基于精益供应链治理的我国药物供应保障评价及策略优化研究

The improvement of drug supply guarantee mechanism is an important issue to improve the sense of health satisfaction for Chinese citizen, and to determine the direction of health reform. However, the problems such as the shortage in drug production and circulation phases, the irrational drug price are still exist, making it a difficult point for the health reform. The frequent problems in the drug supply chain are due to the imbalance of supply relationship caused by the distortion of interests in the supply system. This research introduces Lean Supply Chain Management (LSCM) theory as the guidance, to establish a LSCM evaluation system which takes a healthy, efficient, accurate supply relationship as core, to understand the true situation of drug supply chain in our country through empirical research. Built the evaluation model by applying the methods of Principal Component Analysis and Difference-in-Difference, to identify the key indicators by dimension reduction, and to provide multi-dimensional comprehensive evaluation of drug supply relationship, influence factors and drug guarantee capacity. Based on the evaluation results, coordinates the relationship of supply chain variables, improves the efficiency of supply chain internal elements and the coordination of supply chain external environment, and explores the optimization strategy of drug supply guarantee. Expect to provide a new research perspective for the policy evaluation of health reform, and to provide a path for the stakeholders to share the result of health reform better.

药物供应保障机制的完善，是提升我国民众健康获得感、决定医改走向的重大问题。但药物生产及流通环节供应断链兼具、药价高低两极共生等问题依然存在，成为医改攻坚的难点。以上药物供应链条上频发的问题，终源于多元药供给体系下利益扭曲造成的供给关系失衡。本研究以精益供应链治理理论为指导，建立以健康、高效、精准对接的供给关系为核心的精益供应链治理评价体系，通过实证研究掌握我国药物供需链条的真实运行情境。运用主成分分析法和倍差法构建评价模型，在对关键指标进行降维识别的基础上，对我国药物供应关系、影响因素、保障水平进行多维度综合评价。结合评价结果，针对性协调供应链变量关系，提升供应链内部元素间效率及供应链外部环境协同性，探索我国药物供应保障的优化策略。以期为医药卫生体制改革政策评价提供新研究视野，为各利益方更好的分享医改成果提供路径选择。

本研究通过理论研究，专家咨询，共词聚类等多种方式论证，构建了基于精益供应链治理的我国药物供应保障评价体系；对中东西部，涵盖贫边地区多省份样本地区进行现场调研，结合以上评价体系对样本地区基本药物供应保障情况进行综合评估，对项目立项前及现阶段的药物供应保障情况进行对比分析。研究发现：在2016-2018年，样本省份基层医疗机构基本药物采购费用占比均在63%以上，最常采购的基本药物集中于5-10元的低廉药品，未成功供应入库次数最多药品集中于均价0-5元的药品，药品短缺与配送距离无明显相关，与药品标价格、供应市场、成本相关。到2019年-2021年，药物供给网络基本满足需求，分布日趋合理，药品供应价格结构发生变化，同时主要采购品种包括了涉及癌症等重疾的高值药物。本研究发现现阶段药物供应保障能力在需求供给精益性、库存规划动态性、供给网络适宜性、信息对接有效性、患者用药实现性五个维度提升显著，但个别边远地区仍存在药店负担重，高值药难落地现象。本研究为我国现阶段药物供应保障综合管理和短缺药品信息监测体系的建设提供了实证依据，构建了逻辑较为完整的药物供应保障评价框架，形成科学有效的、符合需方要求的高质量供应价值链，提出了针对性的策略建议。