【作者】 唐圣春；

【导师】 张新平；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2009， 博士

【摘要】 研究目的：探讨我国市场经济条件下药品价格规制的内涵与发展历程，对我国药品价格规制进行系统的研究和评述，分析各阶段药品价格规制政策制定的背景以及与当时社会政治、宏观经济之间的关系，政策的主要内容、政策效果、相关利益集团对药品价格规制的应对，总结我国药品价格规制政策的演变规律及对制定新政策的启示。并借鉴国外一些国家的经验，为我国制定药品价格规制政策提供一些新的思路和视角。最后提出完善我国药品价格规制政策的建议。研究方法：本研究综合运用了多种研究方法，主要包括：(1)文献研究。了解有关药品价格规制的政策、研究文献，系统回顾文献上有关药品价格政策与价格体系的经济理论和实证研究。(2)环境分析法。分析我国市场经济条件下药品价格规制政策制定与实施的政治、经济环境，并分析药品价格政策与外围环境之间的相互关系。(3)规范分析方法。分析、总结市场经济条件下我国药品价格规制政策的经验和规律，并与国外部分国家的药品价格规制政策进行比较，从而提出市场经济条件下我国药品价格规制政策的价值取向。(4)利益集团分析方法。分析利益相关方——规制主体和规制对象对药品价格规制政策的实施意愿、能力和实施情况。(5)定量分析方法。分析市场经济条件下我国药品价格规制政策的效果，并与发达市场和新兴市场进行效果比较。(6)时间序列研究。系统地回顾我国药品价格规制政策的演变历程，但侧重于对现阶段的药品价格规制政策进行研究。研究结果：本文通过对药品价格规制的演变及效果分析，得出以下结果：(1)政府对药品价格的规制范围经历了由大到小，再扩大的过程；定价方法在逐步完善。(2)政府对药品价格的规制有一定效果，但效果不明显。中西药品的零售价格指数由1994年的111．8降到2006年的99．1；政府定价范围内的药品价格水平总体上有较大幅度的下降，但实行市场调节价的药品其价格水平出现了市场逆调节现象；专利药品、原研药品与仿制药品之间的价格水平差异不合理，中国部分研发企业的原研药品价格是仿制药的2．5倍。(3)与外围市场相比，在可比的西药当中，基于出厂价计算的中国平均药品价格指数大约是发达市场的35％，是亚洲／新兴市场的55％；但我国患者要承担的渠道平均加价(为60％-70％)要高于外围市场。主要原因在于我国医院环节加成比例(平均为20％-25％)和处方药增值税率(17％)较高。(4)从定性研究结果来看，影响药品价格虚高的表面原因最主要的是医院药品价格不透明、生产流通企业集中度低、医患之间的信息不对称等，深层次的原因是医院实行医药合业制度、医院与病人之间的“医药捆绑”以及医院与药品生产经营企业之间的“医药合谋”。(5)药品定价不仅要考虑成本因素，还要考虑药品的创新性和市场供求状况。(6)药品费用的上升与药品价格没有直接的关系，用药结构和用药数量的改变对药品费用的影响更大。研究结论：(1)我国药品价格规制在逐渐完善，并逐步与国际接轨；在药品价格管理模式上，经历了规制、放松规制到再规制的过程。(2)目前的药品成本加成的定价方法不合理，不能有效控制成本，不利于激发企业药品研发创新；应采用综合性的药品定价方法。(3)药品分类定价方法有其优点，但存在诸多不足，需要完善。(4)单一的药品价格规制政策无法达到有效控制医疗费用的目标，需要有良好的制度环境，如完善的医疗保障制度、国家基本药物制度、医药分业、公立医疗机构合理补偿机制的建立等。(5)药品价格规制既要考虑公共利益，又要考虑相关利益集团的利益(包括药品生产经营企业和医疗机构)。创新点：(1)在理论分析上，提出了药品价格规制的基本原则，即“成本-竞争-期望”理论，并尝试建立了我国药品价格规制数量模型和规制政策运行模型。(2)在实证研究上，系统分析与评价了市场经济条件下我国药品价格规制政策的实际运行效果。(3)在政策分析上，系统回顾、分析了我国药品价格规制的规律和基本特点，并在此基础上提出健全我国药品价格规制的政策建议。更多还原

