大变局!6省市叫停药房托管

2019-02-18 李兴鹏 医学界

继上海、湖北等省市叫停药房托管后,江苏省卫生健康委员会也下发文件,明确禁止药房托管。

继上海、湖北等省市叫停药房托管后,江苏省卫生健康委员会也下发文件,明确禁止药房托管。

日前,江苏省卫健委发布《关于全面停止公立医疗机构药房托管的通知》(下称《通知》),要求全省所有公立医疗机构不得承包、出租药房,不得向企业托管药房或与企业开展类似业务合作;已经实行药房托管、变相托管的公立医疗机构应立即停止托管、变相托管行为。

药房托管走到穷途末路


江苏全面停止药房托管的做法正是为了进一步落实国家卫健委、国家中医药管理局联合发布的《关于加快药学服务高质量发展的意见》中所要求的:“公立医院不得承包、出租药房,不得向营利性企业托管药房。”据了解,该《意见》也是国家层面首次明确提出禁止药房托管。

随着江苏省卫健委文件的下发,已有五省一市先后叫停药房托管,让药房托管再度引发热议。按照江苏省卫健委的要求:

所有公立医疗机构不得承包、出租药房,不得向企业托管药房或与企业开展类似业务合作;
在药房供应链优化过程中,要依法依规开展药品供应延伸服务合作,不得以药品供应延伸服务方式变相托管药房……
对于已经实行药房托管、变相托管的公立医疗机构,江苏表示应立即停止托管、变相托管行为。

虽然药房托管目前已经走到了穷途末路,但在此前较长一段时间内,这一做法曾在不少地方得到大力推行。随着药品零加成全盘落地,全国各地出现了多种以门诊药房与医院脱离为原则的试点模式,药房托管就是其中之一。从“以药养医”到“以药补医”的良性转变,药房托管也为医药改革提供了一种过渡,得以在各地施行。



6省市相继禁止药房托管


而随着一些问题的曝出,药房托管陆续被一些省市叫停,山东、青海、上海、湖北、广东等省市均作出了不同程度的规定,不允许对公立医院进行药房托管。

2018年6月,湖北省卫计委明确表态,药房托管在湖北省是不允许的。而就在湖北省卫计委禁止药房托管的数日前,上海市卫计委正式发布文件,明确:

公立医疗机构在进行药房供应链优化过程中,须审慎设定与医药企业的合作模式,不应与有关企业开展药房“托管”或类似业务合作,禁止了药房托管。

“医学界”了解到,药房托管之所以容易产生腐败,是因为托管企业如果要获得托管资质,需要拿出药品收入40%以上的利润交给医院。以江西一家公立医院为例,其每年采购药品金额约为数千万元,实行药房托管后,托管药企每年要将采购药品金额的近10%作为利润上交给医院。

除此以外,托管企业还要支付医院药房员工的工资。在这种情况下,患者从医院药房买的药,价格不仅不会降低,还会上涨。如果中小企业不能提供给垄断企业30%~40%的扣点,药品就会被排斥于市场之外。这被很多业内人士认为,是在“变相规避国家取消药品加成政策”。



无法真正实现医药分开


2018年11月26日,国家层面正式宣告禁止药房托管。国家卫健委、国家中医药管理局发布《关于加快药学服务高质量发展的意见》,要求公立医院不得承包、出租药房,不得向营利性企业托管药房。至此,禁止药房托管终于有了国家文件。

“医学界”注意到,早在药房托管推行如火如荼的时候,香港艾力彼医院管理研究中心主任庄一强就曾直言“这个政策根本行不通”。在他看来,原来医院有15%的药品加成,卖100元一盒的药,医院可提15元,现在要托管给第三方,那么为了保证这些收入,就会要求托管方以115元一盒的成本接盘,最终这个价格还会转嫁给制药企业。

广东省卫计委原巡视员廖新波也公开表态,“药房托管仅仅是药房的管理者改变了而已,并没有真正实现医药分开,而且托管方就只有一家医药公司,这造成绝对的垄断,而绝对的垄断必然导致绝对的腐败。”

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    2019-05-21 sunmin0227
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    2019-02-20 yinhl1980
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    2019-02-20 spoonycyy

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