关系,进行更为全面系统的研究。本文认为,我国医药行业的诸多问题,主要根源于医药供应链构建不合理。其主要表现是:1、医药供应链交易费用过高,引发药品终端价格虚高;2、政府干预过多,导致医药市场失灵,制药企业偏向于给药品高定价,而药价越高越好销售;3、制药企业不愿在新药研发上投入,而是把主要精力放在药品分销上和将原有药品更换包装变为“新”药品上;4、与其他行业供应链相比,医药供应链上节点企业缺乏利益共享机制,导致医药供应链参与各方利益分配失衡,参与各方协作性较差,整体绩效不高;5、与其他市场相比,医药市场终端存在着多种市场结构即垄断和完全竞争并存;6、由于消费者的医药消费习惯及医药供给方与医药需求方的信息不对称,再加上医疗保险和公费医疗制度的影响,导致消费者的医药消费具有很大的被动性、盲目性和制度安排性。针对医药供应链本身的特点以及我国医药体制改革与医药市场发展的具体情况,本论文进行了大量的数据调查,运用博弈论、垄断理论、政府规制理论、制度伦理学等理论工具,分析医药供应链出现畸形的机理,运用“剔除—减少—增加—创造”坐标格和“新、旧价值曲线”对比来构成医药供应链的战略布局,并在此基础上提出了相应的供应链发展与管理的政策建议。首先,论文对研究我国医药供应链的重要性和必要性进行了分析。论文从医药行业的产品特性、行业主体特性、自身运行特性等三个方面分析了医药供应链相对于一般产业供应链的特殊性。并从我国政府对医药市场的管理观念、管理机制、管理办法和措施方面分析了我国医药供应链的政府管制特点,指出了研究我国医药供应链的理论意义和实践意义。其次,系统深入地分析了我国医药市场的现状和存在的问题。论文分析了我国医药供应链中药厂、批发商、医院、药店、消费者的现状、运行模式、存在问题、发展方向和案例,分析了当前正在执行的药品集中招标采购制度、药品定价机制、新药研发、审批机制、医院经济补偿机制等,指出了医药市场中存在的“市场失灵”和“政府失灵”的具体表现。第三,论文对我国医药市场存在问题的原因进行了分析。论文根据我国医药市场的分析资料,从经济学视角、制度伦理视角分析了我国医药供应链问题产生的原因和根源,论文提出了我国医药市场的混乱和异常现象从根本上说是我国医药供应链畸形所致的这一基本观念,并从物流、信息流、资金流――“三流合一”的角度分析了我国医药供应链存在的问题。第四,论文对我国医药供应链的发展进行了战略分析。论文对我国医药市场几项重要制度进行了点评,分析了我国医药供应链战略研究所面临的环境,并运用“剔除—减少—增加—创造”坐标格和“新、旧价值曲线”对比方法,构建了我国医药供应链的战略布局,并预测了我国医药供应链的未来发展。最后,论文从政府观念、医药体制、制度设计、产业发展等方面提出了我国医药供应链发展和管理的政策建议,旨在降低供应链中的垄断程度、减少信息不对称、打击权力寻租、提高产业竞争力和供应链运行效率,最终达到增加消费者福利,促进医药企业和医药市场的健康发展。本论文的创新之处在于:第一:论文全面、系统地分析了我国医药市场中政府、药厂、批发商、医院、药店、消费者的现状、问题、操作模式,并进行了大量的数据和案例分析。而以往我国对医药市场的研究主要针对供应链中的某一个环节或某一个方面的问题开展,未能从医药市场的整体上去发现和分析问题,因此难以系统地把握和解决我国医药体制的缺陷。第二:基于对我国医药市场的分析,提出了“我国医药市场的混乱和异常现象根本上是我国医药供应链畸形所致”这一基本观点,并重点从“三流合一”的角度分析了我国医药供应链存在的问题,同时运用了大量的市场调查数据和文献数据进行说明和验证。以前我国的研究没有把医药市场的问题和供应链管理有机结合,对医药供应链的研究主要集中在库存控制、物流配送、信息管理系统建设方面,基本未从物流、资金流、信息流全方面来分析医药供应链。第三:运用博弈论、垄断理论、政府规制理论和制度伦理学等对我国医药供应链畸形的原因从经济学视角、制度伦理视角和一般视角进行了分析,论证了我国现行医药卫生体制导致医药供应链畸形的必然性。第四、采用“剔除—减少—增加—创造”坐标格和“新、旧价值曲线”对比图,运用蓝海战略分析方法,构建了我国医药供应链的战略布局,并预测了我国医药供应链的未来发展。更多还原

【Abstract】 As a special commodity, in process of convection, medicine bears characters of public product, unentirly replaceable, twoness of effect, unbalance of consumption information, poor elastic in price to consumer andéclat the same time, main body of medicine trade bears the following characters:(1)medicine concerned service is highly technical and specialized. It is dominated by doctors and drug store practitioners;(2)High professional ethics are required for concerning practitioners;(3)Psychology of consumers is prevailing poor. Fantod, anxious, depress and even panic are found ;( 4 ) Targets of government organizations are multiply. Sometimes, those targets can contradict each other. (5)Medical service bears a character of continuity and rigor(6)It is much retrained by concerning norms and legal regulations.As our country is now still in process of economy system converting and reformation of medical system, there is far cry with foreign countries in medical treatment and medicine market, medicine management system and government regulation and control. While research on the problem is almost blank and there is no foreign experience to refer with. Therefore,in this thesis, I have chosen the research on developing strategy of the country’s medicine supply, expecting to detect the main problems of Chinese medicine convection chains by detail investigation on Chinese medical treatment and medicine market,to perceive the foreground of Chinese medicine supply chains by making corresponding strategy,further the reform of medical system , boost the operation efficiency of medicine convection chain and finally strengthen the competing ability of Chinese pharmaceutical industry.Ever from beginning , government run hospitals have been over proportioned in our medical system, in addition that policies of capital and technology input, review and approval of medical organization, medical insurance, medical treatment at public expense, tax levy and other aspects are in favor of government run hospitals, especially metropolitan large hospitals, resulting in long term monopoly of the medical treatment and sanitation business by those government run hospitals. Income of our hospital consists of government subsidy, charge of medical treatment service and pharmaceutical