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class="pa_0_5_0_10"> <h1 class="Content_title" id="hh"> <span id="a" style="">上海、青海等地纷纷叫停药房托管且行且迷茫</span> </h1> <script>/*jQuery('#hh').width(jQuery('#a').width());*/</script> <div id="i2i2jyu4k" class="Remark"> <span>2018年06月26日 14:22 | 来源：<a target="_blank">中国医药报</a></span> <span id="i2i2jyu4k" class="fr"> <div id="i2i2jyu4k" class="bdsharebuttonbox"><a href="#" class="bds_more" data-cmd="more"></a><a href="#" class="bds_qzone" data-cmd="qzone" title="分享到QQ空间"></a><a href="#" class="bds_tsina" data-cmd="tsina" title="分享到新浪微博"></a><a href="#" class="bds_tqq" data-cmd="tqq" title="分享到腾讯微博"></a><a href="#" class="bds_renren" data-cmd="renren" title="分享到人人网"></a><a href="#" class="bds_weixin" data-cmd="weixin" title="分享到微信"></a></div> <script>window._bd_share_config={"common":{"bdSnsKey":{},"bdText":"","bdMini":"2","bdMiniList":false,"bdPic":"","bdStyle":"0","bdSize":"16"},"share":{}};with(document)0[(getElementsByTagName('head')[0]||body).appendChild(createElement('script')).src='http://bdimg.share.baidu.com/static/api/js/share.js?v=89860593.js?cdnversion='+~(-new Date()/36e5)];</script> </span><span id="i2i2jyu4k" class="fr">分享到：<img src="/images/fx.jpg" /> </span> </div> <div id="i2i2jyu4k" class="text_box"> <p align="center"> <div style="text-indent: 2em; text-align: left;"><p style="text-indent: 2em; text-align: left;">6月1日，上海市卫计委发布《关于本市医疗机构进一步加强药事管理推动药学服务转型发展的通知》，明确公立医院“不应与有关企业开展药房‘托管’或类似业务合作”。</p><p style="text-indent: 2em; text-align: left;">事实上，对药房托管亮出红灯的不只上海。由于医院药房托管操作中存在一系列漏洞，全国有不少地方主管部门也对其持反对态度。青海、山东、广东、湖北等省份都出台了相关文件，规范或禁止药房托管行为，如近期湖北省卫计委也明确表态不允许药房托管。这给近年来频频升温的药房托管泼了一瓢凉水，也令行业内对药房托管可行性的讨论再度升温。药房托管将何去何从？</p><p style="text-indent: 2em; text-align: left;"><strong>三次浪潮</strong></p><p style="text-indent: 2em; text-align: left;">药房托管一般是指医院在药房所有权不发生变化的情况下，通过契约形式将药房交由具有较强经营管理能力并能承担相应风险的医药企业有偿经营和管理的一种经营活动。</p><p style="text-indent: 2em; text-align: left;">国务院办公厅2017年发布的《关于进一步改革完善药品生产流通使用政策的若干意见》提出，推进医药分开，具备条件的医疗机构可探索将门诊药房从医疗机构剥离。对医院来说，药房托管能从形式上将门诊药房剥离，并消减药品零差率销售带来的影响。“在药品零差率销售的要求下，公立医院自己管理药房，不仅账面上没有盈利，还要付出巨大的管理成本。而如果医药商业企业愿意承接药房，相关成本由药企承担，那么医院不仅可以减少成本，还有可能获得额外的场地租金收入或利润分配。”中国医药企业管理协会副会长牛正乾如此解释医院进行药房托管的初衷。