近日，国务院(yuan)(yuan)办(ban)公厅印发《关于完善公立医院(yuan)(yuan)药(yao)品集中采购工作的指(zhi)导(dao)意(yi)见》（以下简称《指(zhi)导(dao)意(yi)见》）。就此(ci)，记者采访了国务院(yuan)(yuan)医改办(ban)负责人。

　　问：《指导意(yi)见》出台的背景(jing)是什(shen)么？对进(jin)一步深化(hua)医改有什(shen)么重(zhong)要意(yi)义？

　　答：党的(de)(de)(de)(de)十八大开启了(le)全(quan)面(mian)(mian)深化医(yi)改(gai)(gai)(gai)的(de)(de)(de)(de)新(xin)阶段，习(xi)近平(ping)总(zong)书记(ji)强(qiang)调，改(gai)(gai)(gai)革已进(jin)(jin)(jin)入深水区，到了(le)一个(ge)新(xin)的(de)(de)(de)(de)历史关头，必(bi)须一鼓作(zuo)气、坚定不(bu)(bu)移，必(bi)须坚定信心、增(zeng)强(qiang)勇气，敢于(yu)啃硬(ying)骨头，敢于(yu)涉险滩，敢于(yu)向积(ji)存(cun)多年的(de)(de)(de)(de)顽瘴(zhang)痼疾开刀，坚决打好全(quan)面(mian)(mian)深化改(gai)(gai)(gai)革这(zhei)场攻坚战。完善药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)工(gong)作(zuo)是深化医(yi)药(yao)(yao)(yao)(yao)卫(wei)生体(ti)制改(gai)(gai)(gai)革的(de)(de)(de)(de)重要内容和(he)(he)关键环节。我国(guo)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)工(gong)作(zuo)起步(bu)于(yu)20世(shi)纪90年代，先后经(jing)历了(le)医(yi)院(yuan)分(fen)散采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)、依托营(ying)利性第三方(fang)中(zhong)介(jie)机构开展(zhan)以(yi)(yi)地(di)(di)(di)市(shi)(shi)为(wei)(wei)单(dan)(dan)位(wei)的(de)(de)(de)(de)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)，到建立政府主(zhu)导(dao)的(de)(de)(de)(de)非营(ying)利性省(sheng)级(ji)平(ping)台(tai)(tai)以(yi)(yi)省(sheng)（区、市(shi)(shi)）为(wei)(wei)单(dan)(dan)位(wei)的(de)(de)(de)(de)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)，再到新(xin)医(yi)改(gai)(gai)(gai)以(yi)(yi)来逐(zhu)步(bu)建立基(ji)层(ceng)(ceng)基(ji)本(ben)药(yao)(yao)(yao)(yao)物(wu)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)新(xin)机制等不(bu)(bu)同(tong)发展(zhan)阶段。实(shi)施(shi)(shi)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)联合(he)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)是国(guo)际惯(guan)例和(he)(he)通(tong)行(xing)(xing)做(zuo)法(fa)，坚持以(yi)(yi)省(sheng)（区、市(shi)(shi)）为(wei)(wei)单(dan)(dan)位(wei)的(de)(de)(de)(de)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)是联合(he)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)(de)一种形式。2006年以(yi)(yi)后，我国(guo)推行(xing)(xing)以(yi)(yi)省(sheng)（区、市(shi)(shi)）为(wei)(wei)单(dan)(dan)位(wei)的(de)(de)(de)(de)网(wang)上药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)，在(zai)规(gui)范药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)行(xing)(xing)为(wei)(wei)、保证药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)质(zhi)量和(he)(he)用药(yao)(yao)(yao)(yao)安全(quan)、降低药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)虚(xu)高(gao)价(jia)格(ge)、遏制医(yi)药(yao)(yao)(yao)(yao)购(gou)(gou)(gou)(gou)(gou)销领域不(bu)(bu)正之风等方(fang)面(mian)(mian)发挥(hui)了(le)积(ji)极作(zuo)用，特别是实(shi)施(shi)(shi)基(ji)本(ben)药(yao)(yao)(yao)(yao)物(wu)制度，构建基(ji)层(ceng)(ceng)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)新(xin)机制，取得(de)了(le)新(xin)突破(po)，人民群众得(de)到了(le)明显实(shi)惠，各(ge)(ge)地(di)(di)(di)也积(ji)累(lei)(lei)了(le)丰(feng)富(fu)经(jing)验(yan)。但是，由(you)于(yu)目前(qian)基(ji)层(ceng)(ceng)与公(gong)(gong)立医(yi)院(yuan)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)是“一个(ge)平(ping)台(tai)(tai)，两个(ge)办(ban)法(fa)”，医(yi)院(yuan)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)招标与采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)脱(tuo)节，部(bu)(bu)(bu)分(fen)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)价(jia)格(ge)虚(xu)高(gao)不(bu)(bu)下，药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)回扣、商业贿赂案(an)件频(pin)发等问(wen)题仍比较突出(chu)，社(she)会(hui)各(ge)(ge)界对此反(fan)映强(qiang)烈(lie)，改(gai)(gai)(gai)革和(he)(he)完善公(gong)(gong)立医(yi)院(yuan)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)办(ban)法(fa)势在(zai)必(bi)行(xing)(xing)。按(an)照中(zhong)央深化医(yi)改(gai)(gai)(gai)工(gong)作(zuo)的(de)(de)(de)(de)总(zong)体(ti)部(bu)(bu)(bu)署，国(guo)家卫(wei)生计生委会(hui)同(tong)有(you)关部(bu)(bu)(bu)门，全(quan)面(mian)(mian)评(ping)估(gu)各(ge)(ge)省(sheng)（区、市(shi)(shi)）药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)集(ji)中(zhong)招标采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)做(zuo)法(fa)，对存(cun)在(zai)的(de)(de)(de)(de)问(wen)题进(jin)(jin)(jin)行(xing)(xing)深入分(fen)析(xi)，并系(xi)统总(zong)结(jie)公(gong)(gong)立医(yi)院(yuan)综(zong)合(he)改(gai)(gai)(gai)革试点城市(shi)(shi)的(de)(de)(de)(de)有(you)益(yi)探(tan)索和(he)(he)基(ji)本(ben)药(yao)(yao)(yao)(yao)物(wu)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)积(ji)累(lei)(lei)的(de)(de)(de)(de)成(cheng)(cheng)功(gong)经(jing)验(yan)，学习(xi)借(jie)鉴国(guo)际药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)(de)通(tong)行(xing)(xing)做(zuo)法(fa)，反(fan)复征(zheng)求(qiu)了(le)地(di)(di)(di)方(fang)、医(yi)改(gai)(gai)(gai)成(cheng)(cheng)员单(dan)(dan)位(wei)和(he)(he)专家的(de)(de)(de)(de)意(yi)见(jian)(jian)，提出(chu)了(le)有(you)针对性的(de)(de)(de)(de)政策措(cuo)施(shi)(shi)，形成(cheng)(cheng)了(le)《指导(dao)意(yi)见(jian)(jian)》初稿。经(jing)国(guo)务院(yuan)医(yi)改(gai)(gai)(gai)办(ban)公(gong)(gong)室全(quan)体(ti)会(hui)议(yi)(yi)审(shen)议(yi)(yi)后，再次广泛征(zheng)求(qiu)有(you)关部(bu)(bu)(bu)门、各(ge)(ge)地(di)(di)(di)方(fang)、药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)生产(chan)流通(tong)企业、医(yi)疗(liao)机构、行(xing)(xing)业协(xie)会(hui)等多方(fang)面(mian)(mian)的(de)(de)(de)(de)意(yi)见(jian)(jian)，充分(fen)吸收采(cai)(cai)纳合(he)理性建议(yi)(yi)，进(jin)(jin)(jin)一步(bu)修改(gai)(gai)(gai)完善，形成(cheng)(cheng)《指导(dao)意(yi)见(jian)(jian)》送(song)审(shen)稿，经(jing)国(guo)务院(yuan)医(yi)改(gai)(gai)(gai)领导(dao)小组全(quan)体(ti)会(hui)议(yi)(yi)审(shen)议(yi)(yi)通(tong)过，2月9日经(jing)国(guo)务院(yuan)同(tong)意(yi)，以(yi)(yi)国(guo)务院(yuan)办(ban)公(gong)(gong)厅(ting)名义(yi)印(yin)发。

