内容提要：通过对中国医疗体制和药价管制模式的分析， 我们发现公立医疗机构在药品零售环节上的双向垄断地位是导致药价虚高的根本原因，医疗服务价格低估导致的“以药补医”机制赋予了医疗机构抬高药价的合法权力，而收益率管制政策进一步诱导医院进销高价药品。此外，单独定价政策加之宽松的新药审批制度为药厂提高药价、医院购销高价药提供了便利。所有这些问题的出现根源于政府管制措施的失当。因此，解决药价虚高的根本措施是减少政府管制，放开处方药零售权，改革公费医疗和医疗保险报销制度，打破公立医院垄断。所谓的“医药分离”改革和“医院药品收支两条线”改革均无法实现抑制药价的目标。

关键词：药品价格、管制失当、药品零售双向垄断、医疗改革困境

Deficiencies in the Health Care System and Distortions in Pharmaceutical Pricing

Through an analysis of China’s health care system and the regulatory model of pharmaceutical pricing, the paper concludes that the prime cause of pharmaceutical price inflation is the two-directional monopoly of public hospitals on pharmaceutical retailing. The low price of medical services means that public hospitals can legitimately use the profit of pharmaceuticals to subsidize the provision of medical services. Moreover, the policy of regulating rate-of-return gives public hospitals a further incentive to buy and sell high-priced pharmaceuticals. In addition, the policy of separate pricing together with the laxity of the system for approving new drugs allows the producer of pharmaceuticals to charge higher prices and facilitates public hospitals’ sale of high-priced drugs. All of these problems result from inappropriate government regulations. Therefore, the basic strategy for solving the problem of pharmaceutical pricing should be to lessen government regulations on health care, open up retail sales of prescription medicines, and reform the system of medical insurance reimbursement, breaking the monopoly of public hospitals.

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