我国基本药物供应保障体系的交易费用及制度变迁

Institutional evolution and transaction cost of supply security system of essential medicine in China

目的:为完善基本药物供应保障体系提供理论基础和依据。方法:通过交易费用理论建立分析框架、提出研究假设,以相关文献、山东省关键人物访谈以及基层医疗机构基本药物中标结果等证据来验证研究假设。结果:我国基本药物供应保障体系经历了自主分散采购、地区集中采购和省集中采购三阶段。自主分散采购阶段,生产企业的反对使基本药物制度建立费用最高,定点生产难以实施。地区集中采购阶段,配送环节面临的垄断,使制度建立费用仍然较高,相关制度安排通过配送市场化以减少这种费用。省集中采购阶段制度建立费用大大降低,使定点生产成为可能;基本药物供应保障价格信号失灵、交易过程复杂化、数量协调加强,导致交易费用上升,使部分基本药物定点生产成为必要。建议:以交易为基础单位权衡供应链所有环节的增量交易费用;定点生产的实施范围应该是市场份额小的基本药物;生产企业应该尽量本地化;完善网上信息采购系统的库存管理功能。

Objective ： To supply theoretical foundation and evidence for supply security policy of essential med- icines. Methods： This article reviewed the relevant transaction cost theory, constructed the theoretical framework and presented the study hypothesis that was confirmed by the qualitative evidence from the key informant interview, pro- curement data of essential medicine and the literature. Results ： The supply security system of essential medicine ex- perienced three stages： independent procurement, regional centralized procurement and provincial centralized pro- curement. In the stage of independent procurement, the highest institutional construction cost originated from the pharmaceutical manufacturer＇s opposition led the designated production to implement difficultly. In the stage of re- gional centralized procurement, the institutional construction cost derived from the monopoly in the distribution chain had been higher. The relevant institutional design of market arrangement made the cost lower. In the stage of provin- cial centralized procurement, the reduction of institutional construction cost made the designated production of essen- tial medicine feasible. The failure of price information, the complexity of transaction and the strengthening of quantity coordination of essential medicine induced the transaction cost higher, which made the designated production indis- pensable. Recommendations： The choice of supply model should trade-off between incremental transaction costs of supply chain based on transaction activity. The implementation scope ket share of essential medicine. The designated manufacturer should management function should be improved in the online procurement of designated production should be a small mar- be localization. At the same time, the inventory system of essential medicine.