医药分业的利益驱动分析

文章认为,在现有条件下,如果我国实行“医药分业”政策,医疗机构表面上是直接的利益受损者,而广大的药品消费者或支付者将是最终的利益受损者,也就是说消费者或支付者将为“医药分业”埋单;药品流通渠道(批发和零售)和生产商是政策受益者。政府将面临提高医疗服务收费标准或增加医疗机构补偿的压力,也将面临着是让医疗机构发展停顿还是医疗服务费用非常规增长的两难抉择,还将面临着通过牺牲医疗机构利益、消费者利益或政府加大投入来扶持药品流通渠道的道义上指责。日前我国药品监督管理机构正在实行的“渐进性的医药分业”政策,这些问题已然显现雏形。实施医药分业政策的理想境界是:药品价格总体下降26％～30％,将469亿元～547亿元的药品毛利化作医疗服务收费标准的调整幅度,以后,医疗服务收费标准按物价指数逐年调整。

Analysis of the driving force in the separation of pharmacy and medicine

The paper argues that if the policy of separating pharmacy from medicine is to be implemented in China in the current situation, medical institutions will appear to be the direct interest losers while the broad masses of drug consumers (or payers) will be the eventual interest losers. In other words, consumers (or payers) will have to cover the costs entailed in separating pharmacy from medicine whereas the channels for drug circulation(wholesalers and retailers) and the drug producers will benefit from the policy. The government will be faced not only with the pressure of either raising the level of charges for medical services or increasing compensations for medical institutions, but also the dilemma of whether to stunt the development of medical institutions or to allow the abnormal growth of medical expenses. Besides, it will be confronted with moral accusations of supporting the channels for drug circulation at the expense of the interests of medical institutions and consumers and increased government input. These problems have already emerged in an embryonic form in the cunent implementation of the policy of "progressive separation of pharmacy and medicine" by the drug administration agencies. The ideal state for adopting the policy of separating pharmacy from medicine would be the overall reduction of drug prices by 26% to 30%, the turnover of the drug gross profit valued at 46.9 to 54.7 billion yuan into the scope for readjusting the level of charges for medical services, and a yearly readjustment in future of the level of charges for medical services according to the price index.