重庆市药品采购制度实施效果、存在问题及建议——基于基层医疗卫生机构的调查
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篇名: 重庆市药品采购制度实施效果、存在问题及建议——基于基层医疗卫生机构的调查
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摘要: 目的:为进一步推动重庆市药品采购制度的完善提供参考。方法:选取重庆市30家基层医疗卫生机构为对象,收集上述机构2009-2013年的药品费用变化和业务开展方面的数据,并通过重庆市卫生计生委收集重庆市药品采购价格、基本药物使用和供应等方面的数据,对重庆市药品采购制度的实施效果、存在的问题进行评价和分析,并提出针对性的建议。结果:相比2009年,2013年重庆市非基本药物价格平均降幅达28.00%,2009版《国家基本药物目录》307个品种价格平均下降32.97%,地方增补目录205个品种价格平均下降43.78%。重庆市政府办基层医疗卫生机构基本药物销售金额占比(不含中药饮片)由2010年的76.48%上升为2013年的92.07%,国家基本药物的平均使用率由6.84%上升为28.12%。被调查基层医疗卫生机构次均门诊药品费用、次均住院药品费用2013年较2009年分别下降16.78%、25.85%,药占比从2009年的56.32%逐年下降为2013年的49.70%。结论:重庆市药品采购制度实施总体上是成功的,但也存在着诸如定价机制不完善、低价短缺药品供应保障困难、基层医疗卫生机构次均门诊费用缓慢回升、用药不合理等方面的问题,建议从完善药品定价机制、优化物流配送、强化医疗保险机构的作用、整治过度用药、完善医疗机构补偿政策等方面加以改进。
ABSTRACT: OBJECTIVE: To provide reference for the further improvement of the drug purchasing system in Chongqing city. METHODS: 30 primacy medical and health institutions in Chongqing were selected to collect the data about cost changes and business development in above-mentioned institutions from 2009 to 2013, the purchasing price, use and supply of essential medicines were collected via Chongqing Municipal Health and Family Planning Commission to evaluate and analyze the effects and existing problems of drug purchasing system, and suggestions were put forward. RESULTS: Compared with 2009, the non-essential drugs’ prices fell an average of 28.00% in 2013, prices of 307 varieties in National Essential Medicine System (2009 edition) fell an average of 32.97%, 205 varieties in supplementary list of local prices fell an average of 43.78%. The proportion of sales amount (not including Chinese herbal medicine) in primacy medical and health institutions increased from 76.48% in 2010 to 92.07% in 2013, the average rate of essential medicines increased from 6.84% to 28.12%. Compared with 2009, the average drug cots and inpatient drug costs decreased 16.78% and 25.85% in 2013, the proportion of drugs decreased from 56.32% in 2009 to 49.70% in 2013. CONCLUSIONS: Generally speaking, the implementation of drug purchasing system in Chongqing is successful, but also exists some problems, such as imperfect pricing mechanism, difficult supply of low-cost drugs, slow rise of average outpatient costs in primacy medical and health institutions and irrational drug use. It is suggested to improve it from aspects of perfecting drug pricing mechanism, optimizing logistics and distribution, strengthening the role of the medical insurance institutions, regulating medication overuse and improving compensation policy of medical institutions.
期刊: 2016年第27卷第21期
作者: 甘洁,王思凌,邓志根,蒲川
AUTHORS: GAN Jie,WANG Siling,DENG Zhigen,PU Chuan
关键字: 重庆市;药品采购制度;效果;问题;建议
KEYWORDS: Chongqing city; Drug purchasing system; Effect; Problem; Suggestion
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