上海市药品零差率政策实施效果的初步分析

Preliminary analysis of pharmaceuticals zero mark-up policy in Shanghai

目的:对上海市社区卫生服务中心实施药品零差率政策一年来的效果进行初步分析。方法:采用上海市药品采购数据库中的数据,对药品金额、数量和价格等进行分析。结果:零差率药品在社区卫生服务中心的使用金额构成比为17.54%,该政策实施后这一比例并无提高;而所有药品的总金额增长了15.79%,金额前20位药品的价格水平提高了11.25%。讨论:零差率药品目录的科学性是该政策得以有效实施的基础,促进合理使用的措施和补偿到位是保证该政策效果的必要条件;分析发现,该政策实施1年来,降低居民就医负担,引导常见病、多发病和诊断明确慢性病在社区诊治等主要政策目标可能并未达到;零差率这一做法是否还要在基本药物制度中继续沿用值得进一步探讨。

Objective：To analyze preliminary effect of pharmaceuticals zero mark-up policy in Shanghai community healthcare centers after one-year practice. Methods：Database of community healthcare centers in Shanghai hospital pharmaceutical phurchasing system is adopted. Expenditure,volume and price are analyzed. Results：Proportion of zero mark-up pharmaceuticals＇ expenditure in community healthcare centers is 17.54%,this figure didn＇t increased after one-year implementation of the policy. But the expenditure of all pharmaceuticals increased by 15.79%,and the price level of top 20 increased 11.25 %. Discussion：Zero mark-up drug list is the scientific basis for the effective implementation of this policy,measures of promoting rational use and sufficient compensation are necessary conditions for the policy effect. From the analysis point of view,policy objectives of reducing the burden of healthcare,guiding patients with common diseases and chronic diseases under clear diagnosis to community did not achieve after one-year implementation. Whether zero mark-up policy still continues to be used in the essential medicines system should be further explored.