Page 7 - 2020年21期

·药事管理·

药品集中采购制度的发展与改革研究 Δ

张雅娟 ，方来英（1.清华大学药学院，北京 100084；2.中国医院协会，北京 100088）
1＊
2
中图分类号 R951 文献标志码 A 文章编号 1001-0408（2020）21-2561-06
DOI 10.6039/j.issn.1001-0408.2020.21.01

摘 要 目的：为我国药品集中采购模式的调整和改革提出政策建议。方法：回顾我国药品集中采购模式的发展过程，通过文献
研究、走访调研、专家访谈发现问题，结合美国、新加坡的药品采购平台建设、药品集中采购组织（GPO）采购、医保支付控费管理
经验，提出基于控费目标的我国招标采购基本模型假设及药品招标采购政策的改革建议。结果与结论：我国的药品招标采购制度
经历了统购统销、分散采购为主、集中采购初创和调整、网上药品集中采购全面推行、“两标”（基本药物招标与非基本药物招标）合
一与联合采购探索、国家药品招标采购试点等阶段。现阶段药品集中采购存在平台隶属关系多样、“两票制”政策下企业遴选可能
涉嫌垄断、降价成为招标采购的最核心绩效指标、GPO采购探索涉嫌垄断经营等问题。本研究基于控费目标构建的模型分析结
果显示，药品费用是效率、药品用量、价格的函数，价格高则费用高，效率低则费用高。未来药品招标采购的目标不应当单纯以控
价为核心，而应当兼顾效率，使招标采购的作用回归到“以量换价”的本质功能。建议我国药品招标采购应建立采购方和支付方相
对独立的统一平台，逐步规范集团化采购模式，发挥医保支付审核的控费功能来代替单纯降价，避免绝对性的统一最低价采购。
关键词 药品集中采购；招标采购；降价；垄断；集团采购组织；改革

Research on the Development and Reform of Centralized Drug Procurement System
2
1
ZHANG Yajuan ，FANG Laiying（1. School of Pharmaceutical Sciences，Tsinghua University，Beijing 100084，
China；2. Chinese Hospital Association，Beijing 100088，China）
ABSTRACT OBJECTIVE：To put forward policy suggestions for the adjustment and reform of centralized drug procurement
mode in China. METHODS：The evolution process of centralized drug procurement mode in China was reviewed，and problems
were found through literature research and expert interview. Combined with the experience of drug procurement platform
construction，GPO procurement and medical insurance payment control fee management in the United States and Singapore，the
reform suggestions were put forward for basic model assumption of bidding procurement based on cost control target and drug
bidding procurement policy. RESULTS & CONCLUSIONS：China’s drug bidding procurement system has gone through the stages
of unified purchase and marketing，decentralized procurement，centralized procurement start-up and adjustment，comprehensive
implementation of online centralized drug procurement，exploration of the integration of“two bidding”（bidding for essential
medicine and bidding for non-essential medicine）and joint procurement，and pilot stage of national drug bidding and procurement.
At the present stage，there are many problems in centralized drug procurement，such as the diversified subordination relationship of
the platform，the possible monopoly of enterprise selection under the policy of“two invoice system”，price reduction becoming the
core performance index of bidding procurement，and the suspected monopoly operation of GPO procurement exploration. The
model analysis based on the goal of cost control shows that drug cost is a function of efficiency，drug quantity and price. High
price leads to high cost，while low efficiency leads to high cost. In the future，the goal of drug bidding and procurement should not
only foucs on price control，but also on efficiency. The function of bidding and procurement will return to the essential function of
“price for quantity”. It is suggested that a relatively independent and unified platform should be established for drug bidding and
procurement in China，and the grouped procurement mode should be gradually standardized，the expenditure control function of
medical insurance payment audit should be exerted instead of simple price reduction，and absolute unified lowest price procurement
should be avoided.
Δ 基金项目：国家食品药品监督管理总局信息中心委托研究课题 KEYWORDS Centralized drug procurement；Bidding and
（No.CFDAIC-XXFW-201882） procurement；Price reduction；Monopoly；Grouped procure-
＊博士。研究方向：医药卫生改革、药品监管、社会学。电话： ment organization；Reform
010-62797567。E-mail：zhangyajuan@tsinghua.edu.cn

中国药房 2020年第31卷第21期 China Pharmacy 2020 Vol. 31 No. 21 ·2561 ·