　　完善(shan)公(gong)(gong)立(li)医院(yuan)(yuan)药(yao)(yao)(yao)品(pin)(pin)集中(zhong)采(cai)购(gou)工(gong)作，有利于(yu)(yu)破除以药(yao)(yao)(yao)补医机制，加快公(gong)(gong)立(li)医院(yuan)(yuan)特别是县级(ji)公(gong)(gong)立(li)医院(yuan)(yuan)改革；有利于(yu)(yu)降(jiang)低(di)药(yao)(yao)(yao)品(pin)(pin)虚高价(jia)格，减轻人民群众(zhong)用(yong)药(yao)(yao)(yao)负担(dan)；有利于(yu)(yu)预防和(he)遏(e)制药(yao)(yao)(yao)品(pin)(pin)购(gou)销领(ling)域腐(fu)败行为，抵制商业贿(hui)赂；有利于(yu)(yu)推动药(yao)(yao)(yao)品(pin)(pin)生(sheng)产流(liu)通企业整(zheng)合(he)重组、公(gong)(gong)平竞争，促进医药(yao)(yao)(yao)产业健(jian)康(kang)发展(zhan)。《指导(dao)意见》的出台(tai)，对于(yu)(yu)加快公(gong)(gong)立(li)医院(yuan)(yuan)改革，规(gui)范药(yao)(yao)(yao)品(pin)(pin)流(liu)通秩序，完善(shan)国家药(yao)(yao)(yao)物政策，建立(li)健(jian)全以基本药(yao)(yao)(yao)物制度为基础的药(yao)(yao)(yao)品(pin)(pin)供(gong)应保障体系(xi)具有重要意义。

