我国社区卫生服务机构药品零差率政策系统综述

Systematically reviewing the policy of "Without Added Profit" for basic pharmaceuticals in community health services institutions.

目的了解我国不同地区或城市社区卫生服务机构药品零差率政策的实施策略、运行现状、实施效果及实施过程中存在的问题。方法借鉴Cochrane系统评价法,制定文献检索策略,并从CNKI、维普期刊全文、万方数字资源等中文数据库以及卫生部网站检索文献,将纳入的文献进行质量评价,并利用自制的文献摘录表对符合要求的文献进行摘录、编码和综合分析。整个系统综述的步骤和过程均由两名研究人员独立完成,遇到不一致问题由二人讨论后统一意见。结果研究发现,目前药品零差率政策已在我国社区卫生服务机构普遍实施,然而各地区或城市在实施范围、开始时间、零差率目录、补偿方式存在一定差异。部分研究结果表明,药品零差率实施后,社区卫生机构门诊人次数显著上升、次均处方费明显下降。在取得成效的同时,配套设施不完备、政府投入机制不完善、零差率药品断货现象等问题较突出。结论研究乡镇卫生院、村卫生室等基层卫生机构药品零差率政策的实施情况的文献较少;在评价药品零差率政策实施现状和效果时,RCT、CBA、ITS等设计更为科学严谨的方法未被采用;药品零差率政策的评价指标体系尚未建立;关于居民对零差率政策的认知情况及态度的研究较少;研究对药品零差率政策的实施监管及控制的方面较少;基层卫生机构对于药品目录以外的药品是否该销售的研究基本上没有涉及;建立完善的药品供应体系需要进一步研究。

Objective ：To understand the strategy, status, effect and problems of implementing the policy of＂ Without Added Profit＂ for basic pharmaceuticals in different community health services institutions. Methods Followed with the searching strategy from Cochrane reference system evaluation, literatures were searched from CNKI, VIP, Wanfang database and website, and their quality was evaluated. Then, literatures were extracted, coded and comprehensively analyzed. Results The policy of＂ Without Added Profit＂ for basic pharmaceuticals has widely carried out in community health services institutions. But there existed differ- ences in scope, starting point, directory and compensation among different areas. After implementation of this policy, there had significant increase of amount of outpatients, but significant decrease of prescription cost. Meanwhile, some problems still existed, such as incomplete facilities,imperfect governmental input mechanism, and shortage of pharmaceuticals. Conclusion Scientific designs as RCT, CBA, ITS were not used in evaluating the policy. The evaluation index system had not been established yet. There had less literatures on the policy of＂ Without Added Profit＂ implementing in grass - roots health institutions, less literatures on residents＇ cognition and attitude at this policy, and less literatures on supervision on this policy. Further study was needed to es- tablish improved drug supply system.