</p><p style="text-indent: 2em; text-align: left;">而作为被委托方，医药商业企业也能在经营托管药房中获得收益?！耙皆菏褂玫乃幸┢吠骋挥晒竟┯图信渌汀薄肮镜囊┢饭┯α醇胺裱由熘烈皆翰挚?，医院的仓库将作为公司的药品供应平台，由公司负责管理和使用，药品进入药房后才归医院所有”——这是某药业公司在2014年公告中披露的与某医院签订《医院药房托管协议》的部分内容。由此可见，被委托方对其他公司的药品能否进入医院药房以及如何进入有很大的影响力，其在医院用药市场中的话语权也由此增强。</p><p style="text-indent: 2em; text-align: left;">近年来，随着公立医院改革深入推进，医院药房托管业务备受医药商业企业青睐?？得酪┮倒煞萦邢薰尽⑸虾Ｒ揭┘殴煞萦邢薰竞凸┛毓晒煞萦邢薰鞠嗉炭挂┓客泄芤滴?。据企业公开信息，目前康美药业在全国托管医院药房数量超过100家，上药集团共托管医院药房226家。</p><p style="text-indent: 2em; text-align: left;">事实上，近几年的药房托管已经是第三次大规模尝试。2001年，三九医药集团托管柳州市中医院等7家医院药房（药剂科），被认为是国内药房托管的首次尝试。2006年，南京在全市一、二级医院全部推行药房托管试验，掀起了药房托管的第二轮浪潮。但两轮尝试均铩羽而归。</p><p style="text-indent: 2em; text-align: left;"><strong>争议伴行</strong></p><p style="text-indent: 2em; text-align: left;">药房托管一直且行且争议。</p><p style="text-indent: 2em; text-align: left;">首都医科大学附属北京天坛医院药学部主任、北京市医管局总药师赵志刚用“怪胎”一词来形容药房托管模式。“除我国以外，全世界其他国家或地区都没有药房托管这种模式。把医院药房像公司一样管理，这令人诧异?？銮遥阄髂Ｊ?、南京模式都已经失败了，为什么还有利益相关方在推动药房托管？”赵志刚质问。</p><p style="text-indent: 2em; text-align: left;">赵志刚的声音代表了部分反对药房托管者的观点。事实上，在相关探索中，药房托管一直存在争议。反对者认为，药房托管有助长腐败、涉嫌垄断的弊端；支持者则表示，腐败和垄断的根源不在药房托管本身，而且作为独立的市场主体，医院和企业对在法律允许范围内的经营行为应该享有充分的自主权。</p><p style="text-indent: 2em; text-align: left;">青海省首家进行药房托管的医院曾深陷腐败泥潭。“托管中出了很多事，药房管理也一塌糊涂?！碧峒罢獯问О艿某⑹?，赵志刚很激动。公开资料显示，2004年3月，青海省红十字医院与某医药公司签订药房托管合作协议。2007年3月~2013年4月，在长达6年的时间里，该院近八成医疗科室和215名医务人员，收受医药公司“红包”累计达1966万余元。36名医务人员受到党纪政纪处分，142名医务人员被批评教育，检察机关立案侦查7人。2016年6月，青海省卫计委发文称，“严禁医疗机构进行药房托管或承包”。</p><p style="text-indent: 2em; text-align: left;">另一个无可回避的话题就是垄断?！捌笠翟诳挂┓客泄芤滴袷?，最开始考虑的可能不是赚钱，而是控制这块市场。其他企业的产品要进入医院，必须跟被委托企业来谈，后者有望从门诊渠道控制医院用药，从而可能演化成垄断?！鄙蕉笱б揭┪郎芾硌г焊苯淌谧蟾赖莱鏊牡Ｓ?。相关部门对此也不无顾忌，并努力探索解决之道。2017年7月21日，广东省价监局召开专题研讨会，邀请多方学者、三甲医院和大型药企代表，就《药房托管行为反垄断执法指南》征求意见。指南提出涉及公立医院、托管企业和行业主管部门3类主体的39种行为表现涉嫌垄断。然而此后进展如何，并无新的消息传出。</p><p style="text-indent: 2em; text-align: left;">药房托管是否会有损合理用药，也引起了很多人的关注。“药房托管后，医院用药供货掌握在一家企业手里，这家企业极有可能会找借口切断那些临床效果好但利润低的药品的供应，诱导医院使用利润空间更高的替代药品，最后变成医院给药企打工?！弊蟾浪?。</p><p style="text-indent: 2em; text-align: left;">“医院药房不应该是简单地卖药，而应该是合理用药的实施者和监督者。医生处方的审核、患者用药指导和教育，都需要高水平的药师把关。这不是商业公司所擅长的。医院开展合理用药以及药事管理需要投入很大的成本，但在某种程度上，用药越合理就越不利于商业公司销售产品?！痹谡灾靖湛蠢?，药房托管不能解决合理用药问题，反而可能加重患者负担?！耙┓客泄芤院?，医院和商业公司都赚钱了，那么谁多掏钱了？”赵志刚言下之意是，自医院开始的药房成本转嫁，最终还是要由患者和国家医保买单。