【Abstract】 Objectives: To discuss the connotation and development course of the regulation of medicine prices in the market economy system in China, research and evaluate the regulation of medicine prices systemically; analyze the backgrounds in which the regulation policies of medicine prices were instituted in every phase and its relationship with politics and macro-economy of the time, the main content and the effects of the policies, the responses of the interrelated stakeholders to the regulation of medicine prices; sum up the evolvement laws of regulation policies of medicine prices and its implications for making the new policy. Meanwhile, referring the experiences of other countries in order to provide some new ideas and views for our country when making regulation policies of medicine prices, in the end, put forward some suggestions so as to perfect the regulation policies of medicine prices in China.Methods: This paper uses many research methods synthetically, including: (1) Literature research. To learn regulation policies of medicine prices, literatures, economic theories and demonstration research. (2) Environment analysis. To analyze the political and economic environment in which the regulation policies of medicine prices were constituted and implemented in the market economy system in China, also the relationships with the external environments. (3) Criterion analysis. To sum up the experiences and laws of the regulation of medicine prices, and compare with the regulation policies of medicine prices of some foreign countries, consequently, bring forward the value orientation of the regulation policies of medicine prices in China. (4) Stakeholder analysis. To analyze the implementation desire, ability, and implementation effect of stakeholders in the regulation policies of medicine prices, including regulation departments and regulation objects. (5) Quantitative analysis. To study the regulation effect of medicine prices of China, and compares it with developed markets and emerging markets. (6) Time-series study. To review systemically the evolvement course of the regulation of medicine prices in China, but emphasize particularly on actual regulation policies of medicine prices.Results: The main results of this paper includes: (1) the regulation ranges of medicine prices by the government became from big to small, and then became big; the pricing methods were perfected gradually; (2) the regulation of medicine prices has some effect, but it isn’t very obvious. The retail price index of Traditional Chinese and western medicines descend from 111.8 in 1994 to 99.1 in 2006; the price level of medicines regulated by the government declined evidently as a whole, but there was a converse market adjustment on the medicines adjusted by the market; the prices discrepancy between patented medicines, original development medicines and generic medicine was not rational, the price of original development medicines of some innovative corporations was 2.5 times more than the generic medicines. (3) compared with the overseas markets, among the comparable western medicines, the average price index of medicines based on manufacturer’s price of China was 35% of that in developed markets, and was 55% of that in Asia or emerging markets; but the average markup ratio in the circulation channel which the patients must be take on of China was higher than the other countries. The main reasons were that markup ratio by the hospitals was very high (average 20%-25%), also the value-added tax (17%). (4) the surface reasons which resulted in nominal price of medicine were that prices of medicine in the hospitals were opaque, the concentration ratio of manufacture & circulation enterprises was low, and information asymmetric between doctors and patients as well, but the essential reasons were that treatment-and-medicine combination in the hospitals, treatment-and-medicine binding between hospitals and patients, and medicine cahoots between hospitals and medicine manufacture & circulation enterprises. (5) The price management departments should not only take into account the cost, but also the innovation of medicines and supply & demand conditions during the pricing. (6) There were not direct relations between medicine prices and the rise of medicine expenditure, the structure and quantity of medicine use have more impact on it.Conclusion: (1) The regulation policies of medicine prices were perfected gradually, and connect international practice step by step; in the management model of medicine prices, it experienced a regulatory system to relax regulations, and then to the process of re-regulation. (2) The cost-plus pricing method at the present time was not rational; it couldn’t control cost effectively and make against innovation of medicine manufacture corporations, so the price regulation departments should adopt comprehensive pricing methods. (3) The medicine-classification pricing has its strongpoint, but also has many shortcomings. (4) The single regulation policies of medicine prices couldn’t achieve the goal that control medical expenditure effectively, furthermore, it needs good system environment, for examples, the medical insurance system, national basic medicine system, the medical service and medicine separation system, and the reimbursement mechanism for public hospitals. (5) The regulation system of medicine pricse should not only consider the public interest, but also consider the interests of the relevant stakeholders, including medicine production & distribution enterprises and medical institutions.Innovation: (1) In the aspect of theory analysis, the paper put forward the basic principles of the regulation of medicine prices, that is "cost-competition-expectation" theory, and attempt to establish the quantity model and function model of the regulation of medicine prices in China. (2) In the aspect of demonstration study, analyze and evaluate systemically the regulation effect of medicine prices in the market economy system in China. (3) In the policy analysis, review systemically and analyze the basic laws and characteristics of the regulation of medicine prices of China, based on the anterior research, bring forward some policy suggestions in order to perfect the regulation of medicine prices in China.更多还原