江苏省世行卫十一项目县乡镇卫生院实施基本药物制度后的监测评价

发布时间：2018-09-09 14:22

【摘要】：目的：通过分析六个项目县乡镇卫生院在基本药物制度实施前后的经济运行、基本医疗服务提供行为(包括服务数量、效率、费用)、用药合理性的变化,发现基本药物实施效果与预期目标之间的差距,并进一步分析差距产生的原因,探讨影响基本药物实施效果的因素,提出进一步完善基本药物实施方案的政策建议,为深化我国医药卫生体制改革提供建议。方法：通过调查六个项目县卫生局卫生统计数据信息、卫生统计年鉴获得相关数据资料,对六个项目县实施基本药物制度的所有乡镇卫生院2009-2012年的基本医疗、财务收支状况以及人力资源情况的各项指标进行纵向趋势和同期横向的比较与分析。随机抽取两个项目县,每个项目县的乡镇卫生院采用分层抽样法,按经营状况最好、中等、最差分层,每层抽取1家卫生院。抽取上述六家样本乡镇卫生院基本药物实施前一年和基本药物实施后一年各100张处方,进行合理用药情况的研究。结果：江苏省项目县乡镇卫生院在基本药物制度实施后2012年与实施前2009年相比：①县均总收入、财政补助收入、业务收入与医疗收入均呈上升趋势。县均总收入增长67.89%,县均财政补助增长了542.55%,县均业务收入增长了11.36%,县均医疗收入增长了49.23%。药品收入占业务收入的比例有所下降,但药占比水平仍较高,超过51%。项目县县均总支出呈上升趋势,其中县均业务支出、医疗支出、药品支出均增加。从支出结构来看,医疗支出增长较快。收支结余中,县均总收支结余减小,业务收支亏损严重。药品收支结余大幅度下降。县均总负债从3556.20万元上升至6285.60万元。②县均基本医疗服务量增加,门急诊人次上升33.79%,出院人次上升4.39%。县均基本医疗服务费用有所下降,次均门诊费用下降10.19%,次均门诊药品费用下降21.43%,次均住院费用下降8.3%,次均住院药品费用下降19.92%。县均基本医疗服务效率则有所降低。③县均职工总数、人员支出、人员支出占业务收入的比例、人员支出占业务支出的比例、人均人员支出以及每职工平均业务收入都有所增加。④每张处方用药品种数、抗菌药物使用率、激素使用率、不合格处方率均有所下降。结论：江苏省六个项目县乡镇卫生院实施基本药物制度已经有一定成效,但仍然存在一定问题,表现为业务收支亏损严重,医疗服务效率下降,资产负债率上升,不合理用药情况依然严峻。建议继续加大政府财政投入,调整医疗服务收费价格,科学制定激励方案,建立国家基本药物制度的动态考核评价机制,加强合理用药的宣传与培训。
[Abstract]:Objective: to analyze the economic operation, the behavior (including the quantity, efficiency, cost) of the basic medical service supply and the change of the rationality of the drug use in the township health centers of six project counties before and after the implementation of the essential drug system. To find the gap between the implementation effect of essential drugs and the expected target, and to further analyze the causes of the gap, to explore the factors that affect the implementation effect of essential drugs, and to put forward policy recommendations to further improve the implementation scheme of essential drugs. To provide suggestions for deepening the reform of medical and health system in China. Methods: by investigating the health statistics data of six project county health bureaus and obtaining the relevant data from the health statistics yearbook, the basic medical treatment of all township health centers in the six project counties that implemented the essential drug system in 2009-2012 was analyzed. Financial income and expenditure as well as human resources indicators of the vertical trend and horizontal comparison and analysis of the same period. Two project counties were randomly selected. The township health centers in each project county adopted stratified sampling method. According to the best, middle and worst levels of management, one hospital was selected from each level. One year before and one year after the implementation of essential drugs, 100 prescriptions were taken from the above six sample township hospitals to study the rational use of drugs. Results: after the implementation of the essential drugs system in Jiangsu Province, the average income, financial subsidy income, business income and medical income of county 1 in 2012 were higher than those in 2009. The county average income increased by 67.89, the county average financial subsidy increased by 542.55, the county average business income increased by 11.36, and the county average medical income increased by 49.23. Drug revenue as a proportion of business income has declined, but the drug proportion level is still high, more than 51. The total expenditure of project county and county is on the rise, among which county average business expenditure, medical treatment expenditure and drug expenditure are all increasing. From the expenditure structure, medical expenditure growth is faster. In income and expenditure balance, county average income and expenditure balance decreases, business income and expenditure loss is serious. The balance of income and expenditure on drugs fell by a large margin. The average total debt of county increased from 35.562 million yuan to 62.856 million yuan. 2. The amount of basic medical service increased, the person-time of outpatient and emergency increased 33.79%, and the number of people discharged from hospital increased 4.39%. The cost of basic medical service decreased, the average outpatient cost decreased 10.19%, the average outpatient drug cost decreased 21.43%, the average hospitalization cost decreased 8.3%, and the average hospitalization drug cost decreased 19.92%. On the other hand, the efficiency of basic medical services at county level decreased to a certain extent. 3. The total number of staff and workers per county, the proportion of personnel expenditure to business income, and the proportion of personnel expenditure to business expenditure, The per capita personnel expenditure and the average business income per worker increased by 4. 4 per prescription variety, antimicrobial use rate, hormone use rate and unqualified prescription rate were all decreased. Conclusion: the implementation of the essential drugs system in the township hospitals of the six project counties in Jiangsu Province has achieved some results, but there are still some problems, such as the serious loss of business income and expenditure, the decline of medical service efficiency, and the increase of the ratio of assets and liabilities. Unreasonable use of drugs is still serious. It is suggested that the government should continue to increase government financial input, adjust the price of medical service charges, scientifically formulate incentive schemes, establish a dynamic assessment and evaluation mechanism of the national essential drug system, and strengthen the propaganda and training of rational use of drugs.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

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