　　问(wen)：《指导意见》的总体考虑是(shi)什么？在完善药品采(cai)购方面有哪些创新举措和(he)亮点？

　　答：完善公(gong)立医院药品(pin)集中(zhong)采(cai)(cai)(cai)购(gou)工作的(de)总体思路(lu)是：全(quan)面贯彻落实党(dang)的(de)十八大和十八届二(er)中(zhong)、三中(zhong)、四(si)中(zhong)全(quan)会精神，按(an)照市场在资源配置(zhi)中(zhong)起决定性作用和更好发(fa)挥(hui)政府作用的(de)总要求，借(jie)鉴国际药品(pin)采(cai)(cai)(cai)购(gou)通行(xing)做(zuo)法，充分吸收基本药物采(cai)(cai)(cai)购(gou)经验，坚持以省(sheng)（区、市）为单(dan)位的(de)网上药品(pin)集中(zhong)采(cai)(cai)(cai)购(gou)方向，实行(xing)一个平(ping)台、上下联动、公(gong)开透明、分类(lei)采(cai)(cai)(cai)购(gou)，采(cai)(cai)(cai)取招生产企(qi)业(ye)、招采(cai)(cai)(cai)合一、量价(jia)挂钩(gou)、双信封制、全(quan)程监(jian)控(kong)等措施，加强对药品(pin)采(cai)(cai)(cai)购(gou)全(quan)过程综合监(jian)管，切(qie)实保障药品(pin)质量和供应。鼓(gu)励地方结合实际探索创新，进一步(bu)提高(gao)医院在药品(pin)采(cai)(cai)(cai)购(gou)中(zhong)的(de)参与度。

　　《指导意见》重(zhong)点围绕“招(zhao)什么、怎(zen)么招(zhao)，怎(zen)么配送，怎(zen)么结(jie)算，如何监(jian)管”等(deng)关键环节，提出了一系列有针(zhen)对(dui)性的(de)创新举措。一是(shi)实行(xing)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)分类采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)。对(dui)不(bu)同药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)分别采(cai)(cai)取(qu)招(zhao)标(biao)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)、谈判采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)、医(yi)院(yuan)直接采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)、定点生产等(deng)方式，保障药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供(gong)应(ying)，降(jiang)低(di)虚高价格。二是(shi)改(gai)进(jin)药(yao)(yao)(yao)款(kuan)(kuan)结(jie)算方式。鼓励(li)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)生产企(qi)(qi)业与医(yi)院(yuan)直接结(jie)算药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)货款(kuan)(kuan)，与配送企(qi)(qi)业结(jie)算配送费(fei)用，进(jin)一步减少中间环节。三是(shi)加强药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)配送管理。重(zhong)点保障偏远、交通不(bu)便(bian)地区的(de)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供(gong)应(ying)配送，鼓励(li)各(ge)地结(jie)合(he)实际探索(suo)县(xian)乡村一体化配送。四是(shi)规范采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)平台(tai)建设。拓展省级(ji)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)集中采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)平台(tai)功能，统一药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)编码，公开(kai)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)信息，实现药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)(cai)购(gou)(gou)(gou)(gou)(gou)数据共享和互(hu)联互(hu)通。五是(shi)强化综合(he)监(jian)督管理。严肃查处医(yi)院(yuan)和药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)生产经(jing)营(ying)企(qi)(qi)业违(wei)(wei)法(fa)违(wei)(wei)规行(xing)为。

　　问：《指(zhi)导意见》提出实(shi)施(shi)药品(pin)分类采购，具体包括(kuo)哪(na)些(xie)内容？

　　答：分类采(cai)(cai)(cai)购(gou)主要针对(dui)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)供(gong)应采(cai)(cai)(cai)取(qu)招标采(cai)(cai)(cai)购(gou)、谈判(pan)采(cai)(cai)(cai)购(gou)、医院(yuan)直接采(cai)(cai)(cai)购(gou)、定点(dian)生产(chan)、特殊(shu)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)采(cai)(cai)(cai)购(gou)等不同方式。一是对(dui)临床(chuang)(chuang)用(yong)量(liang)大、采(cai)(cai)(cai)购(gou)金额高(gao)、多(duo)家(jia)(jia)企业(ye)生产(chan)的基(ji)(ji)本(ben)药(yao)(yao)(yao)(yao)物和(he)非(fei)专(zhuan)(zhuan)利(li)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)，采(cai)(cai)(cai)取(qu)双信封制(zhi)公开(kai)(kai)招标采(cai)(cai)(cai)购(gou)。同时，对(dui)竞(jing)标价(jia)格明(ming)显偏低(di)(di)、可(ke)能存在质量(liang)和(he)供(gong)应风险的药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)，必须(xu)进(jin)行综(zong)合评(ping)估(gu)，避免(mian)恶性(xing)竞(jing)争。二是对(dui)部分专(zhuan)(zhuan)利(li)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、独家(jia)(jia)生产(chan)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)，建(jian)立公开(kai)(kai)透明(ming)、多(duo)方参与的价(jia)格谈判(pan)机制(zhi)，合理降低(di)(di)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)价(jia)格。建(jian)立国家(jia)(jia)谈判(pan)机制(zhi)是一项全新工作，目(mu)前正在研究制(zhi)订谈判(pan)办法。三是对(dui)妇儿专(zhuan)(zhuan)科(ke)非(fei)专(zhuan)(zhuan)利(li)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、急（抢）救(jiu)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、基(ji)(ji)础输液、临床(chuang)(chuang)用(yong)量(liang)小的药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)和(he)常用(yong)低(di)(di)价(jia)药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)，实行集(ji)中挂网，由医院(yuan)直接采(cai)(cai)(cai)购(gou)。四是对(dui)临床(chuang)(chuang)必需、用(yong)量(liang)小、市场供(gong)应短缺的药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)，由国家(jia)(jia)招标定点(dian)生产(chan)、议价(jia)采(cai)(cai)(cai)购(gou)。五是对(dui)麻(ma)醉药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、精神药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、防治传染病(bing)和(he)寄生虫病(bing)的免(mian)费用(yong)药(yao)(yao)(yao)(yao)、国家(jia)(jia)免(mian)疫规划用(yong)疫苗、计划生育药(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)及中药(yao)(yao)(yao)(yao)饮片，按国家(jia)(jia)现行规定采(cai)(cai)(cai)购(gou)。

