加强药品市场管理之管见

由于我国药品市场的运行机制、管理体制及市场运作的法律、法规尚不完善,出现了竞争无序等现象,在一定程度上影响了医疗市场的正常运行。所以,当务之急,必须整治我国药品市场,加强药品流通的管理,充分发挥国有经济在药品流通中的主渠道和控制力作用。一、众所周知,药品是关系人们防病治病、生命安全的特殊商品;药品生产经营行业是一种特殊行业,它的生产和流通的管理体制也应有其特殊性所有制上的特殊。在现阶段,药品的生产和流通应坚持国有经济为宅。其主要依据是:药品是特     

我国药品流通秩序问题探讨

我国药品的流通渠道长,涉及的利益主体多,流通行为隐蔽不易监管,流通企业无序竞争问题严重。在药品流通渠道中,批发企业依赖公立医院渠道销售药品,为了占领市场,批发企业由服务竞争演变为不正当竞争,而生产企业依附于已经控制了流通渠道的批发企业和公立医院。治理我国药品流通秩序必须引导批发企业回归到服务生产与消费的市场功能本位。     

论药品流通领域的"市场失灵"及其治理

一、药品流通领域“市场失灵”剖析 首先，医疗卫生事业的本质属性决定了药品流通领域市场形成机制的局限性。医疗卫生事业具有“公益性”，因此为医疗卫生提供需求的产品，一般都通过公共采购的形式，其生产流通都要严格受国家宏观调控。尤其是药品，作为一种特殊商品，关系居民生命安全与健康，它的生产与流通，特别是在价格形成机制上要受国家严格监控，现行价格政策是实行国家定价和市场调节价两种主要形式。这就决定了它是一个竞争不充分的市场，“市场失灵”是自然的。     

新经济形势下药品价格形成机制探讨

目前,我国医药行业竞争性较强,药价虚高而导致“看病贵”的现状越发严重。针对当前药价过高,对现今药品供求关系、药品市场结构、药品流通制度以及政府对药品的管制等方面进行分析,探讨当下药品价格形成机制。     

我国药品流通领域的现状以及思考

目的:分析我国药品流通市场的现状,总结问题,提出加强药品流通市场管理的政策建议.方法:通过对药品流通概念以及内涵的分析,基于对我国药品流通领域历史沿革和国际社会较为成熟的药品流通领域管理的经验的总结,同时结合近些年药品流通领域的统计数据.结果:现阶段我国药品流通领域存在企业多、规模小和发展不均衡等特点,药品流通领域市场竟争无序,秩序混乱,是客观上造成我国目前医疗卫生服务领域药价虚高和"看病贵"的重要原因之一.结论:通过充分引入市场机制,加强监管,探索公立医院补偿机制改革,以系统论的眼光看待药品流通领域的问题,有望改善我国药品流通领域的现状.     

产业动态

商务部：药品流通企业做大做强箭在弦上 商务部副部长姜增伟近日表示，在保证市场充分竞争的前提下，要争取对药品流通企业兼并重组给予政策支持，鼓励药品流通企业做大做强是商务部接手药品流通管理工作后的重要目标之一。     

取消“以药补医”的困境及对策

取消“以药补医”是我国医药卫生体制改革的重要环节,虽然部分地区已经开始试点,但仍面临困境,表现在医院承担的社会责任和获得的经济利益难以平衡、新的补偿机制难以建立、药品市场良性竞争受阻等方面。破解这些困境需要明确政府在药品市场中的职责,推进药品制度改革和建立新的补偿机制,合理定位市场在药品流通中的角色,正确引导不同利益主体的获利方式。     

新中国成立70周年以来药品价格法律监管：历史回眸、现状检视与未来方向

新中国成立70周年来,我国市场对药品价格的决定作用得以明确,初步建立了药品价格法律监管体制、药品集中招标采购机制和药品价格行政执法队伍。但新时代药品价格法律监管领域仍存在监管法律体系不完善、现有定价机制不合理、市场流通监管乏力连同药价监管权力寻租等亟待解决的问题。建议我国坚持适度干预、社会本位和依法监管的法治理念,通过完善药品价格监管法律、探索药品合理定价机制、加强药品市场流通行政监管及限缩药价监管权力寻租空间,从而为更好地落实健康中国理念提供法治保障。     

架起药品供应保障的桥梁

正当前,药品供应保障领域存在低水平重复生产、药品短缺频发、恶意竞争、购销不规范等不平衡、不充分问题与人民群众用药多样化需求的矛盾。药品供应保障工作是党和政府面对群众服务最现实、最直接、最具体的窗口,直接影响人民群众对健康惠民政策、改革开放和经济发展的获得感、幸福感、安全感。健全药品供应保障制度,需要从药品的生产、流通、使用全链条发力,加强顶层设计,积     

我国药价虚高的原因及对策

剖析我国药品价格虚高、药品市场混乱的根本原因,指出在药品价格政策和流通环节存在的问题和缺陷,提出改革现行药品的价格政策和减少药品流通的中间环节才是根治药价虚高的根本方法。     

医疗服务市场失灵与我国医疗规制体系的完善

医疗服务市场中的各种市场失灵要求政府进行规制。然而我国医疗规制体系还不健全,规制职能弱化。需要进一步完善规制体系,为市场机制运作提供重要基础,实现竞争和政府规制共同发挥作用,使患者得到更多信息和安全有效、符合成本效益的医疗保健服务。     

