杨磊 刘思敏 郝彩霞

摘  要：文章在集中带量采购政策下，研究了医药供应链的最优决策，并分析一致性评价标准和药品采购量基数对供应链决策的影响。结论表明：（1）药品一致性评价标准不能设定的过高，否则会使非中选企业被动降低非中选药品的药品价值，不利于药品市场多元化的同时影响制药企业参加药品集中带量采购的积极性。（2）医保局通过集中带量采购整合同一药品的市场需求量，获得一个较大的药品采购量基数，有利于非中选药品价值的提升，促进药品市场的均衡发展。（3）医保局作为决策者，需要考虑一致性评价标准、单位生产成本、中选药品和未中选药品对社会福利的影响等因素，根据药品采购量基数对集中采购比例进行科学决策，从而保证药品的可获得性，并提升社会福利。

关键词：集中带量采购;医药供应链;斯坦克尔伯格博弈;医保支付

中图分类号：F253    文献标识码：A

Abstract： Under the centralized procurement mechanism， this paper studies the optimal decision-making of the pharmaceutical supply chain， and analyzes the influence of the consistency evaluation standard and the drug procurement base number. The conclusions show that：（1）The consistency evaluation standard cannot be set too high， otherwise it will cause unselected companies to passively reduce the drug value， which is not conducive to the diversification of the drug market and affects pharmaceutical companies to participate in centralized drug procurement. （2）The Medical Insurance Bureau obtains a larger base of drug through the integration of market， which is conducive to the enhancement of unselected drugs' value and balanced development of pharmaceutical market.（3）The Medical Insurance Bureau needs to consider factors such as consistency evaluation standard， production costs， the impact of selected and unselected drugs on social welfare， and make scientific decisions on the proportion of centralized procurement based on the drug procurement base number to ensure drugs' accessibility and improve social welfare.

Key words： centralized procurement; pharmaceutical supply chain; Stackelberg game; medical insurance payment

0  引  言

藥品集中采购自2000年开始在中国实行，这项机制的目的主要在于降低药品价格虚高的部分，削减患者和社会在医疗方面不合理的支出。2018年11月15日，国家明确启动组织药品集中采购试点，试点地区范围为四个直辖市和七个地级市（以下简称“4+7”城市）[1]。本次集中带量采购工作是医保局成立后第一个大规模的联采项目，拟中选价平均降幅52%，最高降幅96%，具有明显的降价效果。采购是药品在医药供应链中流通的重要环节，指药品需求方从药品供给方购进所需药品的行为。……