Sun Gang, Lu Zuxun, Gan Yong, Dong Xiaoxin, Li Yongbin, Wang Yunxia, Li Liqing
aDepartment of Health Management, School of Health Management, Southern Medical University, Guangzhou bDepartment of Social Medicine & Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
Medicine (Baltimore). 2017 Nov;96(46):e7292. doi: 10.1097/MD.0000000000007292.
Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions' incomes due to limited GHF. This is well known as China's "drug maintain medical institutions (DMMIs)" system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.
政府卫生资金投入(GHF)是一个全球性问题。在中国,这一问题尤为突出,由于政府卫生资金投入有限,药品销售成为医疗机构收入的主要来源。这就是众所周知的中国“以药养医(DMMIs)”体系,该体系直接导致抗生素、注射剂和皮质类固醇的使用量非常高。然而,尽管人们普遍承认其存在,但中国关于政府卫生资金投入与不适当用药处方流行率之间关联的统计数据却很少。
采用多阶段抽样策略,选取了2007年至2011年期间中国36个重点城市(区)的城市社区卫生(CH)机构开具的442,100张处方,并核查了政府卫生资金投入情况。本研究考察了政府卫生资金投入与不适当用药处方流行率之间的关联,这与以往的研究略有不同。
数据表明,2007年至2011年期间,随着政府卫生资金投入的增加,处方行为(PB)总体上逐渐改善,不过医生开具的药物仍比世界卫生组织(WHO)的建议略多一些。本研究发现,政府卫生资金投入与处方行为的主要指标之间存在显著的负相关(相关系数大于0.5)。
研究结果表明,政府应进一步完善对医疗机构的补偿机制,以逐步削弱药品销售在医疗机构中的补偿作用。