作为全国首批医改试点省份,福建省积极推进药械采购改革,聚焦解决药械供应企业货款结算周期长的问题,于2017年探索建立药械货款医保代结算机制,由医保结算部门代医院向药械供应企业结算药品货款,逐步将结算范围从药品扩展到集采医用耗材,药械供应企业回款周期压缩至23个工作日内,打通药械货款结算堵点难点问题,消除企业资金垫付后顾之忧,有效优化营商环境,促进形成药械采购供应规范运行的良好生态。本文从政府治理、结构性改革和建立健全药械货款医保代结算制度三个维度出发,通过对福建省有关医疗机构和药械供应企业半结构式访谈和调研,总结分析福建省药械货款医保代结算制度改革的机制构建和运行效果。研究表明,福建省药械货款医保代结算制度改革通过政府主动作为,减少信息不对称和交易成本,各方利益主体都有所获益,缩短了药械供应企业的回款周期,打通了药品配送“最后一公里”,推动了医药产业高质量发展,是“三医”协同发展和治理的典型案例。

As one of the first pilot provinces for healthcare reform in China, Fujian Province has actively promoted reforms in the procurement of medical devices and drugs, focusing on addressing the issue of long payment settlement cycles for pharmaceutical companies. In 2017, Fujian Province explores the establishment of a medical insurance proxy settlement mechanism for medical device and drug payments. This mechanism involves the medical insurance settlement department acting as an intermediary to settle drug payments between hospitals and medical device and drug supply firms. The settlement scope gradually expanded from drugs to medical consumables of centralized procurement, compressing the payment recovery cycle for medical device and drug supply companies to within 23 working days. This reform has resolved bottlenecks and difficulties in the payment settlement process, alleviating concerns over advance payment for enterprises, effectively optimizing the business environment, and promoting the formation of a well-regulated procurement and supply ecosystem for medical devices and drugs. Based on dimensions of government governance, structural reform, and the establishment and improvement of the medical insurance settlement system, this study aims at analyzing the construction mechanism and operational effects of Fujian Province's reform through semi-structured interviews and surveys with pharmaceutical firms and medical equipment supply firms. The study indicates that Fujian Province's reform, by reducing information asymmetry and transaction costs through proactive government actions, benefits all stakeholders, shortens the payment recovery cycle for medical device and drug supply companies, resolves the "last mile" problem in logistics and promotes high-quality development of the pharmaceutical industry. This case exemplifies the coordinated development and regulation of medical insurance, medical services, and pharmaceuticals.