　问：如(ru)何确(que)保药品(pin)采购(gou)工作在阳(yang)光(guang)下运行？

　　答：《指(zhi)导意(yi)见(jian)》在强(qiang)化综合监(jian)督(du)管理方(fang)面，采(cai)取(qu)了多项有针(zhen)对性的(de)具体措施。一是(shi)建(jian)立处方(fang)点(dian)评(ping)和(he)(he)医师(shi)约谈制(zhi)度，发挥药(yao)(yao)(yao)师(shi)的(de)用药(yao)(yao)(yao)指(zhi)导作(zuo)用，规范(fan)医生处方(fang)行(xing)(xing)(xing)(xing)为(wei)(wei)。重(zhong)(zhong)点(dian)跟踪监(jian)控辅(fu)助用药(yao)(yao)(yao)、医院(yuan)超(chao)常使用的(de)药(yao)(yao)(yao)品(pin)(pin)。建(jian)立健(jian)全以基本药(yao)(yao)(yao)物为(wei)(wei)重(zhong)(zhong)点(dian)的(de)临床用药(yao)(yao)(yao)综合评(ping)价体系，推进(jin)药(yao)(yao)(yao)品(pin)(pin)剂型、规格(ge)(ge)、包装标(biao)(biao)准(zhun)化。二是(shi)将药(yao)(yao)(yao)品(pin)(pin)集中采(cai)购(gou)情况作(zuo)为(wei)(wei)医院(yuan)及(ji)(ji)其负责人的(de)重(zhong)(zhong)要考核内容，纳(na)入(ru)目标(biao)(biao)管理及(ji)(ji)医院(yuan)评(ping)审评(ping)价工作(zuo)。对医院(yuan)违规网下采(cai)购(gou)、拖延货款的(de)，视情节轻重(zhong)(zhong)给予(yu)通(tong)报批评(ping)、限期整改、责令支(zhi)付违约金、降低等级等处理。涉及(ji)(ji)商业(ye)(ye)贿赂等腐败(bai)行(xing)(xing)(xing)(xing)为(wei)(wei)的(de)，依法(fa)严(yan)肃查(cha)(cha)处。三是(shi)加(jia)强(qiang)对药(yao)(yao)(yao)品(pin)(pin)价格(ge)(ge)执行(xing)(xing)(xing)(xing)情况的(de)监(jian)督(du)检查(cha)(cha)，强(qiang)化药(yao)(yao)(yao)品(pin)(pin)成(cheng)本调查(cha)(cha)和(he)(he)市(shi)场购(gou)销价格(ge)(ge)监(jian)测，规范(fan)价格(ge)(ge)行(xing)(xing)(xing)(xing)为(wei)(wei)，保护患者合法(fa)权益。依法(fa)严(yan)肃查(cha)(cha)处价格(ge)(ge)违法(fa)和(he)(he)垄(long)断行(xing)(xing)(xing)(xing)为(wei)(wei)，及(ji)(ji)伪(wei)(wei)造或虚开发票、挂靠经(jing)营(ying)、“走票”等违法(fa)行(xing)(xing)(xing)(xing)为(wei)(wei)。强(qiang)化重(zhong)(zhong)点(dian)药(yao)(yao)(yao)品(pin)(pin)质量追踪和(he)(he)全程质量监(jian)管，严(yan)厉打击(ji)制(zhi)售假冒伪(wei)(wei)劣药(yao)(yao)(yao)品(pin)(pin)行(xing)(xing)(xing)(xing)为(wei)(wei)。四是(shi)严(yan)格(ge)(ge)执行(xing)(xing)(xing)(xing)诚(cheng)信记(ji)(ji)录(lu)(lu)(lu)和(he)(he)市(shi)场清退制(zhi)度。各地(di)都要建(jian)立药(yao)(yao)(yao)品(pin)(pin)生产经(jing)营(ying)企业(ye)(ye)诚(cheng)信记(ji)(ji)录(lu)(lu)(lu)并及(ji)(ji)时公布。五是(shi)省级药(yao)(yao)(yao)品(pin)(pin)集中采(cai)购(gou)平台及(ji)(ji)时收集药(yao)(yao)(yao)品(pin)(pin)采(cai)购(gou)信息、药(yao)(yao)(yao)品(pin)(pin)生产经(jing)营(ying)企业(ye)(ye)配送到位率(lv)、不良记(ji)(ji)录(lu)(lu)(lu)等，定期向社(she)会公布。

