湖北省63种药品价格、药品流通成本现状调查与规范价格政策研究
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篇名: 湖北省63种药品价格、药品流通成本现状调查与规范价格政策研究
TITLE:
摘要: 目的:为制定药品价格调控政策、促进药品价格合理化提供参考。方法:按照世界卫生组织和国际健康行动组织药品价格标准化调查法,对湖北省3个不同经济发展水平区域常用的、销售额较大的63种药品在各级医疗卫生机构和药品零售企业的零售价格进行抽样问卷调查(辅以现场考察),计算并统计药品中位价格比(MPR),同时以药品批发和零售企业管理人员、医院药学管理人员为对象就该省药品流通成本进行了初步访谈调查(辅以文献调查),在分析和探讨的基础上提出了控制流通成本、规范药品价格的政策建议。结果:药品价格调查共发放问卷120份,回收有效问卷118份,有效回收率为98.33%;药品流通成本调查中共有来自药品批发和零售企业、医院药学部门的30名管理人员参与了访谈。63种药品在不同类型样本单位的MPR为0.05~44.55。样本一级医疗卫生机构53种药品的67个品规中有38个(56.72%)零售价中位数高于国际参考价,样本二级医疗卫生机构63种药品的79个品规中有57个(72.15%)零售价中位数高于国际参考价,样本三级医疗卫生机构63种药品的80个品规中有63个(78.75%)零售价中位数高于国际参考价,样本药品零售企业37种药品的50个品规中有42个(84.00%)零售价中位数高于国际参考价。在所有样本单位中的MPR最高值<1的有13个品规,在1~<2之间的有12个品规,在2~<5之间的有23个品规,在5~<10之间的有15个品规,≥10的有17个品规。药品MPR比较方面,样本三级医疗卫生机构高于样本二级、一级医疗卫生机构和药品零售企业(P<0.01),样本二级医疗卫生机构和药品零售企业高于样本一级医疗卫生机构(P<0.01),而样本二级医疗卫生机构与药品零售企业比较差异无统计学意义(P>0.05);经济发展好的区域样本单位高于经济发展中等、一般区域样本单位(P<0.01),经济发展中等区域样本单位高于经济发展一般区域样本单位(P<0.01);不同类型样本单位的原研药品均高于相应的仿制药品(P<0.01),且不同类型样本单位的原研药品比较差异均无统计学意义(P>0.05),同时,仿制药品样本三级医疗卫生机构高于样本二级、一级医疗卫生机构和药品零售企业(P<0.05或P<0.01),样本二级医疗卫生机构和药品零售企业高于样本一级医疗卫生机构(P<0.05),而样本二级医疗卫生机构与药品零售企业比较差异无统计学意义(P>0.05)。湖北省药品生产、流通成本以及集中招标采购价格均高于全国水平。结论:湖北省药品价格水平较高,尤其是三级医疗卫生机构药品价格水平明显高于其他单位,经济发展好的区域药品价格水平高于经济发展中等和一般区域,而原研药品价格水平高于仿制药品。医药工业成本、药品流通费用、使用环节价格加成等因素最终导致药品零售价格较高。需要采取综合政策措施控制药品流通全过程的成本,规范药品价格。
ABSTRACT: OBJECTIVE: To provide reference for formulating drug price regulation policy and promoting reasonable drug price. METHODS: According to WHO and HAI drug price standard investigation, questionnaire survey (supplemented by field investigation) about sale price of 63 commonly used drugs with large consumption sum was conducted among 3 districts of different economic development levels in Hubei province. Median price ratio (MPR) was calculated statistically. Primary interview survey (supplemented by literature investigation) about drug distribution cost was conducted among managerial staff of pharmaceutical wholesale and retail enterprises, hospital pharmacy administrators. Suggestions were put forward to control distribution cost and standardizing drug price based on analysis and discussion. RESULTS: Totally 120 questionnaires were sent out, and 118 were effectively received, with effective recovery of 98.33%. Thirty managerial staff from drug wholesale and retail enterprises, hospital pharmacy department were interviewed for investigation of drug distribution cost. MPR of 63 drugs ranged 0.05-44.55 in different types of sample institutions. Among 67 specifications of 53 kinds of drugs, median retail price of 38 specifications (56.72%) was higher than international reference price in first-level sample medical institutions. Among 79 specifications of 63 kinds of drugs, median retail price of 57 specifications (72.15%) was higher than international reference price in second-level sample medical institutions. Among 80 specifications of 63 kinds of drugs, median retail price of 63 specifications (78.75%) was higher than international reference price in third-level sample medical institutions. Among 50 specifications of 37 kinds of drugs, median retail price of 42 specifications (84.00%) was higher than international reference price in sample pharmaceutical retail enterprises. In all sample institutions, maximum MPR of 13 specification were lower than 1; those of 12 specification ranged from 1 to <2; those of 23 specifications ranged from 2 to <5; 15 specification ranged from 5 to <10; those of 17 specification were higher than 10. MPR of third-level medical institution samples were higher than those of second-level and first-level ones, and pharmaceutical retail enterprises (P<0.01). MPR of second-level medical institution samples and pharmaceutical retail enterprises were higher than those of first-level medical institutions (P<0.01). There was no statistical significance in the levels of MPR between second-level medical institutions and pharmaceutical retail enterprises (P>0.05). MPR of sample institutions in well-developed regions were higher than in medium-developed or less-developed regions (P<0.01). MPR of sample institutions in medium-developed regions were higher than in less-developed regions (P<0.01). MPR of original drugs were all higher than those of generic drugs in different types of sample institutions (P<0.01). There was no statistical significance in MPR of original drugs among different types of sample institutions (P>0.05). At the same time, MPR of generic drugs in third-level medical institution samples were higher than in second-level and first-level ones and pharmaceutical retail enterprises (P<0.05 or P<0.01). MPR of second-level medical institution samples and pharmaceutical retail enterprises were higher than in first-level ones (P<0.05). There was no statistical significance between second-level medical institution samples and pharmaceutical retail enterprises (P>0.05). Drug production and circulation cost, centralized bidding and purchasing price in Hubei province were higher than the national level. CONCLUSIONS: The drug price of Hubei province is in high level, especially that of three-level medical institutions is higher than other institutions; drug price of well-developed region is higher than those of medium-level and less-developed region; the price of original drugs are higher than those of generic drugs. The cost of pharmaceutical industry, drug circulation cost and the addition of drug price during application link eventually lead to the higher retailing price of drugs. Comprehensive policy measures need to be taken to control the cost of the whole process of drug distribution and to regulate the price of drugs.
期刊: 2018年第29卷第8期
作者: 王竞,周文犁,刘刚,周延安,周本宏,张先洲,张洪,邹军
AUTHORS: WANG Jing,ZHOU Wenli,LIU Gang,ZHOU Yan’an,ZHOU Benhong,ZHANG Xianzhou,ZHANG Hong,ZOU Jun
关键字: 湖北省;药品价格;药品流通成本;药品中位价格比;调查
KEYWORDS: Hubei province; Drug price; Cost of drugs distribution; Median price ratio of drug; Investigation
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