纵向激励扭曲与药价虚高的管制政策

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3.0 李江 2024-09-20 6 4 383.25KB 52 页 150积分

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硕士学位论文

当前我国药品价格虚高现象严重，不仅给老百姓带来了看病贵、看病难问题，

造成了药品费用的急剧增长，影响到广大人民群众的生命健康，而且也影响了社

会的健康水平，制约了经济的发展。药品价格是医疗费用的主要构成部分，可以

决定人们对医疗服务的消费量和购买量。过高的药品价格可能将弱势群体排除在

基本医疗消费承受能力以外。因此，各国政府对药品价格都会采取严格的控制，

我国针对药品价格过高的问题，采取了多种解决办法和政策措施，但效果甚微。

这也成为社会关注的一个主要矛盾。我们试图用信息经济学，博弈方法，管制经

济学等学科角度来探讨解决问题的思路。

在产业组织纵向理论中，纵向市场结构对商品的零售价有着重要影响，药品

价格形成同样受到纵向环节的制约。本文的理论证明：在药品价格形成的三个环

节中，从上游产业链横向关系看，医药生产厂商众多，基本已经形成竞争市场结

构，但竞争并没有使得药品的价格下降，福利并有让给消费者。完全竞争的市场

结构使得上游市场环节不具备推动药品高价格的内在动力；在产业链的最终环

节，经过论证分析，由于药品的特殊性及其衍生出的诱导需求，使得医院和医生

都具有开高价药的动力。那药品的高价格是如何形成以及维持的呢？

基于对药品价格形成链条的分析，找到药品高价格形成的根源所在。药品高

价格主要来自两个方面，一个是在信息不对称的情况下，医生充当代理人时，会

产生道德风险，医生为了获取更多的信息租金，会选择给病人开一些贵药，或者

提高药品的价格。这样，“贵药”的市场需求就会变大，也导致了医院药房充斥

高价格药品。另一个原因来自于当回扣成为药品批发商的通用策略时，医疗机构

和药品批发商的行为目标产生一致，也就形成所谓的“医药合谋”。这时，医疗

机构具有了提高药品价格的内在动力，医院也希望通过高价格药品获取暴利。从

经济学上来说，一个有效的药品市场应该是，在该市场当中消费者能够选择药品。

但是，药品市场是比较特殊的，比如药品的特殊性、环境的复杂性、患者和医生

之间的信息不对称等等。所以药品价格仅仅依靠市场调节是不能解决上述问题

的，因此药品价格的管制就显得非常重要。

中国的药品价格管制经历从全程管制到放松管制再到部分管制的过程，但是

对于管制效率判断，由于以下几个原因，使得很难选择一个效率标准：首先，医

硕士学位论文

生、制药企业可能控制信息以弱化消费者的选择能力；其次，由于药品分销环节

多，可能存在多个目标，这就要求在权衡多个目标后确定效率标准；最后，医疗

过程中效率评价需要系统的考量。在之前的价格管制体制下，由于效率标准的考

核失衡，使得政府的管制机构被俘获，造成药价虚高的现象持久存在。总之，讨

论药品价格机制的改革方向，首先要加强政府的药品价格管理，而不是试图削弱

政府管理，盲目推进市场化只会导致利益集团的严重不平衡。

总之，本文论证的基本结论：药价虚高是市场结构失衡与市场管制失灵共同

造成的。在上述结论的基础上，提出的政策建议：首先要深化医疗体制改革，打

破公立医疗机构的垄断地位，并进一步加强医生职业道德的约束。其次加强和完

善政府管制体制，避免政府管制政策的失灵。

关键词：纵向激励；药品价格；管制；合谋

ABSTRAT

硕士学位论文

At present, the problem of the pharmaceutical price is at high level all the time is

becoming more and more serious, which not only causes the problem of seeing doctor

expensively an difficultly, increasing of pharmaceutical expense ,affecting the health

of broad masses of people ,but also, affects the health of society, influences the

development of economy. Pharmaceutical prices are the main components of medical

expenses, which can determine people's consumption of medical services, or even

exclude the poor patients, therefore, all governments will strictly regulate

pharmaceutical price. So in china, where a series of public policies and regulations

concerning medical price are issued, but the effect is poor. It has also become a social

concern of the principal contradiction. We tried to use information economics, game

theory methods ，regulatory economics and other disciplines to explore the

perspective of problem-solving ideas.