成都市主城区医疗服务市场结构与竞争状况分析

目的:分析成都市主城区医疗服务市场结构以及竞争现状,发现存在问题并提出建议。方法:文献研究法、赫氏指数和市场集中率分析法。结果:成都市主城区医疗服务市场集中程度有不断增加的趋势,医疗资源集中度高、竞争不够的情况比较突出。结论:医疗服务市场存在马太效应,需大力实施医疗信息公开;吸引非公资本的力度不够,需进一步加强;法律法规不完善,需完善反垄断法。     

对建立医院出资人制度的几点思考

为了国有资产的保值和增值，为了应对日益严峻的市场竞争，建立公立医院出资人制度的需要日显迫切；在法制尚不健全的当前，只有建立起分权制衡的出资人制度框架才有可能收到预期的效果。     

Gatekeeping in health care

We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of general practitioners (GPs). In the secondary care market there are two hospitals choosing quality and specialization. Patients, who are ex ante uninformed, can consult a GP to receive an (imperfect) diagnosis and obtain information about the secondary care market. We show that hospital competition is amplified by higher GP attendance but dampened by improved diagnosing accuracy. Therefore, compulsory gatekeeping may result in excessive quality competition and too much specialization, unless the mismatch costs and the diagnosing accuracy are sufficiently high. Second-best price regulation makes direct regulation of GP consultation redundant, but will generally not implement first-best.     

Does Competition Have an Effect on Price and Quality in Physiotherapy?

We estimate the effect of competition on quality and prices in physiotherapy organised and financed by the Social Insurance Institution of Finland for disabled individuals. Within the physiotherapy market, firms participate in competitive bidding, prices are determined by the market, services are free at the point of use and firms are allowed to react to patient choice only by enhancing quality. Firm‐level data (n = 854) regarding quality and price were analysed. Using 2SLS estimation techniques, we analysed the relationship between quality and competition, and price and competition. Our study found that competition has a negative (yet weak) effect on quality. Prices on the other hand are not affected by competition. The result is likely caused by imperfect information, because it seems that the Social Insurance Institution of Finland has provided too little information for patients to make adequate choices about proper service providers. We argue that by publishing quality information, it is possible to ease the decision‐making of patients and influence the quality strategies of firms active in the physiotherapy market. Moreover, we found that competition appeared as an exogenous variable in this study. Copyright © 2016 John Wiley & Sons, Ltd.     

Competition among pharmacies and the typology of services delivered: The Portuguese case

ObjectiveTo analyze the impact of individual and market characteristics (such as competition) on the typology of services delivered by a community pharmacy after a recent Portuguese pro-competitive regulatory change.MethodsIn this paper, market concentration indices are used to identify market competition groups in the sample. These competition groups are then described with regard to the typology of services on offer by pharmacies within the group. Finally, a system of structural equations is estimated to verify if the decision of a pharmacy to offer or not to offer each of the studied pharmaceutical services is affected by local market regulated competition.ResultsIn some cases, pharmacies belonging to different competition groups do not present significant differences in terms of the typology of services on offer, but according to our regressions, it seems that vaccines and medicines administration services, pharmaceutical care programmes and medicines management programmes are more likely to be offered in pharmacies located in higher competitive markets. These are also urban areas, in which there is already easy access to products sold in pharmacies, and to health services in general.ConclusionsAccess to additional pharmacy services may in some cases increase as market competition increases. Thus, pro-competitive regulatory measures may have led to an asymmetric distribution of pharmacy services across the country, favouring more competitive urban marketplaces. If policy-makers are interested in a more symmetrical distribution of pharmacies services all over the country, they are recommended to take action to ensure equitable access to these services.     

Competition and quality in a physiotherapy market with fixed prices

Our study focuses on competition and quality in physiotherapy organized and regulated by the Social Insurance Institution of Finland (Kela). We first derive a hypothesis with a theoretical model and then perform empirical analyses of the data. Within the physiotherapy market, prices are regulated by Kela, and after registration eligible firms are accepted to join a pool of firms from which patients choose service providers based on their individual preferences. By using 2SLS estimation techniques, we analyzed the relationship among quality, competition and regulated price. According to the results, competition has a statistically significant (yet weak) negative effect (p = 0.019) on quality. The outcome for quality is likely caused by imperfect information. It seems that Kela has provided too little information for patients about the quality of the service.     

Re-forming medical delivery systems: economic organization and dynamics of regional planning and managed competition

This paper compares structural components of medical delivery in two major systemwide reform strategies in the United States. Commonly portrayed in terms of opposing ideologies of planning vs. market reform, regional organization and managed competition have promoted similar structural elements and geographic configurations. They both support growth of institution-based specialized teams and hospital consolidation. They both differentiate hospital care into vertically integrated levels, and develop regions as the key production and market area for organized delivery systems. System-wide management or regulation in each has tried to control allocation of resources, capital investment, and competition. Developed in the context of large-scale industrial production, these components have inherent economic dynamics and together they shape the market structure of medical care. The final section briefly considers the locus of power in the two reform approaches and the implication for choosing mechanisms of reform. It also notes that despite their rhetoric, the two strategies do not shape their services according to information about population benefit. The conclusion points out that the commonalities in structure and power demonstrate the dominance of economic organization in medical reform and contribute to the wide acceptance of this business form of organization as an international model.     

医疗资源合理配置与医疗市场有序竞争

通过对 1995年底武汉地区拥有的医疗资源配置状况和 3所大型综合医院医疗工作量的分析,探讨了医疗市场与医疗资源配置的关系、医疗市场有序竞争对医疗资源发挥作用的影响、医疗资源的合理配置对医疗市场有序竞争的反作用。同时将武汉地区 1995年医疗资源配置情况与美国、英国、日本等发达国家作对比。