Biritwum R B
Department of Community Health, Ghana Medical School, Accra.
West Afr J Med. 1994 Apr-Jun;13(2):124-7.
This paper investigates the sudden fall in clinic attendance at a rural health centre. The pressure to sustain the cash and carry system of procuring drugs is being blamed for over prescription, inconsistent pricing of prescriptions and subsequent fall in clinic attendance. The clinic attendance which was dropping since the introduction of fee-for-service (1985) has now dropped sharply to about 25% after the implementation of the Cash and Carry system (1990). Yet, the average revenue generated per patient has jumped from 201 cedis in 1990 to 348 cedis in 1992. Analysis of the prescription pattern for malaria infection showed that 56% and 89% of patients received injections or were given three or more drugs in the free health service period and in the fee-for-service period respectively. Prescriptions which contained injections or more than three items yielded between 120% and 200% profit to the Health Centre compared to a profit of 60% if only chloroquine and analgesics were prescribed. Consumptions of drugs by staff and non paying patients amounted to about 10% of the revenue generated from the paying patients. It is suggested that, at the health centre level, mechanism for pricing of prescriptions to patients must be reviewed, since motivation for profit could influence the management of diseases and also the use of health facilities. Secondly, refund for drugs consumed by staff and non-paying patients must be recovered in order to remove undue pressure to make profit.
本文调查了一家农村医疗中心门诊量的突然下降。维持药品采购现购自运系统的压力被认为是导致过度开药、处方定价不一致以及随后门诊量下降的原因。自实行收费服务（1985年）以来一直在下降的门诊量，在实施现购自运系统（1990年）后，现已急剧降至约25%。然而，每位患者产生的平均收入已从1990年的201塞迪跃升至1992年的348塞迪。对疟疾感染处方模式的分析表明，在免费医疗期和收费服务期，分别有56%和89%的患者接受了注射或被开了三种或更多药物。与仅开氯喹和镇痛药时60%的利润相比，包含注射或三项以上药品的处方给医疗中心带来了120%至200%的利润。工作人员和未付费患者的药品消费约占付费患者产生收入的10%。建议在医疗中心层面，必须审查向患者的处方定价机制，因为盈利动机可能会影响疾病管理以及医疗设施的使用。其次，必须追回工作人员和未付费患者所消费药品的退款，以消除盈利的不当压力。
