某市社区卫生服务机构实施基本药物制度前后的经济运行情况比较

Comparison of Economic Operations before and after Implementation of National Essential Medicine System in Community Health Service Institutions in a City

目的了解基本药物制度实施前后某市试点三区社区卫生服务机构经济运行情况的变化及存在的主要问题。方法采用整群抽样方法,抽取某市基本药物制度试点三区的41家城市社区卫生服务机构,对基本药物制度实施前后的财政补助、收支结构、结余情况、医疗服务提供量等指标进行分析。结果样本机构经济运行的变化:(1)财政补助增加30.4%;(2)总收入增长5.0%,医疗总收入减少9.2%,药品收入增长6.6%,药占比例增至54.70%;(3)总支出增长14.4%;(4)总收支出现1 577万元的亏损,医疗总结余亏损增加,药品总结余降至753.9万元;(5)门急诊服务量下降8.7%,人均门诊费用增长12.5%。结论社区卫生服务机构实施基本药物制度后,补偿机制尚不健全,虽然政府补偿明显增加,但仍补偿不足,存在亏损运营,部分机构仍存在"以药补医;"社区卫生服务机构部分患者流失。建议加大政府财政投入,完善社区卫生服务机构经济补偿的机制和模式,优化基本药物目录,并加强基本药物制度的宣传教育。

Objective To know the changes of economic operation of the community health service institutions in three pilot districts of a city before and after implementation of national essential medicine system and the existing problems. Methods Totally 41 community health service institutions of three pilot districts in a city by using cluster sampling.The contrast analyses were conducted about indexes of financial aid,income and expense structure,balance condition,and amount of the health services before and after the implementation of the national essential medicine system. Results Th changes in economic operation of the sampling institutions were as the following：（1） Financial aid increased by 30.4%.（2） The total income increased by 5.0%,the medical income by 9.2%,and the drug income by 6.6%.The proportion of the drug income in total imcome went up to 54.70%.（3） The total expenses increased by 14.4%.（4） The loss in total balance reached RMB 15.77 million yuan,the loss in medical balance increased,and the drug balance decreased to RMB 7.539 million yuan.（5） The amount of emergency went down by 8.7% and the average outpatient fee increased by 12.5%. Conclusion After implementation of the essential medicine system,the government compensation increases,however,the compensation mechanism is still incomplete,such as insufficiency of aid,defect of operation,＂replacement of medical technique by drugs＂ in some of the institutions,and loss of a part of the outpatients in community health services.So it is suggested that the government investment be enlarged,the economic compensation mechanism and mode in the community health service institutions be improved,the list of the national essential medicine be adjusted,and the education of the national essential medicine system be emphasized.