Li Zhuge, Shu Defeng, Xia Mei, Gao Dehai, Lu Dan, Huang Ning, Tian Xiaoqing, An Limei, Li Shixue, Li Sheng
School of Public Health, Shandong University, West Block, Jinan, Shandong, China.
The Shandong Provincial Health and Family Planning Commission, East Block, Jinan, Shandong, China.
Technol Health Care. 2015;23 Suppl 1:S169-76. doi: 10.3233/thc-150951.
At present, China has achieved an initial establishment and gradual implementation of a framework for national essential drugs policy. With the further implementation of the national essential drugs policy, it is not clear how the policy works, whether it achieves the original intention of essential drugs policy, and what impact essential drugs policy exerts on the primary health care system. In view of it, we conducted a field research on sample areas of Shandong Province to understand the conditions of the implementation of the essential drugs policy in Shandong Province. From three perspectives of medical institutions, patients and medical staff, this thesis analyzes the impact of essential drugs policy on village-level and township-level health service system, summarizes the effectiveness of implementing essential drugs policy, discovers the problems of various aspects and conducts an in-depth analysis of the causes, and puts forward feasible suggestions to provide reference for improving the essential drugs policy. The assessment results show that the implementation of essential drugs policy in Shandong Province has played a positive role in promoting the sound development of the primary health care system, changed the situation of covering hospital expenses with medicine revenue in the past, contributed to the return of medical institutions to public welfare, and reduced the patient's economic burden of disease. But there emerge many problems as follows: impact on the doctor's diagnosis and treatment due to incompleteness of drug types, and distribution not in place, patient loss and operational difficulty of village clinic. Thus, this thesis makes recommendations of drugs catalog formulation, drug procurement, sales and use, and meanwhile points out that the supporting financial compensation policy and performance appraisal policy and other measures in place are a prerequisite for a positive role of essential drugs policy.
目前，中国已初步建立并逐步实施国家基本药物政策框架。随着国家基本药物政策的进一步实施，该政策如何发挥作用、是否实现基本药物政策的初衷以及对基层医疗卫生体系产生何种影响尚不明晰。鉴于此，我们对山东省样本地区进行了实地调研，以了解山东省基本药物政策的实施情况。本文从医疗机构、患者和医务人员三个角度，分析基本药物政策对村级和乡镇级卫生服务体系的影响，总结实施基本药物政策的成效，发现各方面存在的问题并深入剖析原因，提出可行性建议，为完善基本药物政策提供参考。评估结果显示，山东省基本药物政策的实施对推动基层医疗卫生体系健康发展起到了积极作用，改变了过去以药养医的局面，促使医疗机构回归公益性，减轻了患者的疾病经济负担。但也出现了诸多问题：药品种类不全、配送不到位对医生诊疗造成影响，村卫生室患者流失、运营困难。因此，本文对药品目录制定、药品采购、销售和使用等方面提出建议，同时指出配套的财政补偿政策和绩效考核政策等措施到位是基本药物政策发挥积极作用的前提。