　　《指导意见》还提出要坚持全(quan)国统一市(shi)场(chang)，维护公平竞争环境，反(fan)对各(ge)种形式(shi)的地方保(bao)(bao)护。同时，要全(quan)面推进信息(xi)公开，建立有(you)奖举报制度，自觉接受人大、政协和社会各(ge)界监督，确(que)保(bao)(bao)药品采购各(ge)环节在阳光下运行。

　　问：《指导意见》对药品集中(zhong)采购平台规范化建设(she)有哪些具体要求？

　　答(da)：规(gui)范(fan)化的(de)(de)(de)药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)是完(wan)善药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)工(gong)作的(de)(de)(de)关键环节和(he)重(zhong)要(yao)支(zhi)撑。各(ge)(ge)省(sheng)（区(qu)、市）数据是十分(fen)宝贵(gui)的(de)(de)(de)资源，离开平(ping)(ping)台(tai)(tai)和(he)数据，采(cai)购(gou)(gou)就是无源之水。目(mu)前，各(ge)(ge)地药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)还(hai)缺乏统(tong)一的(de)(de)(de)建设标(biao)准、统(tong)一的(de)(de)(de)功能(neng)(neng)规(gui)范(fan)、统(tong)一的(de)(de)(de)采(cai)购(gou)(gou)编(bian)码，国(guo)家与省(sheng)之间(jian)、省(sheng)际之间(jian)还(hai)没有全部(bu)联(lian)网，因此，《指(zhi)导意见》对规(gui)范(fan)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)建设提(ti)出(chu)了明(ming)确的(de)(de)(de)具(ju)体要(yao)求。一是实(shi)现(xian)互(hu)(hu)联(lian)互(hu)(hu)通。2014年国(guo)家已(yi)启(qi)动药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)供应保障综合管(guan)(guan)理(li)信息系(xi)统(tong)建设，将统(tong)一省(sheng)级药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)规(gui)范(fan)化建设标(biao)准，推动药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)采(cai)购(gou)(gou)编(bian)码标(biao)准化，目(mu)前已(yi)与天津等5个省(sheng)（区(qu)、市）初步实(shi)现(xian)了上下传输，今(jin)年要(yao)加快进度实(shi)现(xian)所(suo)有省(sheng)份互(hu)(hu)联(lian)互(hu)(hu)通、资源共享(xiang)。二是拓展平(ping)(ping)台(tai)(tai)功能(neng)(neng)。省(sheng)级药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)要(yao)面(mian)向(xiang)各(ge)(ge)级医(yi)院(yuan)(yuan)和(he)药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)生(sheng)产经营(ying)(ying)企业提(ti)供优质服(fu)务，提(ti)高(gao)在药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)招标(biao)采(cai)购(gou)(gou)、配送(song)管(guan)(guan)理(li)、结算、评价、统(tong)计分(fen)析、动态监(jian)管(guan)(guan)等方面(mian)的(de)(de)(de)能(neng)(neng)力(li)。三是推进信息公(gong)开。定期向(xiang)社会(hui)公(gong)布医(yi)院(yuan)(yuan)药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)采(cai)购(gou)(gou)价格、数量、回(hui)款时间(jian)、每家医(yi)院(yuan)(yuan)的(de)(de)(de)配送(song)企业名(ming)单及(ji)药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)生(sheng)产经营(ying)(ying)企业配送(song)到位(wei)率(lv)、不良记录等，接受(shou)社会(hui)监(jian)督。四是落实(shi)责(ze)任分(fen)工(gong)。维(wei)护政府主导、非(fei)营(ying)(ying)利性的(de)(de)(de)药(yao)(yao)(yao)(yao)(yao)品(pin)(pin)集(ji)中(zhong)(zhong)采(cai)购(gou)(gou)平(ping)(ping)台(tai)(tai)的(de)(de)(de)公(gong)益性质，省(sheng)级人(ren)民政府要(yao)给予必要(yao)的(de)(de)(de)人(ren)力(li)、财力(li)、物力(li)支(zhi)持，这项工(gong)作只能(neng)(neng)加强不能(neng)(neng)削(xue)弱。

