公立医院药品零差率集中招标预购制初步构想及分析

Conceptualization and Analysis of A Novel Combined Drug pre-procurement Scheme for China Public Hospitals

目的:探索新的公立医院药品采购机制,解决长期困扰我国医疗服务的药品滥用和价格虚高问题。方法:综合运用利益相关者分析、系统思维和假设情境比选等方法。结果:提出了在现有集中招标采购和零差价销售的基础上引入"总量预购"的制度构想,遴选出适用药品范围、预购总量界定、中标厂商数量等关键因素,并针对这些因素提出了基本的设计策略。结论:现有药品集中招标采购和零差率销售与总量预购的作用各有侧重,联合运用有望收获协同功效,从而有效防范长期盛行的与药品相关的道德风险并成倍放大既有改革成果。

Objective： To conceive a novel combined drug pre-procurement scheme for public hospitals so as to tackle the long exiting drug abuses and over pricing in China. Methods： Utiliaing comprehensive methods including stakeholder analysis, systems thinking and scenario comparisons. Results： The study worked out： （1） A new conceptual scheme combing collective biding for drug provision companies, zero-profit selling of drugs by caregivers and prepayment contracts between companies and caregivers; （2） Key factors affecting the scheme implemention; （3） Main alternative strategies tacking potential problems in implementing the scheme. Conchmion： The existing schemes of collective biding and zero-profit selling of drugs and the new proposed prepayment scheme act at different processes of drugs provision through utilization; put together, they will have cooperative effect in a synergetic way and radically reduce drug overselling by companies and over-prescribing by caregivers.