国家基本药物政策实施对基层医疗机构的影响：一项中国的横断面研究。
The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China.
作者信息
Guo Zhigang, Guan Xiaodong, Shi Luwen
机构信息
School of Pharmaceutical Science, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, China.
International Research Center of Medicinal Administration, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, China.
出版信息
BMC Health Serv Res. 2017 Nov 13;17(1):723. doi: 10.1186/s12913-017-2698-x.
BACKGROUND
In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China.
METHODS
The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010. A questionnaire survey developed by the study team was distributed to all of the primary healthcare institutions. Nine indicators from three dimensions as the outcome variables were used and calculated to evaluate the impacts of implementation of policies. All of the outcome variables were tested using independent-samples T test between the treatment group (with the NEMPs implemented) and the control group (without the NEMPs implemented).
RESULTS
The ratio of drug sales and institution revenues at primary healthcare institutions was 42.99% in the treatment group, which was significantly lower than the control group (53.90%, p < 0.01), while the ratio of financial subsidies of the treatment group was shown to be higher (30.78% VS 20.82%, p < 0.01). The rate of healthcare workers income growth was greater in the treatment group (15.35% VS 5.79%, p = 0.006). The treatment group exhibited higher outpatient and emergency visits per month in urban areas (2720 VS 1763 visits per month) and rural areas (3830 VS 3633), and higher prescriptions per month in urban areas (2048 VS 1025, p = 0.005) and rural areas (3806 VS 3251). The treatment group used more essential medicines and received greater income from essential medicines while the drug price markup rate was lower.
CONCLUSIONS
The NEMPs appear to affect the transformation of the operation mechanisms of primary healthcare institutions, the improvement of the mechanisms for government investment, and the healthcare pricing system. Meanwhile, the gaps between urban and rural areas need to be addressed. In conclusion, the NEMPs of China are instrumental to the aim of providing basic healthcare services to every citizen.
背景
2009年，中国实施了国家基本药物政策（NEMPs），作为新一轮医疗体制改革的一部分。本研究旨在评估国家基本药物政策对基层医疗卫生机构的影响，并探讨这些政策在中国新医疗改革中的作用。
方法
该研究共选取了中国六个具有代表性的省份，于2010年8月至12月选取了261家基层医疗卫生机构作为样本。研究团队编制的问卷调查表发放给了所有基层医疗卫生机构。使用并计算了来自三个维度的九个指标作为结果变量，以评估政策实施的影响。所有结果变量均在治疗组（实施国家基本药物政策）和对照组（未实施国家基本药物政策）之间使用独立样本t检验进行检验。
结果
治疗组基层医疗卫生机构药品销售额与机构收入之比为42.99%，显著低于对照组（53.90%，p<0.01），而治疗组财政补贴比例更高（30.78%对20.82%，p<0.01）。治疗组医护人员收入增长率更高（15.35%对5.79%，p=0.006）。治疗组城市地区每月门诊和急诊就诊量更高（每月2720次对1763次），农村地区更高（3830次对3633次），城市地区每月处方量更高（2048张对1025张，p=0.005），农村地区更高（3806张对3251张）。治疗组使用了更多基本药物，从基本药物中获得的收入更高，而药品加价率更低。
结论
国家基本药物政策似乎影响基层医疗卫生机构运行机制的转变、政府投入机制的完善以及医疗定价体系。同时，城乡差距需要得到解决。总之，中国的国家基本药物政策有助于实现为每位公民提供基本医疗服务的目标。
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