　　问：《指导意见》在哪些方面鼓励地方探索创新(xin)？

　　答：我(wo)国幅员辽阔，地(di)域(yu)差异明显，改革(ge)需要在(zai)实(shi)(shi)践中(zhong)(zhong)(zhong)(zhong)不断探索(suo)、积累经验。《指导(dao)意见(jian)》强(qiang)(qiang)调用(yong)“四个有(you)利于(yu)”来检验公(gong)立医(yi)(yi)(yi)(yi)院药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)工作的(de)(de)成(cheng)效，鼓(gu)励(li)各地(di)结(jie)(jie)合(he)(he)(he)实(shi)(shi)际(ji)，探索(suo)创新(xin)(xin)。一是坚持以(yi)省(sheng)(sheng)（区(qu)、市(shi)(shi)）为单位的(de)(de)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)，鼓(gu)励(li)省(sheng)(sheng)际(ji)跨区(qu)域(yu)、专(zhuan)科医(yi)(yi)(yi)(yi)院联合(he)(he)(he)采(cai)购(gou)。也允许(xu)(xu)各地(di)结(jie)(jie)合(he)(he)(he)实(shi)(shi)际(ji)，按照“四个有(you)利于(yu)”原则探索(suo)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)的(de)(de)多种形式。二是采(cai)取(qu)统筹兼顾(gu)，放管结(jie)(jie)合(he)(he)(he)，外加推力，内增活(huo)力的(de)(de)策略，对(dui)公(gong)立医(yi)(yi)(yi)(yi)院改革(ge)试点(dian)城市(shi)(shi)，允许(xu)(xu)以(yi)市(shi)(shi)为单位在(zai)省(sheng)(sheng)级药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)平(ping)台上(shang)自行采(cai)购(gou)，公(gong)开交(jiao)(jiao)易，成(cheng)交(jiao)(jiao)价(jia)(jia)格(ge)(ge)(ge)不得高于(yu)省(sheng)(sheng)级中(zhong)(zhong)(zhong)(zhong)标(biao)价(jia)(jia)格(ge)(ge)(ge)。如果试点(dian)城市(shi)(shi)成(cheng)交(jiao)(jiao)价(jia)(jia)格(ge)(ge)(ge)明显低于(yu)省(sheng)(sheng)级中(zhong)(zhong)(zhong)(zhong)标(biao)价(jia)(jia)格(ge)(ge)(ge)，省(sheng)(sheng)级中(zhong)(zhong)(zhong)(zhong)标(biao)价(jia)(jia)格(ge)(ge)(ge)应按试点(dian)城市(shi)(shi)成(cheng)交(jiao)(jiao)价(jia)(jia)格(ge)(ge)(ge)调整(zheng)。由各地(di)根(gen)据实(shi)(shi)际(ji)情况制定具体(ti)(ti)办法。三是鼓(gu)励(li)各地(di)利用(yong)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)平(ping)台签订电子合(he)(he)(he)同、在(zai)线支(zhi)(zhi)付(fu)、集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)结(jie)(jie)算(suan)，保障购(gou)销公(gong)平(ping)、及(ji)时供(gong)应、及(ji)时支(zhi)(zhi)付(fu)。四是坚持上(shang)下联动，整(zheng)合(he)(he)(he)医(yi)(yi)(yi)(yi)院与(yu)基层药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)供(gong)应配(pei)(pei)送(song)服务，鼓(gu)励(li)各地(di)远近结(jie)(jie)合(he)(he)(he)、城乡联动，探索(suo)县乡村一体(ti)(ti)化(hua)配(pei)(pei)送(song)，提高采(cai)购(gou)、配(pei)(pei)送(song)集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)度，切实(shi)(shi)保障偏远、交(jiao)(jiao)通不便地(di)区(qu)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)配(pei)(pei)送(song)。五是强(qiang)(qiang)化(hua)生产(chan)企(qi)业主体(ti)(ti)责(ze)任，鼓(gu)励(li)生产(chan)企(qi)业与(yu)医(yi)(yi)(yi)(yi)院直(zhi)接结(jie)(jie)算(suan)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)货款，与(yu)配(pei)(pei)送(song)企(qi)业直(zhi)接结(jie)(jie)算(suan)配(pei)(pei)送(song)费用(yong)。六是鼓(gu)励(li)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)研(yan)发创新(xin)(xin)，允许(xu)(xu)各地(di)对(dui)采(cai)购(gou)周期(qi)内新(xin)(xin)批准(zhun)上(shang)市(shi)(shi)的(de)(de)药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)另行组织集(ji)(ji)(ji)中(zhong)(zhong)(zhong)(zhong)采(cai)购(gou)，避免药(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)研(yan)发新(xin)(xin)药(yao)(yao)(yao)上(shang)市(shi)(shi)与(yu)临床使用(yong)脱(tuo)节、影(ying)响患(huan)者就医(yi)(yi)(yi)(yi)用(yong)药(yao)(yao)(yao)实(shi)(shi)际(ji)问题。

