Murakami H, Phommasack B, Oula R, Sinxomphou S
Bureau of International Cooperation, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 Japan.
Health Policy Plan. 2001 Mar;16(1):98-106. doi: 10.1093/heapol/16.1.98.
Pharmaceutical cost recovery programmes, which have been mainly implemented in Africa, are gradually spreading to Southeast Asian countries that formerly belonged to the socialist bloc. This report describes the economic and operational realities of revolving drug funds (RDFs) at district hospitals and health centres in the capital of the Lao PDR by reviewing research conducted by the implementing department. People in the municipality spent an average of US$11 on drugs in 1996. The RDFs comprised only 3% of the total yearly drug sales in the municipality, whereas private pharmacies accounted for 75%. The RDFs were forced to operate in conjunction with the remaining government drug endowment and the thriving private pharmacies. This scheme has provided a stable supply of essential drugs. The assurance of drug availability at the front-line health facilities has resulted in increased utilization of the facilities despite the introduction of a drug fee. The cost recovery rate was 107% at health centres and 108% at district hospitals in two monitored districts during the 10 months from November 1997. Decentralized financial management was essential for cost recovery, allowing timely adjustment of selling prices as purchase prices rapidly inflated after the Asian economic crisis. The health staff observed that the people perceived drugs as everyday commodities that they should buy and take based on self-diagnosis and personal preference. Adaptation of the public health authorities to market-oriented thinking along with the establishment of pharmaceutical cost recovery occurred with few problems. However, both financial and operational management capacity at the municipal level pose a major challenge to policy clarification and scheme setting, especially in procurement, control of prescribing practices and the integration of drug dispensing with other components of quality clinical care.
药品成本回收计划主要在非洲实施，如今正逐渐扩展至曾属于社会主义阵营的东南亚国家。本报告通过回顾实施部门开展的研究，描述了老挝首都万象市各地区医院和卫生中心循环药物基金（RDF）的经济与运营实际情况。1996年，该市居民人均药品花费为11美元。RDF的药品销售额仅占该市年度药品销售总额的3%，而私人药店占75%。RDF不得不与剩余的政府药品捐赠以及蓬勃发展的私人药店协同运营。该计划确保了基本药物的稳定供应。尽管收取了药费，但一线卫生设施药品供应的保障使得这些设施的利用率有所提高。在1997年11月起的10个月里，两个受监测地区的卫生中心成本回收率为107%，地区医院为108%。分散式财务管理对成本回收至关重要，在亚洲经济危机后采购价格迅速上涨时，这使得能够及时调整销售价格。卫生工作人员观察到，人们将药品视为日常商品，应基于自我诊断和个人偏好自行购买和服用。公共卫生当局适应市场导向思维以及药品成本回收的建立过程中问题较少。然而，市级层面的财务和运营管理能力对政策阐释和计划制定构成了重大挑战，尤其是在采购、处方行为控制以及药品调配与优质临床护理其他环节的整合方面。
