| In the long historical process of the medical industry development in China, the model of amalgamation of prescribing & dispensing (APD), as the informal institutions, had been continued, because it was affected by culture, technology and other factors. After the founding of the People's Republic of China, the model of APD was fixed as an formal institutions. In the condition of shortage of doctors and medicines, this institutions afforded facilities for people seeing a doctor and getting medicine, played an active role in protection of health and safety and meeting the basic medical needs of the people. Since reform and opening policies were adopted in China and the market mechanism was introduced in the field of health care, health services and pharmaceutical industry have made rapid development. With significant improvement in the medical conditions and new breakthrough in medical technology and significant improvement in pharmaceutical production capacity, the era of shortage of medical resources has passed off. But, as reform of the APD lags behind, medical establishments hold the positions of bilateral monopoly in drug distribution. In order to maximize profits, their behaviors are distorted. Medical establishments squeeze profits from the competitive pharmaceutical companies in the wholesale market and prescribe much and expensive medicine for people by monopolizing the option on taking drugs. The institutions not only makes people bear the high medical expenses and face health hazard, but also make the pharmaceutical industry sink into a vicious cycle of low-level development because it causes the confusion of pharmaceutical production and operation. Pharmaceutical enterprises and patients demanded to change the situation, and bring the political pressure to the government by kinds of ways in order to promote the medical institutions to evolve toward to their interests. Medical establishments hinder the institutions evolution in order to maintain their vested interests through participating in making policies, political lobbying and so on. Central government synthesized the interests of various aspects and mandated the separation of prescribing & dispensing (SPD). However, more than 10 years passed by, and local reform quests are in a big way, but the statewide uniform effective institutions can not come to the top. Why the policy that benefit both the State and the people come to a dead end, have to make people think deeply. Therefore, the research not only contribute to enrich the research on the SPD, but also contribute to cut off special benefits chain in the drug distribution, lighten patients medical burden, and promote medicine industry development healthily.The basic proposition is that:Since the market economy reform in China, the reform of the APD which doesn't adapt with the market mechanism lags bahind, which cause the benefit imbalance among medical establishments, patients and medicine enterprises.The game among interest groups promotes the evolution of the SPD from APD. But because the influence of the interest groups is unbalanced, the institutionsal evolution has not gotten rid of the way of dependence on "compensation for the medical cost through drug-selling profits". In order to promote the institutionsal evolution and realize the thorough SPD, the institutions platform must be constructed for orderly game among interest groups and the related institutionss must be improved.Surrounding the basic proposition, This paper fuses the institutionsal economics, the health economics, the public economics and so on, and analyses background condition of institutions evolution, benefits conflict and competition among interest groups, experimental reforms locally, and the institutions evolution trend in the long term, attempts to reveal the law of the evolution of the SPD from the APD using institutionsal analytical method. Therefore, the full paper is divided into seven chapters:Chapter one is introduction. It depicts the research backgrounds, research significances, research subject, research methods, research path, main contents, contributions and shortcoming, in order to make it easy to understand the purpose and contents of the research.Chapter two is literature review and analysis framework. At first the chapter has made plain the researches on the APD, the SPD and the evolution of the SPD from the APD. Then it comprehensively apply the theories of path dependence, interest groups and public choice to found the analysis framework of the evolution of the SPD from the APD, in order to provide academic support for the research, and help to make it easy to understand the basic frame of the paper.Chapter three explores the evolution of the APD. The purpose is to make good bedding for the research on the institutions evolution. The institutions of the APD has existed since ancient times. In the particular period, it is different in degree, form and relation among medical establishments, patients and medicine enterprises. Therefore, according to the different stage this chapter introduces the APD in the ancient time; then it analyses the institutions under the planned economy system; at last it analyses the institutions after the market economy reform.This chapter analyses the relation among medical establishments, patients and medicine enterprises to reveal the change of interests among them, while setting forth the institutions at the different stage.Chapter four analyses the influence which is exerted by the APD on the interest entity since the market economy reform. The purpose is to illustrate the reason of the evolution of the SPD from the APD. Because the angle of the research is interest groups and institutions evolution, this chapter illustrate the positive effects and the negative effects that the system brings to medical establishments, patients, medicine enterprises and government respectively, to explain the reason of the evolution of the SPD from the APD.Chapter five analyses the behaviors of interest groups during the evolution of the SPD from the APD.This chapter mainly explains the factor that urge the evolution of the SPD from the APD. Therefore, it introduces the formation and behavioral characteristics of interest groups under the institutions of the APD; then it analyses the benefits conflict between the interest groups and their institutions preference; at last it analyses the competition between interest groups to promote or prevent the evolution of the SPD from the APD and the government response to it.Chapter six analyses the models about the SPD in practice. At first the chapter introduces four kinds of typical model and their performance, including "separation between revenue and expenditure", "Pharmacy custody", "Pharmacy assisting" and "Pharmacy stripping". Then the differences and similarities of the models are summed up. Inside, the differences are that realization degrees are different; the similarities are that none of the models has gotten rid of the way dependence on "compensation for the medical cost through drug-selling profits". Finally, the paper think that the reason why the reform of the SPD is not radical is disequilibrium among interest groups. The disequilibrium among interest groups is owing to intrinsic characteristic and institutions flaw.Chapter seven illustrates the ideal model of the SPD and government functions in China. The chapter puts forward the ideal model and key problems of the SPD in China. The government functions in evolutionary process of the SPD are discussed, which are to improve related institutions of the SPD and establish qualifications for orderly game among interest groups. |
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