我国基本药物制度实施失效节点的多级递阶结构与治理策略研究

发布时间：2018-07-05 08:55

本文选题：基本药物制度 + 失效节点　；参考：《中国全科医学》2017年22期

【摘要】：目的构建我国基本药物制度实施失效节点的多级递阶结构模型,阐释各阶层的内在逻辑,从而为我国基本药物制度提供精准的治理策略。方法于2017年1月,参考既往研究范式和文献,借助4名卫生政策领域专家头脑风暴,筛选出我国基本药物制度实施环节的失效节点;采用解释结构模型法(ISM)分析各节点的层级关系和传导环路。结果共筛选出16个我国基本药物制度实施环节的失效节点,分别为:基本药物遴选目录;基本药物生产供应;基本药物采购配送;基本药物合理使用;基本药物价格管理;基本药物支付报销;基本药物质量安全;医生处方率;患者接受度;医院推行力度;监管体系;制度衔接;法律约束;筹资、补偿机制;激励机制;竞争环境。ISM分析结果显示,该16个失效节点存在1个四阶梯结构(分别命名为:输出终端、作业单元、协同联动、规则建设)和1条纵向传导环路;直接要素为医生处方率、患者接受度、医院推行力度,内隐要素为法律约束。我国基本药物制度实施受困于"规则建设缺失-协同机制失灵-作业实效欠佳-终端输出低效"四层环路的逐级影响。结论我国基本药物制度需要协同型综合改革,治理策略包括:健全基本药物制度需立法先行,形成全品种、全过程完整追溯与监管链条;借助基本药物制度配套机制的联动效应,发挥基本药物制度作业单元的执行实效,提升基本药物制度在终端的输出效率。
[Abstract]:Objective to construct a multilevel hierarchical structure model of the failure node of the essential drug system in China, and to explain the internal logic of each class, so as to provide a precise management strategy for the essential drug system in China. Methods in January 2017, referring to the previous research paradigm and literature, four experts in the field of health policy brainstorming were used to screen out the failure nodes in the implementation of the essential drug system in China. The analytic structure model (ISM) is used to analyze the hierarchical relationship and conduction loop of each node. Results A total of 16 ineffective nodes were selected for the implementation of the essential drugs system in China. They were: the selection catalogue of essential drugs, the production and supply of essential drugs, the purchase and distribution of essential drugs, the rational use of essential drugs, the price management of essential drugs; Essential drug payment reimbursement; essential drug quality and safety; doctor prescription rate; patient acceptance; hospital implementation; regulatory system; institutional convergence; legal constraints; financing, compensation mechanism; incentive mechanism; competitive environment. ISM analysis results show, The 16 failure nodes have a four-step structure (named output terminal, operation unit, cooperative linkage, rule building) and a longitudinal conduction loop. Implicit elements are legal constraints. The implementation of essential drug system in our country is trapped by the influence of the four-layer loop of "lack of rule building, failure of synergistic mechanism, poor effectiveness of operation and low efficiency of terminal output". Conclusion the system of essential drugs in our country needs synergistic comprehensive reform. The management strategies include: to perfect the system of essential drugs, to legislate first, to form the whole variety, to trace the whole process completely and to supervise the chain; With the help of the linkage effect of the matching mechanism of the essential drug system, the implementation effect of the operation unit of the essential drug system can be brought into play, and the output efficiency of the essential drug system in the terminal can be improved.
【作者单位】：牡丹江医学院卫生管理学院;牡丹江医学院药学院;哈尔滨医科大学卫生管理学院;哈尔滨医科大学药学院;哈尔滨医科大学附属肿瘤医院药学部;
【基金】：黑龙江省自然科学基金项目(G201411) 黑龙江省教育厅人文社会科学项目(12542298)
【分类号】：R95

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