【作者】 郝佳；

【导师】 刘伟；

【作者基本信息】 郑州大学 ， 药学， 2011， 硕士

【摘要】 近年来,“看病难,看病贵”已经成为社会热点问题。我国卫生总费用逐年大幅增加,卫生总费用占GDP的比例也呈上升趋势。虽然近年来随着新农合医疗体系与各种城镇医疗保险的普及,我国各种形式的医疗保障覆盖率达80%,但总体来讲,报销比例偏低,医疗费用支出的半数以上部分仍由个人支付,医疗费用支出的增长速度超过了个人经济收入增长的速度,“看病贵、看病难”问题严重。在门诊病人和出院病人医疗总费用中,药品费用的支出比重高达40%-60%。经济合作与发展组织国家为5%一20%,日本为20%左右,都大大低于我国的情况。我国医疗费用过高的一个关键因素就是医疗过程中药品费用过高。我国目前存在着药价虚高的现象,即药品价格长期严重偏离生产成本,因此若能有效地控制药价就可以极大地缓解看病贵的问题,从而大大减轻居民的医疗负担。药品是一种直接关系到人民身心健康特殊商品,药价虚高不仅增加了人民群众的经济负担,加重看病难的现象,还严重影响和破坏了制药企业的正常生产经营秩序,导致了商业贿赂等社会腐败现象,助长了不正之风的蔓延,给整个社会的和谐发展造成了极大威胁。因此,要达到促进医药领域合理药品价格秩序的形成、促进医药行业健康发展、促进公众健康福利提高这一宏伟目标,解决药价虚高问题是关键。药价虚高是一个综合性病症,其根源在于我国医药体制上的种种弊病,药品生产经营企业、医疗机构、政府部门都有责任,包括药品生产流通体制、医院的“双垄断”的经营体制、医疗机构“以药养医”的经济补偿机制、医疗机构的薪酬制度、药价管制模式、现有的医疗保险制度,药品定价模式不合理、药品注册销售过程中的寻租现象等。本文参照发达国家药品费用控制的成功经验,提出了一些政策建议。对药品的生产经营企业,提高市场准入条件,促进规模化经营,减少流通环节。对于医疗机构,打破其“双垄断”的特殊地位与“以药养医”的不合理经济补偿模式,从根本上消除医药间的直接经济联系。同时改革医疗机构薪资制度,加强医德医风建设。对于政府来说,应加大对卫生事业的投入,完善“双G”认证标准,改革药品定价机制,完善药品招投标制度、医疗保险制度等相关体制的改革等。解决药价虚高问题是一项综合性工程,需要从以上各个方面全面推进我国医药体制改革,形成治理合力。更多还原

【Abstract】 In recent years, "expensive medical bills and difficult access to quality medical services " has become a hot social issue. With years of significant increase in total health expenditure, the proportion of the expenditure in GDP is rising too. Although in recent years, with the establishment of a new rural cooperative medical care system and the rising popularity of a variety of urban health insurances, our various forms of medical care have achieved a coverage of 80%, reimbursement rate is generally low. People still pay a large proportion of medical costs, and health care costs grow faster than personal income. "Expensive medical bills and difficult access to quality medical services" is a serious problem. In the total medical costs that discharged patients and outpatients have paid for, the proportion of drug expense takes up to 40%-60% while the percentage is 5% to 20% in the member countries of Organization for Economic Cooperation and Development (OECD),20% in Japan, which are significantly lower than that in China. The high drug cost in the medical process is an important and direct contributor to the high cost of health care in our country.The prices of medicines are unreasonably high currently, which means the drug prices are drastically higher than the production cost. Therefore, drug price control can greatly ease the problem of expensive medical treatment, and greatly reduce the medical burden of ordinary people. Drug is a special commodity which is directly related to people’s physical and mental health. Formidable price not only increases people’s financial burden, making medical treatment more unaccessible, but also seriously affects and disturbs the normal pharmaceutical production and operation, causing commercial bribery and other social corruption, fueling the spread of unhealthy practices, bringing long-term instability to the entire community and a great threat to the harmonious development. Therefore, solving the problem of high medicine prices is very important. It can promote the establishment of a reasonable order of drug prices, the healthy development of the medicine industry, and the improvement of the public health and welfare.Artificially instigated high drug price is a syndrome rooted in China’s abuses of the medical system. Medicine production enterprises, medical institutions and government departments are all responsible for the problems including the drug production and distribution system, the hospital’s operating system of "double monopoly", the "supporting hospital with medicine" in medical institutions, the economic compensation mechanism, the medical sector pay system, the mode of drug price regulation, the existing system of medical insurance, the unreasonable drug pricing, and the rent-seeking phenomenon in the process of drug registration. It is a comprehensive project to solve the problem of high medicine prices. Our country should comprehensively improve the medical system from the aspects mentioned above, and take advantage of governmental power. Some policy suggestions were proposed in the present thesis, based on the success of medicine price control in developed countries,更多还原