医院药价存在的问题与解决方法

近年来,药品价格成了社会关注的焦点之一,政府为了整顿药品价格秩序,加强药品价格管理,降低药品费用,切实减轻政府、企业和群众的负担,制定了《关于改革药品价格管理的意见》,并对差价过大、价格虚高的药品以及属于国家医疗保险药品目录的品种实行了多次降价。 根据国家宏观调控与市场调节相结合的原则,药品价格实行政府定价和市场调节价。政府定价药品,由价格主管部门制定最高零售价,药品零售单位(含医疗机构)在不突破政府制定的最高零售价的前提下,制定实际销售价格。对于市场调节价药品,医疗机构在不超过生产企业制定的零售价格     

关于药品零售定价法的初探

1997年12月对日,全国人大常委会八届第29次会议审议通过的《中华人民共和国价格法》于1998年5月1日起实施。该法规定：我国实行市场调节价、政府指导价和政府定价3种价格形式,其中市场调节价在价格机制中占主导地位。药品是用来治病防病的特殊商品,有其特殊性,与我国的卫生事业是政府实行一定福利政策的社会公益事业的性质一样也具有一定的社会福利性,因而药品的盈利性不是唯一的目的,因此对药品价格实行政府定价是必要的。当前社会上普遍反映药品价格贵、药品利润大、药品折让率过高等实际情况,其原因主要有：大量低水平药厂的重复…     

国际药品价格管制方式及效果研究的系统综述

目的：分析国际药品价格管制方式及效果。方法：采用系统综述的方法归纳不同国家药品价格管制方式、对象、过程及效果。结果：共纳入来自36个国家的130篇文献,其中包括定价管制政策文献97篇,评价定价管制影响文献33篇,且多为评价参考定价效果研究。大多国家主要对报销药品价格进行控制;国家价格比较和参考定价是两种最主要的政府定价方式;药品加成采用递减加成体系;现有证据表明参考定价对于降低药品价格、节省药品开支和对其他卫生服务的影响效果较好。建议：以药物经济学评价为基础,通过参考定价对药品报销价进行有效管制,通过协商谈判、递减加成和完善医保支付方式来控制药品费用不合理增长。     

药品价格居高不下的原因及对策

近几年来药品价格居高不下已成为全社会关注的热点。本文旨在分析药品价格高的主要原因并提出相应的对策。一、药品价格居高不下的原因(一 )药品生产企业方面１．药品虚高定价。国家明确规定药品出厂价格原则上以社会平均成本为基础加规定销售利润和税金确定 :即平均成本加２０%左右为出厂价。然而药品生产企业为追求最大的生产利润 ,在向物价管理部门申报出厂价格时普遍存在虚报生产成本的现象 ,并将各种宣传、推介、临床科研费及灰色费用统统计入生产成本 ;同时地方政府从自身的利益出发 ,也愿把地产药品价格定得高一些。这些原因导致了药…     

我国药品价格管制的政策选择

我国已建立起一整套药品价格管制政策，但是，以成本加成为基础的价格管制与其他体制与机制性因素互动作用后，促成并强化了我国特定背景下医药不正当利益纽带关系。现行的成本加成定价管理是对企业创新产生的成本的补偿，而不是对企业创新产生的价值的回报。在成本加成的定价管理基础上，综合考虑药品的创新程度及其对医疗费用的影响，同时参考周边国家和地区同一药品品种的市场销售价格，可以作为我国药品价格管制变革的替代性方案。更长远地，我国应该构建以价值为基础的药品价格管制方式，以药品的成本效果为导向合理确定其相对价格水平。对仿制药可借鉴国际经验采用参考定价方法。     

药品价格管制与医疗体制改革的关系分析与探究

随着医疗卫生体制改革的进一步推进,我国“看病难”、“看病贵”的现状虽然有所缓解,但医疗费用仍在不断上涨,卫生费用占国内生产总值的比例越来越高.医疗费用的快速增长,严重影响了国民经济的发展.目前在我国,医疗费用最主要的构成部分是药品费用,所以控制药品费用的增长,是改善医疗费用持续上涨之现状的关健因素,而控制药品费用就集中体现为对药品的价格管制.该文通过对我国药品价格管制的分析,提出建立健全药品价格机制等医改的关键要素,旨在为医疗体制改革的整体进程,提供一个多角度多层次的视角.     

