国家药物政策框架构建下的我国药物政策改革逻辑分析与研究——基于2009-2019年的药物政策文本分析

Logic Analysis and Research of China’s Medicine Reform under the Construction of National Medicine Policy Framework:Based on the Analysis of the Text of China’s Medicine Policy in 2009-2019

目的:为完善我国国家药物政策体系提供参考。方法:收集2009年-2019年4月我国药物领域的政策文件,按照世界卫生组织国家药物政策的行动要素对政策文本进行归类,根据政策文本数量与政策力度分析国家药物政策框架构建的情况;提取归纳不同主题的主要改革措施,并在此基础上分析我国药物领域的改革逻辑。结果与结论:我国国家药物政策框架已经初步建立,但尚不均衡,在人力资源和药物资金筹措等方面的政策数量与政策力度均略显不足。分析我国国家药物政策框架可以发现:(1)我国药物政策框架包含有药物“质量保障”和“可负担性”两条政策主线,而“提质”和“降费”是国家药物政策的两个主要目标;(2)国家药物政策框架构建具有阶段性的改革重点,经历了从“以需求侧改革为重点”向“供给端和需求端改革并重”的过程;(3)药物采购环节在改革中的重要性不断加强。建议我国应增强国家各药物政策方面的均衡性,完善人力资源、药物资金筹措以及合理用药等方面的政策建设;应加强顶层设计,组建多部门协同决策与协调工作机制,以增强不同药物政策间的协调性;此外,还应进一步发挥采购环节的改革抓手作用。

OBJECTIVE:To provide reference for improving China’s national medicine policy framework. METHODS:The medicine policy documents of 2009-April 2019 were collected,and then policy texts were categorized according to national medicine policy elements of WHO. According to the number and strength of policies,the construction of national medicine policy framework was analyzed. The main reform measures of different themes were extracted and summarized. On this basis,the logic of medicine reform in China was analyzed. RESULTS & CONCLUSIONS:National medicine policy framework has been established primarily,but it is not balanced,such as the number and intensity of policies on human resources and medicine financing are slightly inadequate. Analysis of China’s national medicine policy framework reveals that:(1) in the process of construction,“quality assurance”and“affordability”are the two main policy lines,and“quality improvement”and“cost reduction”are the two main policy objectives;(2)the construction of national medicine policy framework has a phased reform focus,and it has gone through a process from“demand-side reform”to“supply-side and demand-side reform”;(3) the importance of medicine procurement in the reform has been strengthened continuously. It is suggested to strengthen the balance of national medicine policy, improve human resources,medicine financing and rational medicine use policy construction;it is also suggested to strengthen top-level design, establish a multi-department collaborative decision-making and coordination mechanism, and enhance the coordination of medicine policies;in addition,the role of procurement links reform should be further played .