实施基本药物制度对供需双方的影响及对策研究..doc

实施基本药物制度对供需双方的影响及对策研究 唐圣春 常星 刘春生 魏占英 陈红敬 （中国医学科学院卫生政策与管理研究中心，北京，100020） 【摘 要】目的：分析社区卫生服务机构开展基本药物制度试点对供需双方的影响及其原因，为政策建议提供依据。方法：对机构开展问卷调查，对相关人员进行半结构式访谈。结果：基本药物制度试点对不同地区社区卫生服务机构的影响存在差异，部分机构的服务量和收入有所下降，由于补偿不到位影响了医务人员积极性；基本药物价格水平总体上大幅度下降，但次均门诊费用的变化存在地区差异；由于基本药物目录不完善等原因，影响到患者用药。结论：需要根据实际情况对基本药物目录进行调整；完善基本药物招标和配送机制，保障基本药物的生产供应；采取综合措施提高基本药物使用率，控制医疗费用；进一步建立健全社区卫生服务机构的补偿机制。 【关键词】基本药物制度；补偿；门诊人次；次均门诊费用 Research on the Influence of the Implementation of National Essential Medicine System on the Supply Demand and Countermeasures TANG Sheng-chun, CHANG Xing, LIU Chun-sheng, WEI Zhan-ying, CHEN Hong-jing Center for Health Policy and Management, Chinese Academy of Medical Sciences, Beijing, 100020, China 【Abstract】supply demand in pilots and their causes so as to provide for policy making. Methods: Questionnaire method is adopted to investigate the community health service institutions, and semi-structured interview applied to stakeholders. Results: There are differences among the influence of the implementation of NEMS in pilots. The outpatient visits and income has decreased in some institutions; the positivity of medical staff was influenced due to the imperfect reimbursement mechanism; the price of essential medicines has reduced in total, while the changes of the outpatient expense per capita are different; the imperfection of NEMS has influences on the normal use of medicines. Conclusion: According to the actual condition, NEMS should be improved and adjusted; perfect the tendering and distribution mechanism of essential medicines to ensure the production and supply; take comprehensive steps to promote rational use of medicines, control the medicines expense；and establish and improve reimbursement mechanism. [Key word] Essential medicine system; Compensation; Outpatients headcount; Average medical expense per?outpatient? 新医改方案提出，要加快建立以国家基本药物制度为基础的药品供应保障体系，并且将“初步建立国家基本药物制度”作为近三年要着力抓好的五项重点改革之一。同时，《医药卫生体制五项重点改革2010年度主要工作安排》明确提出：继续扩大基本药物制度实施范围，在不少于60％的政府办城市社区卫生服务机构和县（