澳大利亚经验对我国药品价格管制的启示

通过药品管理体系、定价方法、通用品替代政策和药品价格管制对医药行业的影响等方面，对澳大利亚药品价格管制经验作了详细的介绍，并从中得出中国目前在药品价格管制改革过程中注意的问题。     

国家发展改革委关于改进低价药品价格管理有关问题的通知

一、改进低价药品价格管理方式。对现行政府指导价范围内日均费用较低的药品（低价药品）,取消政府制定的最高零售价格,在日均费用标准内,由生产经营者根据药品生产成本和市场供求及竞争状况制定具体购销价格。     

政府管制与取消管制对药品价格的影响研究——以消化类药品为例

目的:探究政府管制与取消管制对药品价格的影响,为药品定价政策制定提供依据。方法:研究提取全国医药经济信息网数据库中2011年1月-2016年6月64种消化类药品价格水平、用量和费用的月度数据,通过有对照的间断时间序列(interrupted time-series,ITS)模型,分别分析政府管制和取消管制后样本药品的价格水平、用量与费用变化,其中使用固定拉氏价格指数衡量药品价格水平。第一个ITS分析政府管制的影响,利用2011年1月-2015年6月的月度数据,间断点为2012年5月;第二个ITS分析取消管制的影响,利用2014年6月-2016年6月的月度数据,间断点为2015年6月。结果:政府管制政策实施后,短期内干预组药品相比于对照组的价格指数无显著变化(β_6=-0.000 452,P=0.994),但长期增长趋势显著下降(β_7=-0.050 7, P0.001)。在取消管制政策实施后,短期内干预组相较于对照组药品明显下降(β_6=-0.042 7,P=0.005);长期来看,两组药品价格指数变为上升趋势,干预组相较于对照组药品价格指数趋势变化无显著差异(β_7=0.002 83, P=0. 170)。政府管制与取消管制政策实施前后,消化类药品的用量和费用均无显著变化。结论:政府管制可以有效控制药品价格增长趋势,而取消管制在短期可以使药品价格降低,长期来看药品价格仍持续增长,价格管制或取消管制对药品的用量和费用无影响。     

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。     

The implications of external price referencing on pharmaceutical list prices in Europe

External price referencing (EPR) is a frequently applied cost-containment measure to control pharmaceutical prices. This study aims to determine the implications of EPR on ex-factory pharmaceutical prices in European countries.Prices of 21 pharmaceuticals and 17 non-pharmaceutical services were collected with a survey and price corridors were defined in 7 countries. To increase the sample size for further analysis, pharmaceutical prices were retrieved from EURIPID database for 8 additional countries. Regression analyses were applied to evaluate explanatory variables on pharmaceutical list prices including EPR components, GDP per capita, and population size in 15 European countries.Price corridor was narrower for pharmaceuticals compared to non-pharmaceutical services. In univariate regression analysis, higher GDP per capita and population size were associated with higher prices, and taking lowest price from referenced basket of countries was associated with lower prices. In multiple regression analysis, GDP per capita, population size and number of countries referencing a country had modest, but significant association with prices.Findings indicate small price variation for pharmaceuticals that points towards the occurrence of price-convergence. The relatively minor association of EPR with pharmaceutical list prices could be explained by manufacturers’ compensatory mechanisms including confidential price reductions and discounts while maintaining high list prices in countries with strong price-control measures or delayed product launch in countries with traditionally lower prices. Consequently, EPR cannot be directly associated with narrow European price corridor, and lower income countries still have slightly lower list prices.     

