集中采购制度改革能提高我国药品质量吗

Can the Reform of Centralized Procurement Improve Pharmaceutical Quality in China

健全药品集中采购制度,是医疗卫生体制改革的重要任务。近年来,我国药品集中采购从省级政府主导逐渐转变为由国家组织开展。这一改革能否发挥国家统筹的优势,提高药品质量,值得深入分析。基于博弈模型探讨集中采购定价与企业质量决策问题,分析不同省份间子博弈精炼纳什均衡及其影响因素,并比较了省级药品集采与国家层面集采对药品质量的决定作用。结果表明:各省级政府仅最优化自身总福利,其经济规模越小,消费者药品价格敏感程度越高,定价越低﹔在国家层面,因为药品研发创新投入的正外部性能够完全内在化,所以,无论各影响因素如何变化,国家采购中企业选择的药品质量均优于省级采购。因此,全面开展国家药品集中采购,有助于实现我国从“仿制药大国”到“仿制药强国”的转型。

To improve the centralized procurement system for medicines is an important task of the reform of medical-sanitary system. In recent years, China’s centralized drug procurement is gradually turning from the provincial government-dominated into that of national organized. Whether the reform can take advantages of the national overall planning and improve drug quality is worthy of an in-depth analysis. By employing a game model, this study explores the problem of the pricing of centralized procurement and corporate quality decision-making, analyzes the Subgame Perfect Nash Equilibrium of different provinces and its influencing factors, and compares the different impacts on drug quality of the centralized procurement at the national level and at the provincial level. The results show that the provincial governments only optimize their own total welfares. The smaller the economic scale, the higher the sensitivity level of the consumers to the drug prices, and the lower the pricing will be. At the national level, because the positive externality of innovative input for drug R&D can be fully internalized, so regardless of changes in the influencing factors, the quality of drugs chosen by the enterprises in the national procurement is always superior to that in the provincial procurement. Therefore, to carry out comprehensive national centralized drug procurement can help China to realize the transformation from a"Big Country of Generic Drugs"to a"Strong Country of Generic Drugs".