【作者】 岳宁；

【导师】 孙鹤；

【作者基本信息】 天津大学 ， 药事管理， 2010， 硕士

【摘要】 药品费用的快速增长是世界各国面临的难题,这一问题在我国也同样存在。对药品费用进行有效控制可以降低医疗总费用;可以优化卫生资源的配置,将有限的卫生资源用于提供更多更好的医疗卫生服务;可以提高医疗服务的公平性和可及性,让人人享有基本的医疗服务和优质药品;可以降低个人、政府、企业支付医疗费用,减轻患者的疾病负担。同时,国内外理论研究和实践经验表明,药品价格只是影响药品费用的一个方面,仅通过单纯降低药品价格来控制费用是远远不够的。首先,本研究结合药品市场的固有结构及特点,运用微观经济学理论分析了国内药品费用现状,并探讨了近些年药品费用控制措施及实施效果。结果发现,目前药品费用调控效果多以价格变化作为主要评价指标,伴随着药品价格降低的趋势,药品市场相继暴露出廉价药品短缺、同一药品价差过大、费用仍然持续上升等问题。因此进行药品费用的相关分析,找到影响我国药品费用的关键性因素并挖掘其根源,探索控制药品费用的突破口是十分必要的。其次,本研究采用天津市城镇职工医疗保险数据,通过三因素和六因素指数分析法对药品费用影响因素进行了实证分析。药品总费用三因素分析显示,2003-2007年间药品费用增长了9%,其主导因素为混合效应增长了48%,数量效应增长了10%,而药品价格下降了33%;分别观察注射剂与口服制剂费用中影响因素的变化程度,结果显示两种试剂的价格均显著降低,而混合效应贡献率显著上升,其中口服制剂的混合效应五年间增长达到了71%,是注射剂的一倍,但变化趋势不同的是,在注射剂用量增长22%的同时口服制剂用量下滑;另外,与以往定性研究所推断不一致的是,六因素实证分析结果表明通用名替代同样推动了药品费用的小幅增长。这些现象的产生可能是由于“医药补医”的存在使得价高的药品即可获得较高的绝对利润;并且一些价高的国产药品回扣也较高,导致医生更倾向处方高价药品,在这两种力量的共同推动和作用下,更加突出了药品过度使用和医疗保险中的道德风险等问题,进而导致用药量也呈现出上升趋势。最后,在实证研究的基础上,本文提出了建立以供方为主,供需兼顾的药品费用控制体系的必要性,并着重强调了药品费用控制关键在于建立和完善以预付制为主的医药费用管理良性激励及约束机制,在实现对医疗供方进行良性长效激励的同时,达到了合理降低药品费用支出以控制药品费用的目的。更多还原

【Abstract】 The expanding of drug expenditure which is widely discussed in the world has become one of the great challenges. Controlling the expense of drug effectively can help to decrease the total medical expenditure, to utilize the distribution of limited health resource to provide more qualified healthcare service to the public, to enhance the equity and accessibility of medical service and drug usage, as well to alleviate the burden of government, enterprise and individual patients. Additionally, the theoretic research and empirical study show that the drug price is only one of the factors which results in the growth of drug expenditure. It is not enough to dominate the surging drug expenditure only by cutting the price.Firstly, the implementation and effect of drug cost containment was analyzed based on the combination of the inherence characteristics of pharmaceutical market. The results show that price change is currently the main evaluating indicator of adjective effect on drug cost. However, lots of problems are exposing in succession with the decreasing price trend, including the shortage of cheap drugs, the big difference among the same active ingredients, and the continuing rising expenditure. Therefore, it is necessary to analyze the drug cost to figure out its key affective factors and the inherent cause behind it, then further to explore the breakthrough to control it.Secondly, empirical study was used to evaluate the factors affecting the drug cost by three-factor and six-factor index analysis. The result of the three-factor index analysis shows that the drug cost grows 9% in which the mixed effect and the volume effect increase by 48% and 10% respectively, while the drug price decreases by 33%. As to formulation, both prices of injection and oral drugs drop obviously while the mixed effect still go up (oral 71%, injection 35%), but these two formulations show the opposite trends in volume change. Furthermore, the result of the six-factor index analysis shows that the utilization of the generic drug promotes a minor growth of drug cost different from the previous qualitative results. There are two main reasons that arouse these effects: on one hand, the existence of the compensation system of subsidizing hospitals by charging more medicine fees leads to the higher absolute profits of the expensive drugs; on the other hand, the higher commission leads to the doctors to prescribe the expensive drugs. And the problems of drug abuse and moral hazard of the medical insurance become more prominent, which further induces the increasing trend of the drug dose.Finally, based on the outcomes of empirical methods, we suggest that it is necessary to build up the system of drug costs containment denominated by providers. Furthermore, this research emphasizes particularly on establishment of prepayment impress system which is proved to be one of the most effective approach drug contaminant. As administrative authority, the government should pay great attention to the establishment of healthy and long term economic incentive plans.更多还原