药品价格管制三方信息博弈模型研究

Research on the Tripartite Information Game Model of Regulation of Drug Price

医疗费用的快速增长是世界各国面临的一大难题,而药品价格过高是导致这个结果的重要原因。药品价格管制失灵的根源并不单单是以药养医的医疗体制,关键是在现行以药养医的体制不能够提供给医院使用低价药、医药企业从低定价、管制机构说出真话的激励机制,以及现行体制不能有效抑制利益相关者规避政府的价格管制。本文基于利益集团的委托代理及信息博弈理论模型,分析了在信息不对称情况下,管制机构、中央政府、医药利益集团在药品价格管制下博弈行为选择。解决药品价格管制失灵的办法是增加政府对医疗机构的投入,减少管制机构说出真话所面临的压力,阻止管制机构、中央政府、医药利益集团的串谋。

Drug price is not only related to the attainability, accessibility and safety of consumers, but also re- lated to the sustainability of medical service system and the drug manufacturing enterprises. The drug price is econ- omy and society, which makes that most countries implement the price control. In recent years, the rapid growth of health care costs is one of the major challenges faced by all countries in the world. The proportion of drug costs in medical expenses is too high in China, which is highly associated with expensive prices of drugs. The drug price control led to the dilemma of patients, medical enterprise, medical institution, Department of medical insurance, Department of medical price control and the government. Why the effect of drug price control isn＇t obvious and ap- pears the dilemma？ This paper analyses the game relationship of drug price control between the government, the control institution and the medical benefit groups. There are many contributing factors to the failure of the regulation of drug price more than the current medicine system with the combination of medical treatment and drug, and more than the bidirectional monopolization role between the public medical institution in the process of drug retail, which led to not only the virtual - high of drug price, but also the high percent of medical costs and rapid increasing of medical costs. The biggest three among the reasons of the above phonemes, are the lack of the equilibrium mecha- nism of drug price which considers the government, the control institution, the medical benefit groups at the same time, the lack of an incentive mechanism which encourages hospitals to use cheap drugs, pharmaceutical companies to fix low prices, regulatory agencies to tell public the truth. As well as the failure of effectively inhibiting stake- holders to circumvent the government price controls. According to the principal - agent of interest group and the theory of information game model, this paper analyses basic assumptions, process and the equilibrium of game be- havior choice to the drug price regulation made by regulatory agencies, central government, and pharmaceutical in- terest group in case of asymmetric information. Its conclusions are as follows： If the government strengthens the punishment to conspiring behavior of the control departments, although it will restrain the conspiring behavior at short notice, it only increases the probability of the medical interest group and doesn＇t solve the problem of conspi- ring behavior in long terms. It is concluded that the pharmaceutical interest group will not to conspiracy at short no- tice as well as the regulatory agencies will reduce the conspiring behavior in a long run if the government increases punishment. Therefore the effect method of depressing the conspiracy between the control department and the medi- cal interest group is that the government strengthens the punishment to the conspiracy organized by the medical in- terest group. Suggestions are proposed, for example, to reform the drug price control policies to prevent stakeholde- rs from avoiding price control, to improve the procurement system and third - party payment system and to carry out more pharmaceutical pricing methods. To sum up, this paper give a viable solution to the failure of the regulation of drug price, which is to reduce the drug encouragement of medical institution to zero, and to raise more funds from government to the medical institution, to change the unreasonable compensation mechanisms from the government to the medical institution, （for example, the government implements the different compensations for special hospitals when it can＇t compensate all hospitals）, to lower the pressures of telling the truth, to regulatory agencies, to pre- vent regulatory agencies, central government, and pharmaceutical interest group from entering into collusion.