投标竞争、企业群体性败德与集中采购绩效

Bidding Competition,Collective Immoral Actions and the Performance of Centralized Procurement

本文从企业群体性败德这一视角出发,探讨药品集中采购绩效低下的原因以及可行的改进措施。研究表明,片面追求低价格的原有招标模式本身存在的缺陷以及相应出现的正向激励不足,是药品集中采购制度失效的根本原因。相比之下,价格与质量并重的双信封制是更加合理、有效的集中采购模式。当然,在推广双信封制时,必须同时完善与实施质量审核、资质评定、信息公开、监管执法、创新补贴等配套制度与措施。特别地,设置价格下限、质量分层招标等举措有助于抑制企业可能采取的败德行为、增强其在规范生产经营与增加创新投入方面的激励,从而切实提高药品集中采购绩效、保证其作用得到充分发挥。

It is an important part for the deepening medical and health system reform of China to comprehen- sively push forward the drug centralized procurement in public hospitals. During the past implementation, however, this mechanism was ineffective and widely criticized. So, what is the root cause, the system＇ s intrinsic defects or the enterprises＇ business decisions？ In view of the importance of the drug centralized procurement system, we try to conduct a detailed analysis of this issue. Taking the universality of moral hazard such as fake production into ac- count, we investigate the reasons for the low performance of drug centralized procurement, and discuss feasible countermeasures from the perspective of collective immoral actions. In other words, we regard the enterprises that producing similar drugs as a general team, and then probe the enterprises＇ decisions about prices and quality. Dur- ing the bidding process, the enterprises compete for drug purchase contracts through competitive decision-making. According to the discussion under two kinds of situation, the original mode and two-envelope system, we find that ： （i） the fiercer is the market competition, the lower the bid price, which will lead the immoral action to be u- niversal selection for enterprises to get positive profit ; （ii） when the penalty is not serve, ahnost all enterprises have intrinsic motivation to take immoral actions ; （iii） under the case of two-envelope system, the weight of quali- ty, or its importance relative to quantity, will affect the enterprises＇ choices between formal production and illegal/ improper production; （iv） through implementing reasonable two-envelope system, we can effectively curb enterpri- ses＇ immoral actions that seeking illegal profit and encourage them to improve the drug＇ s quality. The study indi- cates that the design defects of the original mode, such as unilaterally pursuing lower price and insufficient positive incentives, are the fundamental reasons why the drug centralized procurement system is failure. Compare to the old mode, the two-envelope system, emphasizing both price and quality of drugs, is more reasonable and efficient bid- ding pattern. Of course, when expanding the application of two-envelope system, it is essential and important to improve or implement some supporting institutions and measures, including quality reviews, qualification assess- ment, information disclosure, regulation and law enforcement, and innovation subsidies. In particular, setting ap- propriate price floor or bidding according to quality stratifications will do help to restrain the immoral acts of phar- maceutical enterprises, and improve their incentive in normalized production and operation and independent innova- tion, which can really enhance the performance of the drug centralized procurement and guarantee the full play of its function. Finally, there are two aspects that need our special attention. First, the bid price, as a result of the bidding process, is the price ceilings for the winning bidder to sail drug, which means that the drug centralized procurement exerts the price ceilings regulation on the winning enterprises. Under the system of ＂ supporting medicine with drugs＂, this institution and the price regulation on medical services distort the incentives and constraints facing en- terprises and medical institutions, which lead to some serious problems containing the failure of the drug centralized procurement system and excessive medical treatment. Therefore, in order to improve the drug centralized procure- ment system＇ s performance and bring its effect on controlling or even decreasing medical expenses into full play, it is essential and urgent to promote the reform of medical service system at the same time of improving the design of bidding mechanism. Second, the serious information asymmetric between pharmaceutical enterprises and purcha- sing organizations/government departments is the central reason for the collective immoral actions. Under this kind of circumstance, pharmaceutical enterprises have the ability to deviate from the interests of the principal and pursue the maximization of their own profits. Hence, it is crucial for dealing with the collective immoral actions to elimi- nate information asymmetric, and then provide enough incentives to high-quality enterprises and exert effective con- straints on low-quality enterprises. In this regard, the optimal choices for purchasing organizations/government de- partments is to provide effective, sufficient and appropriate incentives to pharmaceutical enterprises, and simultane- ously enhance the opportunity cost of immoral actions by strengthening supervision. In other words, we need to de- sign drug centralized procurement mechanism that meets two basic principles, participation constraint and incentive compatibility.