國軍醫院與其他公立醫院藥品聯合招標採購模式之評估分析

背景：國軍醫院及其他公立醫院辦理藥品採購需遵守政府採購法等法規，為達統一採購、簡化流程及以量制價等目的，各體系醫院發展出具獨特性之藥品聯合招標採購制度以及為期最長2年之採購契約內容，使藥商因成本及履約責任考量而影響參與藥品聯合招標意願，最終造成部分藥品無法以聯合招標方式採購，無法達成統一採購及以量制價之原始目的。目的：藉由分析國軍醫院及其他公立醫院最近一屆藥品聯合招標採購制度、契約內容及採購效益之差異，評估影響藥品聯合招標決標之關鍵因素為何，作為日後國軍醫院或其他公立醫院辦理藥品聯標採購作業之修正參考方向。方法：收集101-102年間刊登於政府電子採購網及網際網路之「國軍體系」、「榮民體系」、「衛福部體系」及「北市聯醫體系」等4大體系醫院最近一屆已決標之藥品聯合招標資料，彙整共通性制度及契約項目內容，據以研擬出醫院人員及藥商人員觀點之結構式問卷，經問卷訪查後，進一步分析影響藥品聯合招標決標之關鍵因素。結果：研究結果顯示，醫院人員及藥商人員一致認為影響藥品聯合招標決標之關鍵因素為「藥品列標品項原則」、「同等品審查方式」、「合約期間過專利期藥品之列標處理方式」、「健保藥價調整時契約價金調整方式」、「價格投標方式及決標原則」、「併列決標家數原則」、「藥品優惠折讓條款」等七大項目。在藥品聯合招標最終目的方面，「高決標率」較「低決標價」重要。對醫院而言，大部分需求藥品能納入契約，達成以合理藥價統一採購藥品，簡化行政流程目的，對藥商而言，營運銷售之藥品多數列入公立體系醫院契約品項，使公司能維持業績，穩定獲利。結論：國軍醫院及其他公立醫院辦理藥品聯合招標時應審慎設計影響決標之關鍵因素內容，方能提高藥商參與藥品聯合招標意願，使多數藥品能決標納入採購契約項目，達成高決標率之最終目的，各醫院應跨體系標竿學習，以取得藥品聯合招標之最佳採購效益。

關鍵字

藥品聯合招標；採購契約；國軍醫院；公立醫院

並列摘要

Background: Armed forces hospitals and other public hospitals must obey the Government Procurement Act and other regulations to handle drug procurement. For these purposes of developing a unified procurement system, simplifying administration process and reducing costs, hospitals designed a unique drug joint tendering system and a two years maximum period procurement contract. Those may affect the intention of druggists to tender for drug joint tendering because of marketing costs and contract responsibilities. Finally, hospitals may be not able to procure some drug through drug joint tendering, nor to achieve the original purpose. Objective: In order to discover and improve key factors that affect contract awarding of drug joint tendering,we analyze drug joint tendering systems, procurement patterns, and contents of contracts among armed forces hospitals and other public hospitals. Methods: This study conducts by collecting and summarizing the common information of drug joint tendering systems and procurement contracts which published in the government e-procurement system or available on the internet in 2012-2013.The drug joint tendering systems include “Armed forces Hospitals System”, “Veterans Hospitals System”, “Ministry of Health and Welfare Hospitals System” and “Taipei City Hospitals System”. We develop structured questionnaire both in hospital version and druggist version. According to the data of the questionnaires, we survey and analysis the key factors that affect contract awarding of drug joint tendering. Results: The key factors that affect contract awarding of drug joint tendering are following 7 items: “Specification of Tendering Drugs”, “Examine of Drug Equivalency”, “Deal with Tendering Drugs will be off-patent during contract period ”, “Pattern of Contract Price Adjustment Following with NHI Drug Price Adjustment”, “Pattern of Price Tendering and Contract Awarding”, “Maximum Contract Awarding Tenderers of Generic Drug ”and “Discount Terms in Contract”. Most Hospitals and druggists believe “High Percentage of Contract Awarding” is more important than “Low Price of Contract Awarding”. Conclusions: Hospitals must carefully design key factors of drug joint tendering system and contract content to increase the tendering intention of druggists and achieve the purpose of high percentage of contract awarding. Different hospitals system should learn from each other to achieve the best procurement benefit of drug joint tendering.