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“新医改”方案明确提出基本药物制度的设想,引起学者、官员和业界人士的争议。本文试图回答的问题是:基本药物制度在中国实行会遭遇哪些制度障碍?以政治经济学的制度主义为范式,通过综述有关医药卫生体制改革的代表性文献,系统归纳出基本药物制度分析框架。提出当前存在廉价基本药物短缺和同品种高价商品名药泛滥两方面问题。围绕方案所提出政策设计,按照药品生产、定价、招标采购、使用和付费的逻辑划分,分析了制药行业过度竞争、“以药养医”等制约因素,以及采购、报销等配套政策,系统论述了基本药物存在生产(配送)环节供给短缺和使用(招标)环节具有需求短缺的双向短缺问题。在此基础上,得出结论和政策建议。
The “new medical reform” program clearly put forward the idea of a basic drug system, causing controversy among scholars, officials and industry professionals. The questions that this paper tries to answer are: What are the institutional obstacles to the implementation of the essential medicine system in China? Taking the institutionalism of political economy as the paradigm, and by summarizing the representative literature on the reform of the medical and health system, we have systematically summarized the analysis framework of the essential medicine system. He pointed out that there are currently two problems in the shortage of cheap essential medicines and the spread of high-priced commercial drugs of the same type. Based on the policy design proposed by the program, according to the logical division of drug production, pricing, procurement, use, and payment, it analyzes the restrictive factors such as over-competition in the pharmaceutical industry, “remedy for drugs”, and supporting policies such as procurement and reimbursement. The system discusses the shortage of supply in the production (distribution) link of essential drugs and the shortage of demand in the use (tendering) link. On this basis, draw conclusions and policy recommendations.