</p><p style="text-indent: 2em; text-align: left;"><strong>探索之举</strong></p><p style="text-indent: 2em; text-align: left;">各地政府对于药房托管的态度也有很大分歧。有的地方明确反对，如上海；有的地方鼓励尝试，如甘肃；更多的地方保持缄默，态度暧昧。</p><p style="text-indent: 2em; text-align: left;">左根永在做相关课题时，曾研究过药房托管，并在多地进行调研。他发现，地方政府是否支持药房托管，很大程度上取决于地方财政状况。“政府财力雄厚，能补上药房剥离或药品零差率销售给医院造成损失的，禁止药房托管的态度就很坚决?！弊蟾澜馐退担┓客泄苁枪⒁皆焊母锎呱囊恢帧坝Χ浴蹦Ｊ?，它从形式上完成了门诊药房剥离和处方外流，但一招不慎就易对这两个政策造成破坏。</p><p style="text-indent: 2em; text-align: left;">门诊药房剥离的目的是斩断药商和医院间的利益链，破除以药养医。药房托管从形式上隔开了医院与药商，但事实上，在企业缴纳保证金、将营业收入按比例返还给医院的过程中，二者的利益链条反而收紧。在药房托管模式下，院内处方外流基本无望?！氨晃衅笠祷岚汛Ψ骄×窟谧约菏掷?，设法影响医生，让患者在医院药房拿药。当然，药房托管也算处方外流，但这个流向太确定、太单一，医生和药房之间的利益链条并没有被斩断?！弊蟾浪?。</p><p style="text-indent: 2em; text-align: left;">如何规范药房托管？多位业内人士表示，目前还没有看到有效的解决方案。“其实，现在药房托管遇到的问题，在前两次‘浪潮’中都已经出现过。因为药房托管模式的激励机制一直没有变，也没办法变。如果想彻底解决上述问题，只能禁止药房托管。”左根永说。赵志刚也表示：“医药分开的大背景下，药房托管不应该存在，开医院就必须有药房。随着分级诊疗的推行，大医院门诊患者人数下降，门诊药房自然会萎缩，甚至会和美国一样，只剩下急诊药房，门诊药房自动消失。”</p><p style="text-indent: 2em; text-align: left;">不同的地方财政状况不同，不同的医院发展情况不一样，如果想一步到位、在所有地区所有医院实现真正的药房剥离，似乎又不现实?！霸谙中姓呋肪诚?，真正实现医药分开有一个相对漫长的过程，在此期间进行多种探索是非常重要的。药房托管本身并没有真正做到医药分开，但这种探索实践可能使得改革向医药分开的方向迈进一步?！迸Ｕ?。</p><p style="text-indent: 2em; text-align: left;">“实现药房剥离，需要给出时间让医院调整业务结构和药品利润占比?！弊蟾澜馐退担┓客泄苤皇且恢止赡Ｊ?，在过渡期内给医院一个进行收入结构转型的窗口，转型结束后这个窗口就要关闭。而事实上，如何让药房托管规范运营，是必须关注的问题。（记者落楠）</p></div> </div> <p class="Editor">编辑：赵彦 </p> <div id="i2i2jyu4k" class="Paging"> </div> <p class="Keyword">关键词：药房托管药事管理</p> <h1 class="pv_title_2 mt_15"><a href="/index.shtml" target="_blank" class="more mtb_14">更多</a><span id="i2i2jyu4k" class="t" id="a3"><a href="/index.shtml"><img src="/images/xg_t1.jpg" /></a></span></h1> <div id="i2i2jyu4k" class="pa_0_5_0_10"> <ul class="Related_ul bh_150"> <li><a target="_blank" href="/c/2017-02-15/1342622.shtml">不能卖药，数百万“药代”何去何从？</a></li> </ul> </div>  <div id="i2i2jyu4k" class="advContent"><div style="height:40px"></div><script charset="gbk" src="http://p.tanx.com/ex?i=mm_58500226_6900940_24396084"></script></div>  <h1 class="pv_title_2 mt_55"><a href="/tsyx/index.shtml" target="_blank" class="more mtb_14">更多</a><span id="i2i2jyu4k" class="t" id="a4"><a href="/tsyx/index.shtml"><img src="/images/sp_t2.jpg" 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