摘要：
背景:近年来,中国药物政策存在着药品费用快速增长,以及质量、定价和提供能力等方面的问题,其解决的关键在于理清其中的定价和补偿问题.方法:本文较为系统收集了药物领域的学术文献和灰色文献,以及中国政府的官方统计数据,并结合中国国务院发展研究中心举办的研讨会信息,概述了中国的药品定价和补偿情况.结果:通过一个融合了供应方、代理方和需求方多方政策的框架,分析了定价与补偿政策.在目前药品政策的相互影响下,出现了药品价格高、质量低、不合理开药等问题.分立的监管环境也不利于药品政策的改革.结论:提高药品质量标准、市场集中度、政府补贴,以质量为导向的招标、扩大零差率政策的实施范围、建立补偿与合理开药的联动机制以及促进卫生技术评估与比较效能研究来改善定价和补偿政策.另外,整合广泛的监管分立体制、改善透明度和打击腐败等问题将有助于确保制定出具有一致性的、循证的政策.%Background:In recent years, there has been rapid growth in pharmaceutical spending in China. In addition, the country faces many challenges with regards to the quality, pricing and affordability of drugs. Pricing and reimbursement are important aspects of pharmaceutical policy that must be prioritised in order to address the man-y challenges. Methods:This review draws on multiple sources of information. A review of the academic and grey lit-erature along with official government statistics were combined with informa-tion from seminars held by China's State Council Development Research Center to provide an overview of pharmaceutical pricing and reimbursement in China. Results:Pricing and reimbursement policy were analysed through a framework that incor-porates supply-side policies, proxy-demand policies and demand-side policies. China's current pharmaceutical policies interact in such a way to create dysfunction in the form of high prices, low drug quality, irrational prescribing and problems with access. Fi-nally, the country's fragmented regulatory environment hampers pharmaceutical policy reform. Conclusions:The pri-cing and reimbursement policy landscape can be improved through higher drug quality standards, greater market con-centration, an increase in government subsidies, quality-oriented tendering, wider implementation of the zero mark-up policy, through linking reimbursement with rational prescribing, and the promotion of health technology assess-ment and comparative effectiveness research. Addressing broader issues of regulatory fragmentation, the lack of trans-parency and corruption will help ensure that policies are created in a coherent, evidence-based fashion.
