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政府管制下我国医药商业供应链合作机制研究
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摘要
我国自上世纪90年代末以来实施的医疗体制改革,一直没能解决好医疗费用高居不下、药品价格虚高以及药品流通效率低下等很多问题,这些情况也一直是学界关注的对象。研究表明,在我国药品价格的结构中,除了制度性赋予的顺次加价因素外,医药品分销渠道运行效率偏低所导致的高流通成本在药价中占据了较大比例。通过调整和改善医药商业供应链分销系统中的企业合作关系,能够在一定程度上降低渠道流通成本,进而为实现抑制药价增长过快和提高社会福利的宏观目标贡献力量;同时也对改善医药行业及企业自身的流通能力、具有一定的理论和现实意义。
     相对一般行业,我国医药商业供应链最显著的特点是受政府持续和多方面地管制。本文在考察我国医药商业供应链中的企业合作行为时,将政府管制及制度变迁作为外部的重要因素加以考察,运用制度变迁理论、政府管制理论、供应链合作理论等加以分析,并对经济变革过程中的管制政策、医药商业供应链合作关系的演变过程、政策变化对合作关系的影响以及在不同的商业供应链合作模式下的利润分享等进行理论研究与实证分析。其主要研究内容及创新性成果体现在以下三个方面:
     ①对医药供应链合作关系发展研究,现有文献更多地从一般供应链合作发展角度分析,本文通过管制等理论分析与实证检验,提出医药商业供应链的合作关系及演变发展是政府管制和市场双重作用的结果,但政府管制对合作关系的形成和影响具有更强的约束和引导性作用的观点。论文从理论研究和调查问卷着手,具体考察我国的经济体制的基本模式、改革及相应的制度变迁,对我国医药商业供应链合作的经济环境变迁、合作模式演进以及管制的影响等进行了具体分析,深入研究了不同时期医药行业的管制政策及其演变过程,并通过数据和实证分析,总结出我国医药商业供应链的企业合作关系和合作趋势演变主要受政府管制影响的规律。
     ②对医药供应链参股合作利润分配问题,现有文献一般从利润分配系数等方面进行分析,本文讨论了政府对药品交易成本及两级价格等的管制对利润分配的影响,提出了医药商业供应链企业参股合作必定会形成价格同谋,采取合作管制方式能对其有显著抑制作用的观点。论文以1个医药生产企业和1个销售商组成的二级、双边供应链参股合作系统建立实证框架,通过建立三阶段讨价还价模型,研究不同合作主导方条件下的利润分配形式和比例,并对影响利润分配的各因素进行了详细分析。着重论证了政府对合作成本、药品交易价格以及终端销售价格进行管制条件下的利润分配及影响策略因素,从而进一步验证了对于价格需求弹性很小的药品,政府对参股合作中药品的零售价、出厂价以及批发价等价格增量幅度主要环节实行价格管制的理论依据和现实合理性。
     ③对医药供应链协议合作利润分配,现有文献主要从供应链分配机制等方面分析,本文以1个医药生产企业和2个医药销售商组成的供应链二级分销网状协议合作建立实证框架,考察了政府管制对医药商业供应链企业协议合作方式和利润分配结果的影响。证实了在医药流通政策的约束和影响下,药品销售商由生产企业的批发(分销)商转为物流合作商的趋势,其合作方式、利润来源和分配都也随之变化。在药品定价、物流费率和药品销售量不变的市场环境下,药品生产商和物流供应商的利润都会显著降低。提出虽可通过降低生产和流通成本、减少物流费用及扩大销量等途径增加合作利润,而供应链合作是实现社会和企业双赢目标的有效途径的理论新观点,并据此证明了管制在宏观引导方面的有效性。
High hospitalization costs and drug prices, quality and safety of drugs, and the lowefficiency of medicine distributions have been hot spot issues since the reform of theMedicare system at the end of1990s’. The main problems include the expensivemedical treatment and speedy increasing of drug prices. Current researches show thatbesides institutional factors, high distribution costs resulted from poor operationefficiencies of medicine distribution channels play an important role in high drug prices.The improvement of cooperation relationship of firms in medicine business supplychain can decrease operational costs and deduce rises in drug prices, and enhance civilmedical benefits. Therefore, this research is meaningful theoretically and practically.
     Compared with ordinary consumer goods, Chinese medicine business supply chainis featured as being controlled by the government continually and strictly. Therefore,considering the firm cooperation in Chinese medicine supply chain, the governmentalregulations and its institutional changes ought to be brought in as an important externalinfluential factor. With Institutional Change Theory, Government Regulation Theoryand Supply Chain Cooperation Theory, this research theoretically and empiricallystudied the medicine regulation policies in different periods; the historical changes ofthe cooperation in Chinese medicine business supply chain; the influence of policychanges on the cooperation relationship; and the benefit sharing models in variousmodels of cooperation in Chinese medicine business supply chain. The main work andinnovations of this paper are as the following.
     The distribution cooperation relationship in medicine business supply chain and itschanges resulted from government regulations and market development. Andgovernment regulations heavily guide and restrict the formation and development ofdistribution cooperation. From the aspect of Institutional Change Theory andGovernment Regulation Theory, this research analyzed the institutional changes andthe development of cooperation models of distribution cooperation relationship inChinese medicine supply chain; and the influence of government regulation policies onthe cooperation models. Then with the analysis of medicine regulation policies indifferent periods, this study summarized that the corporation relationship in Chinesemedicine business supply chain changed with the changes of policies. And thisconclusion was examined by an empirical study.
     This study proved that in the model of share cooperation of medicine businesssupply chain, two parties of cooperation tend to be price conspirators and jointly make ahigh medicine price, but the government regulation policies can significantly curtail theprice conspiracy. With a two-side supply chain consisting of1manufacture firm and1sales firm as the example, a three-stage bargaining model was constructed to discuss theprofit allocation and various influences. The influence of government regulationpolicies of cooperation costs, medicine exchange prices and the final sale prices wereanalyzed. And the model proved that, aimed at the medicine with small elasticity ofdemand, it is reasonable and effective for the government to have price control atdifferent stages such as retail prices, the factory prices and wholesale prices.
     It is proved that the government regulation policies can change the cooperationmodels in Chinese medicine supply chain, can limit the extraordinary profits inmedicine distributions, and can urge firms to improve their distribution and logisticsmanagement. A two-stage supply chain consisting of1manufacture firm and2salesfirms was exampled to analyze the influence of government regulations on thecooperation models and their profit allocations. With the constraints of medicinecirculation policies, medicine sales changed from the wholesales/distributors to logisticcooperators of medicine manufactures; and the cooperation models, profit allocationschanged as well. With given fixed prices, logistic costs and sales volumes, the profits ofmanufactures and logistic suppliers significantly decreased. Therefore, in order toimprove profits for manufactures and logistic suppliers, they need to decrease the costsin manufacturing and distributions, adjust logistic charge ratio and enhance salesvolumes. In such a way, the objective of macroscopic readjustment and control ofmedicine policies can be realized to a certain extent.
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