市场经济条件下我国药品价格规制研究[D]

华中科技大学博士学位论文市场经济条件下我国药品价格规制研究姓名：唐圣春申请学位级别：博士专业：社会医学与卫生事业管理指导教师：张新平20090501I123456121994111.8200699.1II2.5335%/55%60%-70%20%-25%17%456123451--23IIIResearchontheRegulationofMedicinePricesintheMarketEconomySysteminChinaDoctorcandidateTangShengchunSupervisorProf.ZhangXinpingABSTRACTObjectives:TodiscusstheconnotationanddevelopmentcourseoftheregulationofmedicinepricesinthemarketeconomysysteminChina,researchandevaluatetheregulationofmedicinepricessystemically;analyzethebackgroundsinwhichtheregulationpoliciesofmedicinepriceswereinstitutedineveryphaseanditsrelationshipwithpoliticsandmacro-economyofthetime,themaincontentandtheeffectsofthepolicies,theresponsesoftheinterrelatedstakeholderstotheregulationofmedicineprices;sumuptheevolvementlawsofregulationpoliciesofmedicinepricesanditsimplicationsformakingthenewpolicy.Meanwhile,referringtheexperiencesofothercountriesinordertoprovidesomenewideasandviewsforourcountrywhenmakingregulationpoliciesofmedicineprices,intheend,putforwardsomesuggestionssoastoperfecttheregulationpoliciesofmedicinepricesinChina.Methods:Thispaperusesmanyresearchmethodssynthetically,including:(1)Literatureresearch.Tolearnregulationpoliciesofmedicineprices,literatures,economictheoriesanddemonstrationresearch.(2)Environmentanalysis.ToanalyzethepoliticalandeconomicenvironmentinwhichtheregulationpoliciesofmedicinepriceswereconstitutedandimplementedinthemarketeconomysysteminChina,alsotherelationshipswiththeexternalenvironments.(3)Criterionanalysis.Tosumuptheexperiencesandlawsoftheregulationofmedicineprices,andcomparewiththeregulationpoliciesofmedicinepricesofsomeforeigncountries,consequently,bringforwardthevalueorientationoftheregulationpoliciesofmedicinepricesinChina.(4)Stakeholderanalysis.Toanalyzetheimplementationdesire,ability,andimplementationeffectofstakeholdersintheregulationpoliciesofmedicineprices,IVincludingregulationdepartmentsandregulationobjects.(5)Quantitativeanalysis.TostudytheregulationeffectofmedicinepricesofChina,andcomparesitwithdevelopedmarketsandemergingmarkets.(6)Time-seriesstudy.ToreviewsystemicallytheevolvementcourseoftheregulationofmedicinepricesinChina,butemphasizeparticularlyonactualregulationpoliciesofmedicineprices.Results:Themainresultsofthispaperincludes:(1)theregulationrangesofmedicinepricesbythegovernmentbecamefrombigtosmall,andthenbecamebig;thepricingmethodswereperfectedgradually;(2)theregulationofmedicinepriceshassomeeffect,butitisn’tveryobvious.TheretailpriceindexofTraditionalChineseandwesternmedicinesdescendfrom111.8in1994to99.1in2006;thepricelevelofmedicinesregulatedbythegovernmentdeclinedevidentlyasawhole,buttherewasaconversemarketadjustmentonthemedicinesadjustedbythemarket;thepricesdiscrepancybetweenpatentedmedicines,originaldevelopmentmedicinesandgenericmedicinewasnotrational,thepriceoforiginaldevelopmentmedicinesofsomeinnovativecorporationswas2.5timesmorethanthegenericmedicines.(3)comparedwiththeoverseasmarkets,amongthecomparablewesternmedicines,theaveragepriceindexofmedicinesbasedonmanufacturer'spriceofChinawas35%ofthatindevelopedmarkets,andwas55%ofthatinAsiaoremergingmarkets;buttheaveragemarkupratiointhecirculationchannelwhichthepatientsmustbetakeonofChinawashigherthantheothercountries.Themainreasonswerethatmarkupratiobythehospitalswasveryhigh(average20%-25%),alsothevalue-addedtax(17%).(4)thesurfacereasonswhichresultedinnominalpriceofmedicinewerethatpricesofmedicineinthehospitalswereopaque,theconcentrationratioofmanufacture&circulationenterpriseswaslow,andinformationasymmetricbetweendoctorsandpatientsaswell,buttheessentialreasonswerethattreatment-and-medicinecombinationinthehospitals,treatment-and-medicinebindingbetweenhospitalsandpatients,andmedicinecahootsbetweenhospitalsandmedicinemanufacture&circulationenterprises.(5)Thepricemanagementdepartmentsshouldnotonlytakeintoaccountthecost,butalsotheinnovationofmedicinesandsupply&demandVconditionsduringthepricing.(6)Therewerenotdirectrelationsbetweenmedicinepricesandtheriseofmedicineexpenditure,thestructureandquantityofmedicineusehavemoreimpactonit.Conclusion:(1)Theregulationpoliciesofmedicinepriceswereperfectedgradually,andconnectinternationalpracticestepbystep;inthemanagementmodelofmedicineprices,itexperiencedaregulatorysystemtorelaxregulations,andthentotheprocessofre-regulation.(2)Thecost-pluspricingmethodatthepresenttimewasnotrational;itcouldn’tcontrolcosteffectivelyandmakeagainstinnovationofmedicinemanufacturecorporations,sothepriceregulationdepartmentsshouldadoptcomprehensivepricingmethods.(3)Themedicine-classificationpricinghasitsstrongpoint,butalsohasmanyshortcomings.(4)Thesingleregulationpoliciesofmedicinepricescouldn’tachievethegoalthatcontrolmedicalexpenditureeffectively,furthermore,itneedsgoodsystemenvironment,forexamples,themedicalinsurancesystem,nationalbasicmedicinesystem,themedicalserviceandmedicineseparationsystem,andthereimbursementmechanismforpublichospitals.(5)Theregulationsystemofmedicinepricseshouldnotonlyconsiderthepublicinterest,butalsoconsidertheinterestsoftherelevantstakeholders,includingmedic