【摘要】：自從上世紀(jì)80年代以來(lái),我國(guó)藥品市場(chǎng)進(jìn)入迅速發(fā)展時(shí)期,藥品回扣現(xiàn)象也隨之產(chǎn)生。近三十年來(lái),藥品回扣一直以來(lái)都是社會(huì)關(guān)注的焦點(diǎn)之一,它不僅阻礙了藥品市場(chǎng)的健康發(fā)展,還侵害了國(guó)家和患者的合法利益,誘使一部分醫(yī)務(wù)工作者走向違法犯罪的道路。本文首先簡(jiǎn)要介紹了藥品回扣的概念、產(chǎn)生與發(fā)展,提出藥品回扣與醫(yī)藥代表聯(lián)系密切。簡(jiǎn)單介紹了國(guó)內(nèi)藥品價(jià)格虛高現(xiàn)象嚴(yán)重,藥品生產(chǎn)成本與定價(jià)嚴(yán)重不符。然后簡(jiǎn)單分析藥品回扣產(chǎn)生的危害:它嚴(yán)重?cái)_亂了藥品市場(chǎng)秩序,使假冒偽劣藥品充斥市場(chǎng),危害患者的生命健康;藥品生產(chǎn)成本與定價(jià)不符,造成國(guó)家稅收的嚴(yán)重流失;藥價(jià)虛高加重患者的醫(yī)療負(fù)擔(dān),許多患者因病致貧;藥品回扣造成醫(yī)患之間信用缺失,醫(yī)患矛盾激化,不利于構(gòu)建和諧的醫(yī)患關(guān)系。然后分別從以下幾個(gè)方面分析藥品回扣產(chǎn)生的原因:醫(yī)藥產(chǎn)業(yè)結(jié)構(gòu)不合理,小企業(yè)占多數(shù),難以形成核心競(jìng)爭(zhēng)力,產(chǎn)品嚴(yán)重供大于求;政府監(jiān)管不力,藥品定價(jià)機(jī)制不合理,政府工作人員缺乏醫(yī)學(xué)知識(shí)背景;醫(yī)療機(jī)構(gòu)運(yùn)行體制存在缺陷,政府財(cái)政補(bǔ)償不到位,醫(yī)生的合法收入偏低,難以抵抗高回扣的誘惑;醫(yī)院在藥品購(gòu)銷領(lǐng)域處于雙壟斷地位,患者處于弱勢(shì)地位;立法不完善,回扣定性不明確,民事賠償相關(guān)法律缺失等。為了規(guī)制藥品回扣,本文針對(duì)以上原因,提出下面幾點(diǎn)意見(jiàn),有些已經(jīng)在實(shí)行,有些還需完善,也有些新方法期待能夠被采納。整頓藥品市場(chǎng)秩序,制定規(guī)范科學(xué)的藥品定價(jià)體系;實(shí)行醫(yī)藥分開(kāi),如進(jìn)行藥房托管;打破“以藥養(yǎng)醫(yī)”的機(jī)制,加大醫(yī)院的政府資金投入,提高醫(yī)院藥事服務(wù)費(fèi),尊重醫(yī)生的勞動(dòng)價(jià)值;鼓勵(lì)民營(yíng)醫(yī)院的發(fā)展,形成強(qiáng)大的醫(yī)療服務(wù)網(wǎng)絡(luò);健全藥品采購(gòu)管理體系,加強(qiáng)各級(jí)采購(gòu)人員相互之間的監(jiān)督管理;優(yōu)化集中招標(biāo)采購(gòu)制度,并提出新見(jiàn)解,建議對(duì)現(xiàn)有的集中招標(biāo)采購(gòu)制度加以修改,允許醫(yī)院和藥品生產(chǎn)企業(yè)進(jìn)行二次議價(jià);完善基本藥物制度,增加藥物品種,保持藥物的及時(shí)供應(yīng);用法律手段嚴(yán)懲藥品回扣行為,分不同情況,分別定為受賄罪和非國(guó)家工作人員受賄罪,并且建議立法機(jī)關(guān)明確相應(yīng)的民事賠償;加強(qiáng)醫(yī)務(wù)人員的法制教育,以實(shí)際案例警戒醫(yī)務(wù)人員;加強(qiáng)醫(yī)務(wù)人員醫(yī)德教育,培養(yǎng)高尚的職業(yè)道德,從自身開(kāi)始拒絕藥品回扣。通過(guò)以上幾個(gè)方面的分析,希望對(duì)規(guī)制我國(guó)的藥品回扣有所幫助。
[Abstract]:Since 1980's, China's drug market has entered a period of rapid development, drug rebate phenomenon also emerged. In the past 30 years, drug rebate has been one of the focus of social attention. It not only hinders the healthy development of the drug market, but also infringes the legitimate interests of the country and patients, and induces some medical workers to the road of illegal crime. This paper first introduces the concept of drug rebate, its emergence and development, and points out that drug rebate is closely related to pharmaceutical representatives. This paper briefly introduces the phenomenon of false high drug price in China and the serious discrepancy between drug production cost and pricing. Then it analyzes the harm caused by drug rebate: it seriously disturbs the order of drug market, makes fake and inferior drugs flood the market, endangers patients' life and health, and the cost of drug production does not accord with pricing, which results in the serious loss of state tax; The deficiency of drug price increases the medical burden of patients, many patients become poor because of illness; the rebate of drugs leads to the lack of credit between doctors and patients, the contradiction between doctors and patients intensifies, which is not conducive to the construction of a harmonious relationship between doctors and patients. Then analyze the reasons of drug rebate from the following aspects: the structure of pharmaceutical industry is unreasonable, small enterprises account for the majority, it is difficult to form the core competitiveness, and the product supply exceeds the demand seriously; Government supervision is weak, drug pricing mechanism is unreasonable, government staff lack of medical knowledge background, the operating system of medical institutions has defects, the government financial compensation is not in place, the legal income of doctors is low, it is difficult to resist the temptation of high rebate; The hospital is in the double monopoly position in the field of drug purchase and sale, the patient is in the weak position; the legislation is not perfect, the rebate quality is not clear, the civil compensation related law is missing and so on. In order to regulate drug rebates, this paper puts forward the following suggestions for the above reasons: some are already in practice, some still need to be perfected, and some new methods are expected to be adopted. To rectify the order of the drug market, to establish a standardized and scientific drug pricing system, to separate medicine from medicine, for example, to conduct pharmacy custody; To break the mechanism of "nourishing medicine with medicine", to increase the investment of government funds, to raise the service charge of pharmacy, to respect the labor value of doctors, to encourage the development of private hospitals, and to form a strong medical service network. To improve the drug procurement management system and strengthen the supervision and management among procurement personnel at all levels; To optimize the centralized bidding procurement system and put forward new ideas, it is suggested that the existing centralized bidding procurement system should be revised to allow hospitals and pharmaceutical manufacturing enterprises to carry out second price bargaining; Improve the system of essential drugs, increase the variety of drugs, and maintain the timely supply of drugs; Using legal means to severely punish drug rebates, according to different circumstances, respectively as bribery crime and non-state staff bribery crime, and suggested that the legislature clear the corresponding civil compensation; Strengthen the legal education of medical personnel, alert medical personnel with actual cases, strengthen medical moral education of medical personnel, cultivate noble professional ethics, and refuse drug rebates from their own point of view. Through the above several aspects of analysis, I hope to regulate the rebate of drugs in China.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：F203

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本文編號(hào)：2316203