ABSTRACT People widely pay attention to medical and medicine expenditure increasing in China. Since 1980s, health expenditure rose rapidly in China, the growth rate of average year for health expenditure exceeds over the gross domestic product (GDP) in China. And drug expenditure is about 45 percent in total medical expenditure. The growth rate of drug expenditure rises as quickly as medical expenditure. The drug expenditure of patients increase more and more, for drug expenditure rises rapidly. The problem which is drug expenditure increasing becomes focus topic in Chinese society, for the drug expenditure of government, collectivity and person grow rapidly. It is also a problem which is drug expenditure increasing rapidly in other countries. Drug expenditure also increases in oversea countries, and every country has a growth rate of drug expenditure. But it is very few in the world what the percentage of drug expenditure is in China, it is very high. The central drug market is hospital in China, and the proportion of hospital drug market is approximately 80 percent in China drug market. And the drug revenue of hospital is probably 45 percent in total revenue of hospital. In 1954, China government implemented a policy of drug price advance which was a policy of economy compensation for public hospitals, government allows that public hospital can advance 15 percent in wholesale price, and the advance price is the retail price in public hospitals, then the revenue of drug price advance is the revenue of drug in public hospitals. Since 1980s, with government finance subsidy for public hospitals decreasing, it is important that drug revenue is one of revenues in public hospitals, and the drug revenue gradually became one of the major revenues in public hospitals. So, drug revenue is controlled at first and the proportion of it is adjusted in public hospitals, then drug expense can be controlled in China. The first three medicines are anti-infection drugs, circulation system agents and digestive system agents in China drug expenditure. The top three medicines are hormones drugs, blood system drugs and urinary system drugs at the growth rate of average year in China drug expenditure. According to epidemiology changes, the two-week morbidity rate(%0) of acute respiratory track infectious disease is at first in Chinese residents and the incidence rate of chronic disease goes up year by year. This the reason why the drug expenditure of anti-infection drugs is at first and the growth rate of three kinds of drugs is high. So, these kinds of drugs need to trace investigation and their price would be controlled in reason. is Non-medical insurance patients are higher than medical insurance patients except respiratory system drugs in the growth rates of drugs expenditure. And only 30 percent residents are covered by medical insurance in China, rural residents are less than citizen residents in the proportion of medical insurance. And rural residents are generally lower than citizen residents in the revenue. Then rural residents may be more than citizen residence in the burden of drug expenditure. Non-medical insurance patients do not difference between drug expenses by themselves and by government in drugs, they are more than medical insurance patients in the proportion of drug vi expenses by themselves. And drug expense by self is generally higher than by government in drug price. So, it conduces drug expenditure decreasing that all presidents are covered medical insurance and the price of major drugs are controlled. Since 1990s, China government implements many policies to control drug expenditure increasing, but the effect of these policies is not evidence. It is not effect to control drug expense increasing whatever the policies aimed at drug revenue of public hospitals and drug price in the market. Therefore, for decreasing drug expenditure, this article suggests that all residents would be covered medical insurance in China, the price and amount of drug would be control in reason in China, and the drug revenue would be decrease on the base of ensuring business fund in public hospitals. Key words: drug price advance drug expenditure policy research vii

澳門大學碩士學位論文 中文摘要 我國醫藥費用快速增長,引起了社會普遍關注。自二十世紀八十年代,我國 的衛生費用急劇上漲,衛生總費用的年均增長幅度已經超過了國內生產總值 GDP 的年均增長幅度。其中,藥品費用約占到醫療總費用的45%左右。藥品費 用的增長速度與醫療費用的增長速度相似,都呈現為快速增長。藥品費用的快速 增長,患者的負擔隨之加重。國家、集體和個人藥品費用隨之增加,讓藥品費用 問題成為眾人心中的焦點話題。 藥品費用快速增長,並不是中國特有的現象。世界上許多國家的藥品費用, 也都有不同程度的增長,但像我國藥品費用占醫療費用比例之大的國家,並不常 見。我國的藥品銷售主要集中在醫院,醫院銷售的藥品約占到整個藥品市場的 80%左右。我國醫院的藥品收入約占到整個醫療收入45%左右。1954年,我國 出臺了醫院藥品加成政策作為醫院的一項經濟補償政策 該政策允許醫院對藥品 的批發價格,按照15%的比例進行加成,加成後的價格為醫院的銷售價格,藥品 加成的收入為醫院的藥品收入。到了二十世紀八十年代,隨著我國對醫院的財政 補貼的減少,藥品收入作為醫院的業務收入之一,發揮著巨大作用,並逐漸成為 醫院主要業務之一。所以,控制我國藥品費用,要先控制醫院的藥品收入,調整 醫院的業務收入比例。 在我國的藥品費用中,藥品費用排名在前三位的是抗感染藥物、循環系統藥 物和消化系統藥物。藥品費用年均增長最快的三類藥物分別是激素類及調節內分 泌功能藥物,血液系統藥物和泌尿系統藥物。根據我國居民的流行病學變化發 現,我國居民的急性呼吸道感染性疾病兩周患病率位於首位,慢性疾病發病率逐 年上升。這解釋了抗感染藥物的藥品費用排名在首位,以及另外三種藥品費用增 長的原因。所以,這幾種類型的藥品需要繼續追蹤調查並適當控制該類藥品的藥 品價格。 從醫保和非醫保人群的藥品費用增長狀況來看,非醫保人群的藥品費用增長 率除呼吸系統藥物之外,其他均高於醫保人群的藥品費用。我國的醫療保險目前 只覆蓋了全國30%的人口,另外 70%的人口沒有醫療保險,其中農村人口比例 高於城市人口比例。從收入角度來看,農村人口的收入普遍低於城市人口的收 入。所以,相對來說,農村人口的藥品費用負擔可能要大於城市人口。另外,由 於非保險人群的用藥沒有自付和公費藥物的區別 非保險人群自付藥品比例高於 有保險人群,且通常自付的藥品的藥品價格比公費藥品價格高。因此全面覆蓋醫 療保險,控制藥品市場上主流藥品的藥品價格,有助於減少藥品費用。 自二十世紀九十年代,我國推出了多項政策意圖控制我國的藥品費用增長, 但是效果均不明顯。無論是針對醫院的政策,還是針對藥品價格的政策,都沒有 有效的控制我國藥品費用的增長。因此,建議從全局出發,建立全國的醫療保險, 全面控制藥品市場的藥品價格和藥品用量,並在保證醫院獲得正常經營資金的基 礎上減少醫院的藥品收入,從而減少我國的藥品費用。 關鍵字:藥品價格加成藥品費用 政策研究