药品流通价格管理失控造成的规制成本增加和社会福利损失探讨

本文主要探讨了政府对药品价格管制中的制度设计不科学造成的药品流通中的寻租、医院的加价销售导致了药品流通的监督管理脱节，药品流通价格虚高的轨迹。并分析了药品流通企业与制药企业的博弈造成药品流通层层加价，使患者福利损失的机理，提出了药品价格管制的办法。     

推行药品集中招标采购试点工作的探讨

政府要加大价格管制力度．从源头上对药品价格进行治理．核实药品成本．对药品进行合理定价．药品集中招标采购可作为辅肋手段     

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。     

药品价格管制与社会福利的经济学分析

世界范围内大多数国家都实施了药品价格管制政策,文章试从药品研发生产函数及静态和动态经济效率权衡的角度探讨药品价格管制对社会福利的影响,以期从理论角度为我国药品价格政策的制定提供新的思路和借鉴.     

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。     

中欧药品价格构成比较与对策建议

采用WHO/HAI药品价格构成调查方法,调查2017年版《国家基本医疗保险、工伤保险和生育保险药品目录》中所列2 535种药品的实际出厂价格和市场零售价格,分析药品价格各组成部分在零售价格中所占比例。调查结果显示,在政府取消价格管制后,中国药品价格构成仍然不合理。药品实际出厂价格在零售价格中所占比例仅为25%左右,供应链上出厂价格以外的附加费用占零售价的75%左右。本文分析认为,政府管制药品价格主要源于医药市场的信息不对称引发的药品价格扭曲。借鉴发达国家药品价格管制成功经验,建议实行全部处方药价格管制、采用参考定价以及控制流通加价等政策工具,最终将实现全面降低药价的目标。     

欧盟国家的药价是如何形成的？

药品在现代医疗体系中具有极为重要作用，为提高卫生资源使用效率、改善药品的可负担性，欧盟各国均对药价进行严格管制。管制结果为欧盟药品价格中平均60％～70％为生产成本，     

基于ARIMA模型的国内药品价格管制政策评估

政府出台了多项管制政策以控制过快上涨的药品价格,国内学者们对其效果尚无定论。利用20014年4月至2011年4月间与药品相关的价格指数时间序列数据建立求和自回归移动平均(ARIMA)模型,进而对此期间颁布的药品价格管制政策的效果进行评价。评价结果发现,这些政策对药品相关的价格指数的作用均不明显,从实证角度证实了近年来政府实施的各项价格管制政策未能达到很好地控制药品价格上涨、减轻群众用药负担的目的。建议政府一方面切实调查了解药品生产、流通成本,另一方面加快改革医疗卫生体制。     

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.     

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。     

澳大利亚药品定价体系及对我国的启示

从澳大利亚药品定价管理的历史、定价组织管理机构、工作流程、定价方法、监督机制等方面,全面了解澳大利亚药品定价体系,对理顺我国药品定价体系有一定借鉴意义。     

More the same than different: worldwide drug policy issues

Pharmaceutical policies in Europe were described in the previous issue of the journal. These policies were described in 5 areas: regulation and access; pricing, price control, and cost; publicly administered drug insurance; patient advocacy; and research ethics. While the underlying policy issues are strikingly similar, each country has developed its own set of solutions to address them. This article provides insight into the Canadian drug policy environment by comparing and contrasting it with the European experience.     

Australian pharmaceutical policy: price control, equity, and drug innovation in Australia

This paper outlines the increasing salience of drug "innovation" in the debate for reform of Australia's pharmaceutical policy, particularly change to Australia's price control mechanisms. The pharmaceutical industry has consistently criticised the central role of price control in Australia's pharmaceutical regulatory regime as an impediment to drug innovation and industry growth. Despite ambivalent or contrary evidence on the impact of price control on drug innovation, this criticism, and the appeals for reform it supports, appear to be increasingly influential in directing pharmaceutical policy. This is particularly evident in the implementation of the Australia/United States Free Trade Agreement, which has led to a weakening of the historical process of evidence-based reference pricing in Australia. Should drug innovation come to dominate Australian pharmaceutical policy, there is the potential to precipitate a devaluing of the current public orientation of regulation and diminish equitable access to affordable pharmaceuticals. The manner in which trade policy has effectively undermined a publicly funded pharmaceutical benefits scheme has clear implications for many countries that maintain such programmes.     

A review of public opinion towards alcohol controls in Australia

Background  

Increasing concern about the negative impact of alcohol on the Australian community has renewed calls for tighter regulatory controls. This paper reviews levels of and trends in public support for liquor control regulations, regulation of alcohol promotions, and alcohol pricing and taxation reforms in Australia between 1998 and 2009.     

对我国医疗机构服务价格监督管理的思考

通过对我国医疗服务价格改革的回顾和现场调查,了解了我国医疗价格监督管理组织体系和监督管理方式等,分析了医疗价格制定、价格调整、价格构成和价格监督等方面的问题,提出了建立统分结合的价格制定体制和灵活的价格调节机制,强化医疗保险对医疗价格的约束,改革医疗服务价格制定方法和医疗成本核算方法,建立多方共同参与的价格管理组织体系的政策建议。     

药品零差率销售的经济学分析

对药品零差率销售产生的现象从价格管制角度进行了经济学理论分析,试图说明该项政策对切割医院及药品厂商的利益联系并非治本之策,并探讨关于切断医药利益链条的制度安排。     

Access to essential drugs in Guyana: a public health challenge

Guyana's pharmaceutical sector faces major challenges that limit access to essential drugs. This study analyzes Guyana's drug policy and regulation, public financing, and drug procurement and delivery. The study also identifies main barriers to drug access and proposes alternatives to strengthen the country's public health functions. Data were collected from the country's regulatory agencies, public procurement agency, pharmacies, wholesalers, and pharmaceutical companies. The information was supplemented with interviews with a convenient sample of Guyanese health authorities and stakeholders. Data were also compiled from scientific databases, and web pages of the country's Ministries of Health, Commerce and Finance, the Bureau of Statistics, and international organizations. Major barriers to drug access include: (1) lack of national drug policy and regulation, and limited role of the regulatory authority; (2) inefficient drug selection and irrational drug use; (3) insufficient financial resources and lack of drug pricing policy; (4) inefficient planning and managing public supply system; (5) deficient epidemiological and information systems; and (6) inadequate infrastructures and human resources shortage. Improving drug access in Guyana requires the strengthening of the country's public health functions and the implementation of a national drug policy and pricing policy, streamlining the drug financing, procurement, and planning and managing drug supply; and adequate infrastructures and human resources.     

Reference pricing with endogenous generic entry

Reference pricing intends to reduce pharmaceutical expenditures by increasing demand elasticity and stimulating generic competition. We develop a novel model where a brand-name producer competes in prices with several generics producers in a market with brand-biased and brand-neutral consumers. Comparing with coinsurance, we show that reference pricing, contrary to policy makers’ intentions, discourages generic entry, as it induces the brand-name producer to price more aggressively. Thus, the net effect of reference pricing on drug prices is ambiguous, implying that reference pricing can be counterproductive in reducing expenditures. However, under price regulation, we show that reference pricing may stimulate generic entry, since a binding price cap weakens the aggressive price response by the brand-name producer. This may explain mixed empirical results on the competitive effects of reference pricing. Finally, we show that reference pricing may be welfare improving when accounting for brand preferences despite its adverse effects on entry and prices.