实施基本药物制度是否降低了农村居民的医药费用负担：来自安徽三县区的经验

Whether the Essential Medicine Policy Decreases the Medical Cost of Rural Population:Experience from Three Counties in Anhui Province

目的:研究基本药物制度实施是否真正降低了患者的医药费用负担。方法:通过现场调查和二手数据分析抽样调查了安徽省三县乡镇卫生院在基本药物制度实施前后服务量、医药费用及就医流向的变化。结果:实施基本药物制度后安徽省三县乡镇卫生院的门诊/住院医疗费用均明显下降,但门诊/住院人次数也有较大幅度下降,而同期在县及县以上医疗机构治疗的农村患者数量却增长明显。结论:基本药物制度的实施的确降低了在乡镇卫生院就诊患者的医药费用,但不恰当的人员激励机制会导致乡镇卫生院不愿意提供医疗服务,使医疗服务上移,可能不会降低农村患者的医药费用负担。

To study whether the implementation of essential medicine policy decreases the medical cost of rural population. Methods： Three counties were randomly selected in each county, and two towuship health centers were also randomly selected. The data of outpatient and inpatient services, medical cost and health-seeking changes are collected and analyzed through filed survey, collecting second-hand data and key inforumnt interview. Results： Medical cost of outpatient and inpatient decreased ＇after the implementation of essential medicine policy, the number of outpatients and inpatients also decreased, but the number of rural population to county hospital or higher level for medical services incleases. Conclusion： The implementation of essential medicine policy truly decreases the medical cost of rural population that happened in the township health eenteT~, but the in＇ational incentive mechanism to health care providers make them reluctant to provide basic medical services, which let the rural population to get the services at higher hospitals, So the whole medical expense burden of rural residents would not be decreased.