In the longitudinal theory of industrial organization, vertical market structure

have a significant impact on the retail prices of commodities, pharmaceutical pricing

also constraint by the vertical part. The proof of this theory: the formation of

pharmaceutical prices in the three links in the industry chain from upstream to see

horizontal relationships, a number of pharmaceutical manufacturers, the basic

competitive market structure has been formed, but the competition did not make the

prices of drugs down , consumers do not have the welfare. Perfectly competitive

market structure do not have the intrinsic motivation to make the price higher;

through argumentation analysis, the final link in the chain, because of the special

nature of medicines and their derived-induced demand, the hospital and doctors have

high-priced medicines to open the driving force. That is how the high prices of drugs

to form and maintain it?

The formation of the chain based on the analysis of pharmaceutical prices and

find the root of the formation of high prices. Drugs of high prices, mainly from two

aspects, one is the case of asymmetric information, the doctor acting as an agent, it

will create moral hazard. The doctor would choose to open a number of expensive

drugs to patients, or raise the price of drugs in order to obtain more rents. In this way,

硕士学位论文

VII

" drugs of high level " market demand will be larger, but also led to high prices

flooded the hospital pharmacy drug. Another reason comes from when the

commission became a common strategy in drug wholesalers, medical institutions and

pharmaceutical wholesalers conduct the objectives of consistent, thus forming the

so-called " pharmaceutical collude" . At this time, medical institutions to raise drug

prices with the intrinsic motivation, the hospital also hopes to reap huge profits

through high prices of medicines. From an economic point of view, an effective drug

market should be, in the market among consumers to select drugs. However, the

pharmaceutical market is relatively unique, such as the special nature of drugs,

environmental complexity, patients and doctors and so forth between the information

asymmetry. Therefore, market regulation and price of drugs alone can not solve the

above problems, and therefore the control of drug prices becomes very important.

China's drug price control through deregulation from full control to the control

then part of the process, but for judging the efficiency of control, due to several

reasons, makes it difficult to select an efficiency standards. First of all, doctors and

pharmaceutical companies may control the choice of information in order to weaken

the ability of consumers; Secondly, because many links in the distribution of drugs,

there may be multiple targets, which require balancing multiple targets determined

efficiency standards; Finally, the medical treatment process the efficiency of the

system of evaluation needs to be considered. In the previous price control system, due

to efficiency standards for the assessment of balance, making the government's

regulatory agencies have been captured, resulting in the phenomenon of persistence

hold down prices. In short, to discuss the direction of reform drug pricing mechanism,

we must first strengthen the Government's drug price control, rather than trying to

weaken the government administration, blindly push forward market-oriented interest

groups will only lead to a serious imbalance.

Thus the key conclusion is that hold down prices is the imbalance between market

structure and market control of a common cause of failure. In the above conclusions,

based on the policy recommendations: First to intensify the health care system, to

break the monopoly of public medical institutions, and to further strengthen medical

硕士学位论文

VIII

ethics constraints. Second, to strengthen and improve the system of government

control, to avoid the failure of government regulatory policies

Key words: vertical Incentive；the price of drug ；regulation；collude

第一章绪论................................................................................................................1

第一节问题提出的背景和意义.......................................................................1

硕士学位论文

第二节文献综述...................................................................................................2

第三节本文的结构安排.......................................................................................7

第二章药品流通的纵向结构与局部垄断势力........................................................9

第一节制药环节的市场结构...........................................................................10

第二节药品批发和社会零售环节的市场结构...............................................13

第三节医疗服务环节的组织和消费关系.........................................................14

第三章药价虚高的纵向形成机制........................................................................19

第一节不对等的医患委托——代理合约.......................................................19

第二节医院的局部垄断势力与医药的不对称合谋.......................................21

第四章药品价格管制失灵与药价虚高的可维持性............................................27

第一节药品价格管制制度...............................................................................27

第二节不对称信息与政企合谋下的政府管制...............................................31

第三节药品价格管制体制的改革...................................................................34

第五章中国医疗价格政府管制实证分析及政策建议............................................38

第一节中国医疗价格政府管制实证分析.........................................................38

第二节完善我国药品价格管制的政策建议.....................................................41

参考文献......................................................................................................................43

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摘要：

硕士学位论文IV当前我国药品价格虚高现象严重，不仅给老百姓带来了看病贵、看病难问题，造成了药品费用的急剧增长，影响到广大人民群众的生命健康，而且也影响了社会的健康水平，制约了经济的发展。药品价格是医疗费用的主要构成部分，可以决定人们对医疗服务的消费量和购买量。过高的药品价格可能将弱势群体排除在基本医疗消费承受能力以外。因此，各国政府对药品价格都会采取严格的控制，我国针对药品价格过高的问题，采取了多种解决办法和政策措施，但效果甚微。这也成为社会关注的一个主要矛盾。我们试图用信息经济学，博弈方法，管制经济学等学科角度来探讨解决问题的思路。在产业组织纵向理论中，纵向市场结构对商品的零售价有着重要影响...

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