浦北县实施基本药物制度对居民基本医疗服务影响分析

发布时间：2018-06-08 13:16

本文选题：浦北县 + 基本药物制度　；参考：《安徽医科大学》2014年硕士论文

【摘要】：背景：随着时代的发展以及生活水平的不断提高,人们的健康意识也随之不断提高。因此,人们对基本医疗服务提出了更高的要求。为满足广大人民群众不断发展变化的医疗服务需要,我国积极的实行了基本药物制度政策。通过实行国家基本药物制度,可以有效保障和满足广大人民群众在基本医疗用药方面的实际需求,更好的保证基本医疗卫生活动的需要,促进基本医疗服务水平的稳步提高。但是,实施基本药物制度是一项十分复杂的系统工程,是对基层医疗卫生机构药品供应保障体系的根本性变革,同时对医疗机构和广大患者的用药行为产生深远影响。目的：探讨基本药物制度在浦北县的施行情况,提出切实可行的浦北县基本药物制度改革的措施,更好的提高广大居民的基本医疗服务水平。方法：2014年3月至6月,从浦北县下属的乡镇卫生院中随机选择13家,采用实地调研结合问卷调查的方式,对这13家乡镇卫生院2011年至2013年的基本药物制度实施情况进行了解,并通过对施行过程中存在问题进行探讨,掌握浦北县基本药物制度实施现状以及存在的具体问题。结果：2011至2013年,浦北县在实施基本药物制度之后,门急诊人次数方面呈现出逐年上升的明显变化,其中,2013年与2011年比较,人次数上升达到40%以上,两年的门急诊人次数比较差异有统计学意义(P0.05)。出院人数和实际占用床日数方面,从2011年到2013年,呈现出明显的下降情况。其中,较之2011年,下降了28%,较之2012年,下降了51%,经比较差异有统计学意义(均P0.05)。2013年,13家乡镇卫生院的门诊次均费用出现不同程度的降低,其中3家的下降幅度甚至超过40%以上。住院次均费用和住院床日平均费用随着年份的变化,呈现出不断增加的情况,尤其是住院次均费用,出现明显的上涨。乡镇卫生院的的收入包括当地各级财政的补助以及自身业务的收入。2013年,较之之前的两年,在业务支出方面,13家乡镇卫生院均呈现出明显增加的情况,经比较差异有统计学意义(均P0.05)。且2011年支出总额增加达到2200万元以上,增幅达到36%,年均增长也达到15%以上。2011年,5家在财务方面出现缺口。经过财政补贴,仍然有1家乡镇卫生院出现财政缺口。到了2013年,在财务方面出现缺口的乡镇卫生院进一步增加,达到11家。结论：基本药物制度的实施过程中存在一定的问题,基层要积极的以基本药物制度为抓手,统筹推进综合改革,建立基层医疗卫生机构运行新机制,从而更好的维护广大人民群众的身体健康。
[Abstract]:Background: with the development of the times and the continuous improvement of living standards, people's health awareness has been improved. Therefore, people put forward higher request to basic medical service. In order to meet the changing needs of medical services, China has actively implemented the policy of essential drugs system. Through the implementation of the national essential drug system, it can effectively guarantee and meet the actual needs of the broad masses in basic medical treatment and medication, better guarantee the needs of basic medical and health care activities, and promote the steady improvement of the basic medical service level. However, the implementation of essential drug system is a very complex system engineering, it is a fundamental change in the drug supply and security system of primary medical and health institutions, and has a profound impact on the drug use behavior of medical institutions and patients. Objective: to explore the implementation of the essential drug system in Pubei County and put forward practical measures to improve the basic medical service level of the residents in Pubei County. Methods: from March to June 2014, 13 township health centers in Pubei County were randomly selected, and the implementation of essential drug system in 13 township health centers from 2011 to 2013 was investigated by field investigation and questionnaire survey. Through the discussion of the problems in the course of implementation, we can grasp the present situation of the implementation of the essential drugs system in Pubei County and the concrete problems. Results from 2011 to 2013, after the implementation of the essential drug system in Pubei County, the number of outpatient and emergency attendances increased significantly year by year. In 2013, compared with 2011, the number of visits increased by more than 40 percent. There was significant difference in the number of outpatient and emergency patients in two years (P 0.05). The number of discharged patients and the number of bed days actually occupied decreased significantly from 2011 to 2013. Among them, compared with 2011, there was a decrease of 28% and a decrease of 51% compared with 2012. The difference was statistically significant (P 0.05). In 2013, the average outpatient expenses of 13 township health centers decreased in varying degrees, of which 3 decreased by more than 40%. The average cost of hospitalization and the average cost of bed per day increased with the change of year, especially the average cost of hospitalization. The income of township health centers includes subsidies from local governments at all levels and income from their own operations. In 2013, compared with the previous two years, the 13 township health centers all showed a marked increase in business expenditure. The difference was statistically significant (all P 0.05). Total expenditure increased by more than 22 million yuan in 2011, an increase of 36 percent and an average annual growth rate of more than 15 percent. After financial subsidies, there is still a township health center financial gap. By 2013, the financial gap in the township health centers further increased to 11. Conclusion: there are some problems in the implementation of the essential drug system. The basic level should take the essential drug system as the starting point, carry out the comprehensive reform as a whole, and establish a new mechanism for the operation of the primary medical and health institutions. In order to better maintain the health of the general public.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

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