　　问：《指(zhi)导意(yi)见(jian)》的出台能产生哪(na)些惠民实效？

　　答：完善公立医(yi)院(yuan)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)集中(zhong)采(cai)购(gou)政策是(shi)健全(quan)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供应保(bao)(bao)障(zhang)体(ti)系(xi)的(de)(de)(de)一(yi)项重(zhong)大(da)改革(ge)举措，《指导(dao)意(yi)见(jian)》的(de)(de)(de)实(shi)(shi)施(shi)(shi)将(jiang)会释放更(geng)多(duo)的(de)(de)(de)改革(ge)红利，让人民群(qun)众得到(dao)更(geng)多(duo)的(de)(de)(de)用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)实(shi)(shi)惠。一(yi)是(shi)降低(di)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)价格(ge)(ge)，减轻患(huan)者负担。通过不同(tong)(tong)采(cai)购(gou)方(fang)式，促进市(shi)(shi)(shi)场充(chong)分竞争，将(jiang)有效降低(di)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)虚(xu)高的(de)(de)(de)价格(ge)(ge)。通过规范临床(chuang)(chuang)用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)行(xing)(xing)(xing)(xing)为(wei)，降低(di)门诊和住院(yuan)次均(jun)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)费，可(ke)以(yi)减少(shao)医(yi)保(bao)(bao)基金和人民群(qun)众药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)费支出(chu)。二是(shi)保(bao)(bao)证药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)质(zhi)量(liang)(liang)，强调用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)全(quan)。《指导(dao)意(yi)见(jian)》明确将(jiang)《药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)生产质(zhi)量(liang)(liang)管(guan)理规范（2010年(nian)修订）》（GMP）认证标准，相关(guan)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)在发(fa)达国家（地区(qu)）上市(shi)(shi)(shi)准入(ru)情况，适宜的(de)(de)(de)剂型(xing)、规格(ge)(ge)、包装作为(wei)重(zhong)要评(ping)价指标，鼓励优(you)先(xian)采(cai)购(gou)达到(dao)国际水平(ping)的(de)(de)(de)仿制(zhi)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，加(jia)强药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)质(zhi)量(liang)(liang)追(zhui)踪和全(quan)程(cheng)质(zhi)量(liang)(liang)监(jian)(jian)管(guan)，进一(yi)步降低(di)了(le)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)购(gou)的(de)(de)(de)安(an)(an)全(quan)性(xing)风险。三是(shi)保(bao)(bao)障(zhang)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供应，满足(zu)用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)需(xu)求(qiu)。在保(bao)(bao)障(zhang)大(da)多(duo)数临床(chuang)(chuang)常(chang)(chang)见(jian)疾病用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)需(xu)求(qiu)的(de)(de)(de)同(tong)(tong)时，强化短(duan)(duan)缺药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)监(jian)(jian)测和预警(jing)，对(dui)常(chang)(chang)用(yong)(yong)(yong)(yong)低(di)价药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)、妇儿专(zhuan)科、急（抢）救药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)取(qu)相应的(de)(de)(de)政策措施(shi)(shi)。同(tong)(tong)时，为(wei)了(le)缓(huan)解临床(chuang)(chuang)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供应短(duan)(duan)缺问题，提(ti)高药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)公平(ping)性(xing)可(ke)及性(xing)，我们还研究印发(fa)了(le)《关(guan)于(yu)做好(hao)(hao)(hao)(hao)常(chang)(chang)用(yong)(yong)(yong)(yong)低(di)价药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)供应保(bao)(bao)障(zhang)工(gong)作的(de)(de)(de)意(yi)见(jian)》、《关(guan)于(yu)对(dui)用(yong)(yong)(yong)(yong)量(liang)(liang)小临床(chuang)(chuang)必(bi)需(xu)的(de)(de)(de)基本药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物品(pin)(pin)(pin)(pin)种实(shi)(shi)行(xing)(xing)(xing)(xing)定点生产试点的(de)(de)(de)实(shi)(shi)施(shi)(shi)方(fang)案》、《关(guan)于(yu)保(bao)(bao)障(zhang)儿童(tong)用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)若(ruo)干意(yi)见(jian)》等(deng)(deng)一(yi)系(xi)列配套文件(jian)，更(geng)好(hao)(hao)(hao)(hao)地满足(zu)群(qun)众基本用(yong)(yong)(yong)(yong)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)需(xu)求(qiu)。四是(shi)遏制(zhi)腐(fu)败(bai)行(xing)(xing)(xing)(xing)为(wei)，扭(niu)转(zhuan)(zhuan)行(xing)(xing)(xing)(xing)业(ye)(ye)风气(qi)。实(shi)(shi)施(shi)(shi)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)集中(zhong)采(cai)购(gou)，全(quan)面推进信息公开，对(dui)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)招标、采(cai)购(gou)、配送、使(shi)用(yong)(yong)(yong)(yong)、结算等(deng)(deng)各环节加(jia)强综(zong)合监(jian)(jian)督管(guan)理，接受(shou)社会各界(jie)监(jian)(jian)督，有利于(yu)预防和遏制(zhi)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)购(gou)销领域腐(fu)败(bai)行(xing)(xing)(xing)(xing)为(wei)，抵制(zhi)商业(ye)(ye)贿(hui)赂(lu)。同(tong)(tong)时，加(jia)强医(yi)德医(yi)风建设，强化药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)采(cai)购(gou)机构、医(yi)院(yuan)和生产经营(ying)企业(ye)(ye)等(deng)(deng)相关(guan)主体(ti)的(de)(de)(de)责任(ren)，针对(dui)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)质(zhi)量(liang)(liang)、价格(ge)(ge)等(deng)(deng)方(fang)面的(de)(de)(de)违法违规行(xing)(xing)(xing)(xing)为(wei)建立严格(ge)(ge)的(de)(de)(de)惩处机制(zhi)，有利于(yu)扭(niu)转(zhuan)(zhuan)行(xing)(xing)(xing)(xing)业(ye)(ye)风气(qi)，更(geng)好(hao)(hao)(hao)(hao)的(de)(de)(de)维护(hu)药(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)生产流通市(shi)(shi)(shi)场良(liang)好(hao)(hao)(hao)(hao)秩序。