药品价格指数在医保支付标准中的应用研究

国家发展改革委提出取消大部分药品政府定价,医保目录内药品以医保支付标准进行支付。在市场价格的基础上形成医保支付标准,因此收集和整合药品市场价格信息成为实施这一政策的关键。药品价格指数可以整合药品市场价格信息,反映药品价格的变化水平。本文通过分析医保支付标准制定的需求,明确应当以分位价格指数的方式制定医保支付标准。通过介绍德国参考定价来具体说明利用分位价格确定医保支付标准的做法,并且引入不同的药品价格指数来分析药品价格变化的原因,为医保支付标准的制定和调整提供依据。     

药品价格问题的研究概述

目的：掌握药品费用的增长情况及价格变化、生产成本及流通环节利润分配等情况，为药品价格管理的改革和完善提供依据。方法：采用回顾性抽样调查的方法，对1995－2002年全国临床使用量大的药品价格进行调查，同时对1999年全国18个省市80个制药厂家的生产经营状况、20个省市48家药品批发企业的利润及相关影响因素等进行了分析。结果：20世纪90年代中国药品费用的增长速度在10％以上，高于GDP的增长速度。药品价格指数平均高于总物价指数，药品生产的完全成本占其零售价格的54％。结论：我国药品价格可以认为是适宜的，但流通环节分占了太多利润，使制药行业缺乏充足的研究开发资金。     

Identifying Demand Responses to Illegal Drug Supply Interdictions

Successful supply‐side interdictions into illegal drug markets are predicated on the responsiveness of drug prices to enforcement and the price elasticity of demand for addictive drugs. We present causal estimates that targeted interventions aimed at methamphetamine input markets (‘precursor control’) can temporarily increase retail street prices, but methamphetamine consumption is weakly responsive to higher drug prices. After the supply interventions, purity‐adjusted prices increased then quickly returned to pre‐treatment levels within 6–12 months, demonstrating the short‐term effects of precursor control. The price elasticity of methamphetamine demand is ?0.13 to ?0.21 for self‐admitted drug treatment admissions and between ?0.24 and ?0.28 for hospital inpatient admissions. We find some evidence of a positive cross‐price effect for cocaine, but we do not find robust evidence that increases in methamphetamine prices increased heroin, alcohol, or marijuana drug use. This study can inform policy discussions regarding other synthesized drugs, including illicit use of pharmaceuticals. Copyright © 2015 John Wiley & Sons, Ltd.     

Retail prices of essential drugs in Brazil: an international comparison.

OBJECTIVES: Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS: The retail price of all drugs on Brazil's Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazil's prices to Sweden's prices and Brazil's prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS: For the 132 drugs that were listed on both Brazil's and Sweden's lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazil's list and the international unit-price indicator, Brazil's national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS: Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazil's private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.     

药品费用增长总量控制下药品价格适宜性分析

作为促使药品市场有序发展系列研究之一,该文重点分析了药品费用增长总量控制政策下医院低价药对高价药的替代情况。研究对象为头孢菌素类和青霉素类药品。研究结果显示药品膏用增长总量控制能够促使药品价格适宜性提高。     

Medicare Drug Price Negotiation in the United States: Implications and Unanswered Questions

The United States is a relatively free-pricing market for pharmaceutical manufacturers to set list prices at the product launch. Few drug price controls exist, and federal price negotiation as a policy has historically been politically untenable. After decades of debate on whether the federal government, specifically the Medicare program, should more actively manage drug prices, the US Congress passed legislation authorizing Medicare to directly negotiate prices with manufacturers. The purpose of this article is to describe elements and implementation of the price negotiation provisions and then comment on the potential impacts on payers, innovations, and the pharmaceutical industry. While impacting only a few drugs each year in the beginning, price negotiation in the Medicare program will have secondary and long-term effects in the US market and beyond. It is clear that in the United States, the Medicare market for drugs will no longer be a free-pricing environment in the industry.     

Price regulation and generic competition in the pharmaceutical market

In March 2003 the Norwegian government implemented yardstick-based price regulation schemes on a selection of drugs subjected to generic competition. The retail price cap, termed the index price, on a drug (chemical substance) was set equal to the average of the three lowest producer prices on that drug, plus a fixed wholesale and retail margin. This is supposed to lower barriers of entry for generic drugs and to trigger price competition. Using monthly data over the period 1998–2004 for the six drugs (chemical entities) included in the index price system, we estimate a structural model enabling us to examine the impact of the reform on both demand and market power. Our results suggest that the index price helped to increase the market shares of generic drugs and succeeded in triggering price competition.