黄丽君+干荣富

摘 要 长期以来，“医药合业、以药补医”的体制虽然在特定历史阶段促进了我国医药卫生事业的快速发展，但也为“看病难、看病贵”的顽疾埋下了体制性成因。深化医药卫生体制改革选择以改革公立医院药品采购方式、整肃和重建医药生产流通秩序作为切入点和突破口，对药品实行分类采购，属于挂网集中采购的药品在医改省市实施“两票制”，压缩过多和相对无序的商业流通环节。作为降低药品流通成本、破除药价虚高的有益探索尝试，从源头上治理长期困扰医药卫生行业的药价虚高、商业贿赂屡禁不止等问题，以促进医药流通兼并整合。

关键词 公立医院改革 两票制 影响趋势

中图分类号：R197.1 文献标识码：C 文章编号：1006-1533（2016）17-0061-03

Analysis and thinking of two-vote system implemented in drug procurement

HUANG lijun1， GAN Rongfu2（1. Headquarter of Sales & Management for Shanghai Hospitals， Sinopharm Group Co. Ltd.， Shanghai 200051， China； 2. Sinopharm Group Co. Ltd.， Shanghai 200051， China）

ABSTRACT For a long time， the rapid development of health care enterprise in our country was promoted by the system of “integration of pharmaceutical industry with medicine to complement medicine with drug sale” in a certain historical period， but the ills of “difficultly and expensively to see a doctor” were also planted due to the institutional causes. Deep reform of the health care will take the way of drug procurement implemented in the reformed public hospitals and the purge and reconstruction of pharmaceutical production and circulation order as an entryway and breach so as to carry out the category procurement of drugs and to implement “a system of two votes” for the drugs of online centralized purchase in the provinces and municipalities with health care reform to reduce relatively excessive and disordered links of commercial circulation. The artificially higher drug prices， the repeated commercial bribery and other issues plagued the medical and health industry for long time will be fundamentally eliminated as a useful exploration to solve those issues so as to promote the mergers and integration of medicine circulation.

KEY WORDS public hospital reform； two vote system； effect direction

2016年4月，李克强总理主持召开了国务院常务会议，确定2016年深化医药卫生体制改革的重点工作，其中包括：全面推进公立医院药品集中采购，建立药品出厂价格信息可追溯机制，推行从生产到流通和从流通到医疗机构各开一次发票的“两票制”，使中间环节加价透明化。

1 推行“两票制”的重大意义

在公立医疗机构药品采购中推行“两票制”是深化医药卫生体制改革，促进药品生产流通行业健康发展的重大举措，是规范药品流通秩序、压缩流通环节、降低药价虚高的重要抓手，是净化流通环境、打击“过票洗钱”、防止偷税漏税、加强医药市场监督管理的有效手段，是保障城乡居民用药安全、维护人民群众健康权益的必然要求。……