　　问：《指导意(yi)见(jian)》提出的各项政策措施如(ru)何(he)才能得到有效落(luo)实？

　　答：药(yao)品采(cai)(cai)购(gou)(gou)是公(gong)立医(yi)(yi)院(yuan)改(gai)革(ge)(ge)(ge)(ge)的(de)(de)重要(yao)(yao)(yao)(yao)(yao)环节，也是药(yao)品生产流通领域改(gai)革(ge)(ge)(ge)(ge)的(de)(de)重要(yao)(yao)(yao)(yao)(yao)内(nei)(nei)容，同(tong)时(shi)又是多方利(li)(li)益博弈的(de)(de)焦点领域。改(gai)革(ge)(ge)(ge)(ge)现行的(de)(de)采(cai)(cai)购(gou)(gou)办法，必然触动(dong)现有(you)(you)的(de)(de)利(li)(li)益格局(ju)，是一块难啃的(de)(de)硬骨头。特别是公(gong)立医(yi)(yi)院(yuan)药(yao)品集(ji)中(zhong)(zhong)采(cai)(cai)购(gou)(gou)工作政(zheng)(zheng)策(ce)性强(qiang)(qiang)，涉(she)(she)及(ji)面(mian)宽，有(you)(you)些分(fen)类(lei)采(cai)(cai)购(gou)(gou)政(zheng)(zheng)策(ce)措施(shi)还(hai)要(yao)(yao)(yao)(yao)(yao)在实(shi)(shi)践中(zhong)(zhong)不断(duan)完善(shan)。为此，《指导(dao)意(yi)见(jian)》对各(ge)地各(ge)部(bu)(bu)门(men)(men)贯彻(che)落(luo)实(shi)(shi)提出了明(ming)确(que)的(de)(de)工作要(yao)(yao)(yao)(yao)(yao)求(qiu)。一要(yao)(yao)(yao)(yao)(yao)加(jia)强(qiang)(qiang)培训(xun)，加(jia)快组织实(shi)(shi)施(shi)。要(yao)(yao)(yao)(yao)(yao)求(qiu)各(ge)地抓紧组织学习贯彻(che)，抓紧研(yan)究制(zhi)定本地公(gong)立医(yi)(yi)院(yuan)药(yao)品集(ji)中(zhong)(zhong)采(cai)(cai)购(gou)(gou)实(shi)(shi)施(shi)方案，明(ming)确(que)时(shi)间进(jin)度(du)表和技(ji)术(shu)路线图(tu)，确(que)保2015年(nian)全(quan)面(mian)启动(dong)新一轮(lun)药(yao)品采(cai)(cai)购(gou)(gou)。二要(yao)(yao)(yao)(yao)(yao)明(ming)确(que)责任，防(fang)范廉政(zheng)(zheng)风险。各(ge)地要(yao)(yao)(yao)(yao)(yao)加(jia)强(qiang)(qiang)组织领导(dao)和督(du)导(dao)评估，及(ji)时(shi)研(yan)究解(jie)决药(yao)品集(ji)中(zhong)(zhong)采(cai)(cai)购(gou)(gou)工作中(zhong)(zhong)的(de)(de)重大问题，妥善(shan)回应社会关(guan)切。有(you)(you)关(guan)部(bu)(bu)门(men)(men)要(yao)(yao)(yao)(yao)(yao)各(ge)司其职，密切配合，形(xing)成(cheng)合力。要(yao)(yao)(yao)(yao)(yao)建立权力运行监控机制(zhi)，加(jia)强(qiang)(qiang)内(nei)(nei)部(bu)(bu)制(zhi)约和外部(bu)(bu)监督(du)，强(qiang)(qiang)化廉政(zheng)(zheng)风险防(fang)控。三要(yao)(yao)(yao)(yao)(yao)着(zhe)眼(yan)全(quan)局(ju)，统筹推(tui)(tui)进(jin)改(gai)革(ge)(ge)(ge)(ge)。药(yao)品集(ji)中(zhong)(zhong)采(cai)(cai)购(gou)(gou)工作涉(she)(she)及(ji)多方利(li)(li)益调整，牵一发而动(dong)全(quan)身(shen)，要(yao)(yao)(yao)(yao)(yao)处理好(hao)整体(ti)推(tui)(tui)进(jin)和重点突破的(de)(de)关(guan)系(xi)，必须坚(jian)持医(yi)(yi)保、医(yi)(yi)疗、医(yi)(yi)药(yao)“三医(yi)(yi)联动(dong)”，增(zeng)强(qiang)(qiang)改(gai)革(ge)(ge)(ge)(ge)的(de)(de)整体(ti)性、系(xi)统性和协(xie)同(tong)性，注重推(tui)(tui)动(dong)各(ge)项改(gai)革(ge)(ge)(ge)(ge)相互促进(jin)、良性互动(dong)、协(xie)同(tong)配合，形(xing)成(cheng)推(tui)(tui)进(jin)改(gai)革(ge)(ge)(ge)(ge)的(de)(de)强(qiang)(qiang)大合力，确(que)保各(ge)项政(zheng)(zheng)策(ce)措施(shi)落(luo)到实(shi)(shi)处，取得实(shi)(shi)效。要(yao)(yao)(yao)(yao)(yao)防(fang)止畸重畸轻、单兵突进(jin)、顾此失彼。四要(yao)(yao)(yao)(yao)(yao)凝聚(ju)共识，加(jia)强(qiang)(qiang)宣(xuan)传(chuan)引导(dao)。各(ge)地各(ge)有(you)(you)关(guan)部(bu)(bu)门(men)(men)要(yao)(yao)(yao)(yao)(yao)坚(jian)持正(zheng)确(que)导(dao)向，加(jia)强(qiang)(qiang)政(zheng)(zheng)策(ce)解(jie)读和舆论引导(dao)，凝聚(ju)改(gai)革(ge)(ge)(ge)(ge)共识，营造良好(hao)社会氛围。