北京市“药品零差率政策”对社区居民用药行为的影响研究

Impact of "Zero-Profit Policy in Drug Sale" on Medication-taking Behavior of Community Residents in Beijing

目的了解"药品零差率"政策对社区居民用药行为的影响,评价政策的长期效果。方法采用分层随机抽样的方法 ,对1260名"零差率"政策实施前后均在社区卫生服务站就诊的慢性非传染性疾病患者进行问卷调查。调查患者对"药品零差率"政策的认知情况、用药行为变化、对政策的满意度、就医行为及医疗费用变化。结果 "药品零差率"政策实施之初在社区居民中具有较高知晓率,但近一年来有下降趋势;政策在提高社区居民就医满意度、转变居民就诊意愿、改变居民就诊流向、吸引患者更换"零差率"药品等方面发挥了一定的作用。但这些变化的相对比例仍然偏低,与政策预期目标尚有一定差距。结论 "零差率"政策作为基本药物制度的初级阶段,已经在一定程度上起到了降低药费、改变患者就医流向的作用。建议更加科学地遴选药品种类,加大政策宣传力度,发挥社区医生的作用,使政策发挥更大的效益。

Objective To realize the impact of ＂Zero-Profit Policy in Drug Sale＂ on medication-taking behavior of residents in community health service in Beijing,in order to assess the long term effect of the policy.Methods By using stratified random sampling 1 260 patients,who have chronic non-communicable diseases and visited community health stations before and after implementing the ＂Zero-Profit Policy in Drug Sale＂,were enrolled.Questionnaire survey was conducted among the patients.The questionnaire contents included patients′ awareness of the policy,changes in behavior of using medicine,satisfaction about the policy,changes in behavior for seeing doctors,and changes of medical expenses.Results At the beginning of carrying out it,the ＂Zero-Profit Policy in Drug Sale＂ is of a higher recognizing rate among the residents,however the recognizing rate had a tendency to decrease in recent years.The policy has played a given role in raising the residents′ satisfaction on medical service,altering their visiting intention and distribution,and attracting them to take the zero-profit drugs.Nevertheless,the ratio of these behavior changes was still low relatively,with a certain difference from the expected goal of the policy.Conclusion As the primary stage of the essential medicine system,the ＂Zero-Profit Policy in Drug Sale＂ has played an important role,to some extent,to reduce the drug expense and change the distribution of outpatients.It is suggest that we should select medicine categories more scientifically,make the policy more popular,and give scope to general practitioners′ function so as to achieve more efficiency of the policy.