药品零差率改革的管制俘获困境及对策

Regulatory Capture in the Reform of Medicine Price and the Countermeasures

目的:为明确药品零差率改革政策绩效并为县级公立医院收入补偿机制设计提供政策建议。方法:运用管制俘获理论分析了药价管制政策的政策机理及缺陷。结果:不合理的补偿机制设计可能导致管制俘获的问题,对市场机制运用不够是其中的主要原因。结论:为避免管制俘获,政府在对县级公立医院进行补偿时必须做到:第一,重视对市场竞争机制的运用,鼓励医院更多地通过服务量提升获得市场补偿;第二,尊重医生在用药决策的核心地位,通过优化针对医生的激励约束机制规范其用药行为;第三,针对不同类型的县级公立医院采用不同的管制政策。

Objective： To clear the performance of medicine price reform policy and provide the policy suggestion for the county level public hospital revenue compensation mechanism. Methods： It analyzes the mechanism and defects of the medicine price control policy using regulatory capture theory. Results： Incorrect compensation system may lead to regulatory capture problem, and ignore the using of market mechanism is one of the main reasons. Conclusion： To avoid that, our government should take the following countermeasures. Firstly, pay attention to the use of market competition mechanism, encourage the county public hospital get more compensation by supplying more and better qualified service. Secondly, respect doctors＇ core status in the treatment decision-making and regulate their medicine use behavior through the optimization of incentive and restraint mechanisms. Thirdly, use different control policy based on different types of county level public hospital.