我国药品谈判政策演变与创新扩散机制探究

Research on the evolution and diffusion mechanism of medicine negotiation policy in China

国家药品谈判机制是当前我国推动医疗保障改革高质量发展的重要制度安排,本文在政策扩散理论视角下,从时间、空间、主体、内容和路径五个维度出发,探讨2009—2021年我国谈判药政策的扩散机制。结果表明,我国谈判药政策扩散存在一定的独特性,但整体符合我国医改特色路径。时间维度上,扩散曲线呈近似的S型分布;空间维度上,国家行政推动会改变层级效应和地缘邻近效应的效果;主体维度上,扩散主体的合作关系存在明显的阶段性;内容维度上,扩散后期更注重创新,政策的关注点呈现由服务创新逐渐向流程创新和辅助创新过渡、三者并行的趋势;路径维度上,相同政策领域可能存在不同的扩散路径,以特殊药品管理和“双通道”机制为例,扩散路径略有不同,表现出地方政府探索、中央政府政策吸纳后垂直影响和高位推动的扩散模式。综合理解药品谈判政策创新扩散规律,为推进我国卫生领域公共政策创新扩散进程、保障政策落地质量提供参考。

The national medicine negotiation mechanism is an important institutional arrangement to promote the high-quality development of China s medical security reform.Based on the policy diffusion theory,this paper discusses the diffusion process of China s policy on medicine priced through government negotiation from 2009 to 2021 from the dimensions of time,space,subject,content and path.The results show that although diffusion of these policies are of certain uniqueness,it goes in accord with the characteristic path of China s medical reform.The diffusion curve presents an approximate S-shaped distribution in the sense of time;In spatial sense,the promotion of State Administration can change the effect of hierarchical and proximity effect;In terms of subjects,there are obvious stages in the cooperation between subjects;In terms of content,the policies pay more attention to innovation in the later stage,with the focus gradually shifting from service innovation to process innovation and auxiliary innovation,and even showing a tendency of these three being equally important;In the path dimension,diverse paths may be taken within areas regulated by the same policies.The case of special drug management and“two-channel”mechanism show,for examples,slightly different diffusion modes,manifesting vertical influence and a top-down promotion mode after explorations of local governments are accepted by the central government.The paper reports a comprehensive understanding of diffusion of innovations in medicine negotiation policy and provides reference for promoting the process of public policy diffusion in the field of public health in China and quality of policy implementation of guaranteeing policies.