markup. Because of insufficiency of government subsidy budget, hospital running has to be supported by its own business earning as equalize. When income of medical treatment service can not realize its own work merit, hospital can only survive and develop itself from the profit of medicine markup. In addition to the long last medicine consumption habit of the civilian, which depends on the instruction of doctor and the limited self development and low level competition of the medicine sale terminal, namely drug store, hospitals have been dominating the medical treatment and medicine market with its monopoly advantage. By their domination, they have managed to carry out the channel and price restraint to obstruct the development of their rivals. They hold the capital of manufacture and dealer forcibly, grabbing high quota of filthy lucre such as so called sponsor, discount and rebate. They also take advantage of their knowledge of medicine to give patient over dosed prescription, medicine abuse and high cost medicine. Due to defects and twisted phenomenon of government systems of medicine price fixing, new medicine approval , medicine bidding invitation and basic pharmaceutical rules and regulations, false image of high price of medicine has come into being. Therefore, pharmaceutical enterprises are not active in research on new medicine, many so-called new medicines are only original ones what have just changed their appearance or disguised with a new name. Further more, medicine bidding system has not been executed well, resulting in flooding of shoddy and fake medicine. In additional, management concept of our government is comparative backward, its managing function is not fully converted and brought into full play, managing system is not perfect, proper supervision and restraint is not strict, all these factors finally lead to the mess of our medical treatment and medicine market and the freak of medicine convection.As per my opinion, so many above stated problems of our pharmaceutical trade stem from the unreasonable structure of our medicine convection or we can see stem from the twisted supply chain. Irrationality of the medicine convection can be mainly classified as the following:(1)Trade cost during the process of medicine convection is over high, triggering off the high price of medicine at terminal.(2)Over intervene from government has resulted in the defunction of medicine convection, making the pharmaceutical enterprise tilting to drive up medicine fix price, as higher priced medicine can be better sold out;(3)Pharmaceutical producing enterprises are not willing to invest in research on new medicine, on contrary, they concentrate on medicine sale and changing appearance of old medicine to fake;(4)Compare with the convection of other trade, profit share mechanism for pharmaceutical enterprise is short of on medicine convection chain, resulting in unbalance of profit allot , therefore, leading to a poor coordination among the participators and finally resulting in poor management of the medicine convection;(5)compare with the other markets, due to historical current system reasons, at the terminal of medical treatment and medicine market, co-existence of multi trade forms , in general, co-existence of monopoly and free competition is found;(6)Due to consumption habit of the medicine consumer and information asymmetry on supplier side and consumer side, along with influence of medical indemnification system and system of medical treatment at public expense, civilians are passive , blind in medicine consumption. Why abnormality is found in our medicine supply chain? In view of me, it has stemmed from the long term planned economy, current management system of government. Of course , it also has a lot to do with the poor development of our pharmaceutical trade.The thesis discourses upon the topic not only from the management angle of the supply chain, but from all aspects of the management, especially from the angle of system and strategy analysis, focusing on the development and renewal of original