药品集中采购制度下“二次议价”现象的探讨

Discussion on the“Second Bargain”Under Centralized Drug Procurement Policy

药品集中招标采购制度实施以来,一直明令禁止医院与中标药企进行"二次议价"。然而,在实际操作中"二次议价"现象广泛存在。本文从采购体制、医疗机构、医药企业三方面分析"二次议价"形成的原因,探讨禁止"二次议价"产生的不良后果。提出取消购销加成制度,限定药品最高零售价;政府设立药品参考定价,调整"二次议价"利益分配;规范医疗保险制度的费用支付机制等方法规范"二次议价"。

Since implementation of the policy of centralized drug bid procurement, hospitals have been banned from making the ＂second bargain＂ with bid winning medical enterprises. However, the ＂second bargain＂ is widely existed in practice. This paper analyzes forming reasons of the ＂second bargain＂ from procurement sys tern, medical institution and medical enterprise and probes into the undesirable effects resulted from banning the ＂second bargain＂. The following measures are taken to regulate the ＂second bargain＂, namely cancelling the purchase sale markup system, restricting the highest retail price of drugs, setting reference price for drugs by government departments and adjusting profit distribution of the ＂second bargain＂, normalizing payment mechanism of the medical insurance system.