Sun Xiaoyun, Jackson Sukhan, Carmichael Gordon A, Sleigh Adrian C
Health Department of Shandong Province, Division of Maternal & Child Health and Community Health, 9 Yan Dong Xin Road, Jinan, Shandong 250014, China.
Soc Sci Med. 2009 May;68(10):1775-9. doi: 10.1016/j.socscimed.2009.02.043. Epub 2009 Apr 1.
In 2003, China introduced a new community-based rural health insurance called the New Cooperative Medical Scheme (NCMS). In 2005, to assess the NCMS effects on village doctors' prescribing behaviour, we compared an NCMS county and a non-NCMS county in Shandong Province. We collected information from a representative total of 2271 patient visits in 30 village health stations (15 per county). The average number of drugs prescribed (4.6 in the NCMS county vs. 3.1 in the non-NCMS county) and use of antibiotics (72.4% vs. 59.3%) and injections (65.1% vs. 56.3%) were high in both counties, and higher in the NCMS county. Within NCMS villages, prescribing for insured vs. uninsured patients showed a similar pattern with more drugs, antibiotics and injections for those insured. Overall, for NCMS patients, the prescription excess was about equal in value to their 20% fee discount. We conclude that over-prescribing is common in villages and worse with NCMS health insurance, raising concerns for health service quality and drug-use safety. We propose that the NCMS should be redesigned with incentives for service quality improvement. A stricter regulatory environment for doctors' prescriptions is needed in rural China to counter irrational drug use.
2003年，中国推出了一项名为新型农村合作医疗制度（新农合）的新型社区农村医疗保险。2005年，为评估新农合对乡村医生处方行为的影响，我们比较了山东省的一个新农合县和一个非新农合县。我们从30个村卫生室（每个县15个）共2271次具有代表性的患者就诊中收集了信息。两个县的平均处方药品数量（新农合县为4.6种，非新农合县为3.1种）、抗生素使用情况（72.4%对59.3%）和注射使用情况（65.1%对56.3%）都很高，且新农合县更高。在新农合覆盖的村庄中，为参保患者与未参保患者开的处方呈现出相似的模式，参保患者的药品、抗生素和注射剂使用更多。总体而言，对于新农合患者，处方超额部分的价值约等于他们20%的费用折扣。我们得出结论，过度处方在农村很常见，在有新农合医疗保险的情况下情况更糟，这引发了对医疗服务质量和用药安全的担忧。我们建议重新设计新农合，以激励提高服务质量。中国农村需要一个更严格的医生处方监管环境来应对不合理用药问题。
