【摘要】：自從上世紀80年代以來,我國藥品市場進入迅速發(fā)展時期,藥品回扣現(xiàn)象也隨之產(chǎn)生。近三十年來,藥品回扣一直以來都是社會關注的焦點之一,它不僅阻礙了藥品市場的健康發(fā)展,還侵害了國家和患者的合法利益,誘使一部分醫(yī)務工作者走向違法犯罪的道路。本文首先簡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。簡單介紹了國內(nèi)藥品價格虛高現(xiàn)象嚴重,藥品生產(chǎn)成本與定價嚴重不符。然后簡單分析藥品回扣產(chǎn)生的危害:它嚴重擾亂了藥品市場秩序,使假冒偽劣藥品充斥市場,危害患者的生命健康;藥品生產(chǎn)成本與定價不符,造成國家稅收的嚴重流失;藥價虛高加重患者的醫(yī)療負擔,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,不利于構建和諧的醫(yī)患關系。然后分別從以下幾個方面分析藥品回扣產(chǎn)生的原因:醫(yī)藥產(chǎn)業(yè)結構不合理,小企業(yè)占多數(shù),難以形成核心競爭力,產(chǎn)品嚴重供大于求;政府監(jiān)管不力,藥品定價機制不合理,政府工作人員缺乏醫(yī)學知識背景;醫(yī)療機構運行體制存在缺陷,政府財政補償不到位,醫(yī)生的合法收入偏低,難以抵抗高回扣的誘惑;醫(yī)院在藥品購銷領域處于雙壟斷地位,患者處于弱勢地位;立法不完善,回扣定性不明確,民事賠償相關法律缺失等。為了規(guī)制藥品回扣,本文針對以上原因,提出下面幾點意見,有些已經(jīng)在實行,有些還需完善,也有些新方法期待能夠被采納。整頓藥品市場秩序,制定規(guī)范科學的藥品定價體系;實行醫(yī)藥分開,如進行藥房托管;打破“以藥養(yǎng)醫(yī)”的機制,加大醫(yī)院的政府資金投入,提高醫(yī)院藥事服務費,尊重醫(yī)生的勞動價值;鼓勵民營醫(yī)院的發(fā)展,形成強大的醫(yī)療服務網(wǎng)絡;健全藥品采購管理體系,加強各級采購人員相互之間的監(jiān)督管理;優(yōu)化集中招標采購制度,并提出新見解,建議對現(xiàn)有的集中招標采購制度加以修改,允許醫(yī)院和藥品生產(chǎn)企業(yè)進行二次議價;完善基本藥物制度,增加藥物品種,保持藥物的及時供應;用法律手段嚴懲藥品回扣行為,分不同情況,分別定為受賄罪和非國家工作人員受賄罪,并且建議立法機關明確相應的民事賠償;加強醫(yī)務人員的法制教育,以實際案例警戒醫(yī)務人員;加強醫(yī)務人員醫(yī)德教育,培養(yǎng)高尚的職業(yè)道德,從自身開始拒絕藥品回扣。通過以上幾個方面的分析,希望對規(guī)制我國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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：F203

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本文編號：2316203