medicine convection chain. The thesis has carried out large quantity of data investigation and case analysis.It has managed to analyze the reason of deformation of the medicine supply chain by combining with the theories of game,monopoly theory ,government norm and syestem , syetem logic . It has formed the strategic layout for medicine supply chain by means of coordinates of eliminate-reduce-increase-create and by comparing the new value curve with the old one. Basing on it, it has put forward corresponding suggestions for developing and managing policies of the supply chain. The thesis discourses upon the Chinese medicine supply chain from the following aspects:Firstly,it carried out the analysis on importance and necessity of the medicine supply chain. It has analyzed character of the government control on the medical treatment and medicine market, demonstrated the theoretical and practical significance of the research on the medicine supply chain.Secondly,it has carried out a systematical and further analysis on the current status and problems of Chinese medical treatment and medicine market. It has demonstrated the detail behaviors of“market defunctions”and“government defunctions”existed in the medical treatment and medicine market.Thirdly,it has carried out the analysis on the current problems of the medical treatment and medicine market. It has pointed out that real reason of the mess and abnormality existed in the medical market is the deformation of the medical supply chain. It has analyzed the problems of the medicine supply chain from the aspects of material convection ,information exchange and capital flow.Fourthly, it has carried out the strategic analysis on development of Chinese medicine supply chain. It also has given comments on several important systems on Chinese medical treatment and medicine market and foreseen the future development of the medicine supply chain.Finally, the thesis has put forward suggestion on developing and management policies for Chinese medicine supply chain. By analysis on the strategy of the medicine supply chain, it has given suggestions for future policy, covering government concept, medicine system, system design and industry development so that to decrease monopoly, reduce asymmetry of information, enhance the industrial competition ability, increase welfare of consumer and promote a healthy development of pharmaceutical enterprises and medical treatment and medicine market.Following innovations can be seen in this thesis:1. It has given an overall, systematic analysis on the current situation, problems, operation pattern of government, pharmaceutical enterprise, wholesaler, hospital and consumer on the medicine chain with a lot of case investigation and analysis. While in the past, research on medical treatment and medicine market only focused on some tache or some problem, therefore it was impossible to detect and analyze the problem integrally, it was, no doubt, impossible to grasp the defect of our medical system and solve the problem.2. Based on analysis on Chinese medical treatment and medicine market, it has drawn the conclusion that the mess and abnormal of the medical treatment and medicine market stemmed from the deformation of medicine supply chain. It analyses the existing problems of the medical treatment and medicine market by studying the material convection, capital flow and information exchange, while in the past, concerning research on the medicine supply chain has never focused on them.3. By means of game theory, monopoly theory ,government norm and syestem , syetem logic , it analyses the reasons of the deformation of the medicine supply chain and has reasoned out the inevitability of the deformation.4. It has formed the strategic layout for medicine supply chain by means of coordinates of eliminate-reduce-increase-create and by comparing the new value curve with the old one eliminate-reduce-increase-create and by comparing the new value curve with the old one and it has foreseen the future development of Chinese medicine supply chain.更多还原