医药价值链再造与深化新医改的路径选择

Reconstruction of Pharmaceutical Value Chain and Pathway Choice of Deepening New Healthcare Reform

目的:为实现我国医药价值链整体价值最大化的改革目标提供路径选择。方法:通过评价国内外政府监管医药价值链的手段与效果,为探索我国医药价值链再造和深化医改提供路径选择,以实现我国医药价值链整体价值最大化的改革目标。结果:国外政府监管医药价值链,通常选择从市场容易失灵的环节入手,重点监管医疗机构的行为,药品流通环节则主要交由市场调节,这样的监管路径较为合理。我国在实施新医改之前,医药价值链存在市场和政府监管双重失灵;实施新医改以来,医药价值链价值中心逐渐回归需求终端,患者效用有所提高;"虚高"的药价被进一步挤出;医疗服务质量缺口依然存在;基层医疗机构的补偿机制仍有待完善。结论:我国医药价值链再造与深化新医改的路径选择,应通过构建医药供求双向约束机制,重点监督医疗机构行为和药品定价,保持医药经营实体活力并持续提高基层医疗机构服务水平,从而实现我国医药价值链整体价值最大化的改革目标。

OBJECTIVE：To provide pathway and choice to realize the goal of reform as the overall value maximization of Chinese pharmaceutical value chain.METHODS：Domestic and foreign government regulation and effect were evaluated to provide pathway and choice for exploring the reconstruction of pharmaceutical value chain and deepening healthcare reform,so as to realize the goal of reform as the overall value maximization of Chinese pharmaceutical value chain.RESULTS：Foreign pharmaceutical value chain regulation usually began with market link which was easy to fail,focused on the behavior monitoring of medical institution;the way that circulation was regulated by the market was reasonable basically.Before New Healthcare Reform,there was regulation failure of pharmaceutical value chain by the market and government.After reform,the demand terminal became the center of pharmaceutical value chain,and the efficacy had been improved.False high price had been further removed;there was room for improvement in the quality of medical service;the reimbursement mechanism of primary medical institution should be improved.CONCLUSIONS：In China,the pathway choice of the reconstruction of pharmaceutical value chain and deepening of New Healthcare Reform should be established a bidirectional constraint mechanism both on medical supply and demand,focused on the supervision of medical institutions and drug pricing,maintain the pharmaceutical business entity vitality and continuously improve service level of primary medical institutions,so as to realize the goal of the reform as overall value maximization of Chinese pharmaceutical value chain.