国家基本药物制度实施对某省乡镇卫生院卫生服务行为及运营状况的影响评价

发布时间：2019-07-22 12:43

【摘要】：目的:为推动乡镇卫生院进一步实施国家基本药物制度提供依据。方法:采用随机系统整群抽样方法抽取某省5%的乡镇卫生院为样本,通过发放调查表获取其国家基本药物制度实施前(2009、2010年)和实施后(2011-2013年)的卫生资源配置情况、卫生服务情况、收支情况等,进行统计、对比和评价。结果:本次共调查了46个乡镇卫生院,回收乡镇卫生院机构调查表46份。样本乡镇卫生院平均床位数由2009年的15.1张增加到2013年的19.4张。年度平均门诊量由2009年的1.12万人次上升到2013年的1.61万人次,年度平均出院人次由2009年的644人次增加到2013年的924人次。政府财政投入占总收入比例由2009年的25.9%上升到2013年的47.1%,药品收入占总收入比例由54.9%下降到29.7%,药品利润率由25.5%下降到3.7%,收支结余亏损比例由17.4%下降到4.3%。辖区人口年平均到乡镇卫生院就诊次数从2009年的0.47次增加到2013年的0.74次,次均住院和门诊药品费用分别由805和28.1元下降到718和24.1元。结论:国家基本药物制度实施对门诊服务未产生消极影响,对住院服务利用则产生了一定的抑制作用。国家基本药物制度的实施有效地降低了药品经济负担,但是卫生总负担却没有下降。这表明单一依靠推行国家基本药物制度来控制过快上涨的卫生费用是难以实现的,需要医药卫生的综合改革、协同、联动,才能有效缓解"看病贵"的问题。
[Abstract]:Objective: to provide the basis for promoting the further implementation of the national essential drug system in township health centers. Methods: 5% township health centers in a province were taken as samples by random system cluster sampling, and the allocation of health resources, health services and income and expenditure before and after the implementation of the national basic drug system (2009, 2010) and after the implementation (2011-2013) were obtained by questionnaire, and the statistics, comparison and evaluation were carried out. Results: a total of 46 township health centers were investigated and 46 questionnaires were recovered. The average number of beds in the sample township health centers increased from 15.1 in 2009 to 19.4 in 2013. The average annual number of out-patient visits increased from 11200 in 2009 to 16100 in 2013, and the average annual discharge increased from 644 in 2009 to 924 in 2013. The proportion of government financial investment in total income increased from 25.9% in 2009 to 47.1% in 2013, the proportion of drug revenue in total income decreased from 54.9% to 29.7%, the profit margin of drugs decreased from 25.5% to 3.7%, and the proportion of income and expenditure balance and loss decreased from 17.4% to 4.3%. The average annual number of visits to township health centers increased from 0.47 in 2009 to 0.74 in 2013, and the cost of hospitalization and outpatient drugs decreased from 805 yuan and 28.1 yuan to 718 yuan and 24.1 yuan, respectively. Conclusion: the implementation of the national basic drug system has no negative effect on outpatient service, but has a certain inhibitory effect on the utilization of hospitalization service. The implementation of the national basic drug system has effectively reduced the economic burden of drugs, but the total burden of health has not decreased. This shows that it is difficult to control the rapidly rising health costs by carrying out the national basic drug system alone. The comprehensive reform, coordination and linkage of medicine and health are needed in order to effectively alleviate the problem of "expensive medical treatment".
【作者单位】：复旦大学公共卫生学院/健康风险预警治理协同创新中心;哈尔滨医科大学卫生管理学院;
【基金】：国家自然科学基金面上项目(No.71373062);国家自然科学基金重点项目(No.71333003)
【分类号】：R95

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