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我国医保谈判药品落地问题的多重制度逻辑分析与政策建议
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| 篇名： | 我国医保谈判药品落地问题的多重制度逻辑分析与政策建议 |
| TITLE： | Multiple institutional logics analysis and policy suggestions on the use of national medical insurance negotiation drugs |
| 摘要： | 目的 厘清国家医保谈判药品（简称“国谈药”）落地难的制度逻辑，促进国谈药在医疗机构落地使用。方法基于医疗机构所处的复杂制度环境，以多重制度逻辑理论构建医疗机构行为选择的分析框架，阐明国谈药落地过程中多重逻辑的互动与冲突，揭示国谈药落地难的机制，并提出应对措施。结果与结论国谈药落地存在国家逻辑、市场逻辑、社会逻辑及专业逻辑四者间不同程度的矛盾与耦合。在多重逻辑博弈中，市场逻辑与专业逻辑倾向规避风险、国家逻辑的“压力型体制”失效、社会逻辑的作用不具有强制性，共同造成了当前医疗机构以完成绩效考核为目标而配备使用国谈药的行动力不足的局面。建议各级政府部门及医疗机构应以政策松绑解除国谈药落地的隐形限制、以激励约束形成医疗机构压力与动力、以绿色采购通道及时回应临床需求、以社会力量构建多方参与国谈药落地监督等，从而改善国谈药的落地效果。 |
| ABSTRACT： | OBJECTIVE To clarify the institutional logics of the dilemma of the use of national medical insurance negotiation drugs（referred to as “national negotiation drugs”）， and promote the implementation and use of these drugs in medical institutions. METHODS Based on the complex institutional environment in which medical institutions were situated， the theory of multiple institutional logics was used to construct an analytical framework for the behavioral choices of medical institutions， and reveal the mechanism of the difficulty in the use of national negotiation drugs by clarifying the interaction and conflict of multiple logics in this process， so as to put forward some measures. RESULTS & CONCLUSIONS There were contradictions and coupling among the state logic， market logic， social logic and professional logic in the use of national negotiation drugs. In the game of multiple logics， the market logic and professional logic tended to be risk-averse， the failed “pressure-type system” of state logic， and the social logic was weakened， which caused the lack of action in the use of national negotiation drugs with the goal of completing performance evaluations in the current medical institutions. Thus， it is suggested to unbundle the invisible policy restrictions on the use of national negotiation drugs， form the pressure and motivation of medical institutions by incentive and constraint mechanisms， respond to the clinical demand by establishing a green procurement channel， and construct the supervision mechanism on the use of national negotiation drugs by social force， etc.， so as to enhance the effect of the national negotiation drugs. |
| 期刊： | 2024年第35卷第14期 |
| 作者： | 李梦颖；伍琳；王昕妍；陈永法 |
| AUTHORS： | LI Mengying，WU Lin，WANG Xinyan，CHEN Yongfa |
| 关键字： | 医保谈判药品；多重制度逻辑；医疗机构；制度环境；行为选择 |
| KEYWORDS： | medical insurance negotiation drugs； multiple institutional logics； medical institutions； institutional environment； |
| 阅读数： | 4 次 |
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