专利药医保准入谈判治理中政府领导力的建构研究

专利药医保准入谈判是治理体系现代化战略在医药卫生领域的重要突破,多元治理主体的加入非但没有削弱政府的重要性,反而赋予了政府作为治理体系"领导者"以更加丰富的内涵。本文整合了已有治理理论模型中关于领导者功能的论述,以其领导力发挥的内在机制为线索,创新性地构建了领导力分析的理论框架。基于专利药医保准入谈判治理的实质,本文结合典型国家的实践经验分析了政府领导力建构的模块和路径,一是提出和选择治理制度,包括药品价格谈判的启动机制与价值评估标准;二是选择治理主体并管理冲突,包括谈判博弈平台与风险共担机制的建设;三是确保治理过程的耦合协调,主要涉及与地方医保和临床使用的衔接。最后建议我国从行政性、适应性和赋能性三个层面继续加强专利药医保准入谈判治理中的政府领导力建设,以保证治理决策的公平与效率为前提,平衡潜在的利益冲突。

Research on the construction of government leadership in the management of patented drug and medical insurance access negotiation

Patented drugs and medical insurance access negotiation is an important breakthrough in the modernization strategy of the management system in the field of medicine and health.The participation of multiple actors in the governance has given the government a richer connotation as the“leader”of the healthcare system management.This paper systematically summarizes the discussion of leaders functions in the existing governance models,and uses the internal mechanism of leadership as a clue to construct a theoretical framework for leadership analysis in an innovative way.Combining the essence of the negotiation and management of patented drugs and medical insurance access,this paper analyzes the modules and specific paths of government leadership construction in combination with the practical experience of typical countries.This includes proposing and selecting governance systems which consists of the starting mechanism and value evaluation standards for drug price negotiation;selecting governance actors and managing conflicts between them through the construction of negotiation game platforms and risk sharing and mitigation mechanisms;and ensuring the coupling and coordination of governance processes by connecting with local medical insurance and clinical use in the management of patented drugs and medical insurance access.As a conclusion,it is suggested that China should continue to strengthen the building of government leadership in the negotiation of patented drugs and medical insurance access from the three levels of administrative,adaptive,and enabling,and balance potential conflicts of interest on the premise of ensuring fairness and efficiency of governance decision making.