北京医改形势下药品市场委托代理关系变化与药品价格关系研究

Correlation of the Changes of Drug Market Principal-agent Relationships with Drug Price in Beijing under Health Care Reform

目的:为新医改背景下理顺医药价格形成机制提供理论依据。方法:以药品市场信息不对称理论等为基础,分析北京药品市场中各交易主体的委托代理关系及其在医改实施前后的变化情况。结果:由于医、药学的专业性和技术性较强,信息不对称现象在医药市场中广泛存在,并由此形成了相关的委托代理关系,具体体现在药品生产企业和医院(医师)、医院(医师)和患者、招标部门和医院(医师)、招标企业和医院(医师)之间。通过实施"医药分开"改革和医保资金总额预付改革,修正了医院(医师)和患者之间的委托代理关系,降低了医药费用。但是由于药品的差异性和可替代性,并未从根本上解除医院(医师)和药品生产企业之间的利益关系。基本药物招标采购模式下,招标部门与医院(医师)、药品生产企业的委托代理关系仍然存在,但可降低逆向选择的风险。结论:纠正对医院(医师)的不合理激励、加强医疗保险机构的监督作用、发挥药品招标采购的协同作用,有助于理顺药品市场中各交易主体间的委托代理关系,充分发挥药品市场的作用,形成合理的药品价格。

OBJECTIVE： To provide theoretical basis for straightening drug pricing mechanism under new health care reform. METHODS： Based on the information asymmetry theory in pharmaceutical market, the relationships of principal-agent and the changes on these relationships under health care reform were analyzed. RESULTS： Related principal-agent relationships had been formed because of strong speciality and technicality of medicine and pharmacy, and widespread information asymmetry in drug mar- ket, representing as relationship between pharmaceutical enterprise and hospital （doctors）, between hospital （doctors） and patient, between tender department and hospital （doctors）, between tender enterprise and hospital （doctors）. The reform of ＂separation of clinic from pharmacy＂ and the reform of ＂global budget of medical insurance＂ corrected the principal-agent relationship between hospitals （doctors） and patients and reduced the medical expenditure. Due to the difference and substitutability of drugs, it didn＇t eradicate the interest relationship between agents （hospitals, doctors） and pharmaceutical enterprise. The current essential drugs bid- ding and purchase model helps to reduce the adverse selection risks, but the principal-agent relationship between the tender department and hospitals （doctors）, pharmaceutical enterprise still existed. CONCLUSIONS： We should focus on following aspects as correcting unreasonable excitation for hospitals （doctors）, strengthening the supervision function of medical insurance institutions, playing drugs bidding and purchase synergistic reaction, which would help clarify the principal-agent relationships among trading parties in the pharmaceutical market and play the role of market to form reasonable drug price.