基本药物制度实施后广西某市社区卫生服务中心与乡镇卫生院门诊服务变化比较

Study on comparing the change of outpatient service between community health service centers and township health centers after the implementation of essential medicines system in a city of Guangxi Zhuang Autonomous Region

目的:比较国家基本药物制度实施前后社区卫生服务中心和乡镇卫生院门诊服务量和费用的变化。方法:收集广西某市9家社区卫生服务中心和17家乡镇卫生院2009—2011年连续36个月的月门诊服务量和门诊费用数据,使用分段时间序列回归方法进行分析。结果:国家基本药物制度实施以后,社区卫生服务中心门急诊人次、次均药品费用瞬时水平和长期变化趋势均保持不变;次均医疗费用瞬时水平下降,长期趋势增加;次均总费用瞬时水平下降,长期趋势保持不变。乡镇卫生院门急诊人次瞬时水平增加,长期趋势减小;门诊病人次均药品费用瞬时水平下降,长期趋势不变;门诊病人次均医疗费用瞬时水平不变,长期趋势增加;门诊病人次均总费用水平和趋势均不变。结论:国家基本药物制度实施后,公立医院举办社区卫生服务中心和政府直接举办乡镇卫生院门诊服务量的变化存在较大差异,可能与两种机构在服务对象、与上级医院关系、非基本药物受限制程度、编制人员比例和工资制度上的差异有关。

Objective：To compare the change of outpatient visits and cost before and after the implementation of national essential medicines system between community health service centers and township health centers. Methods：Monthly outpatient visits and cost of 9 community health service centers and 17 township health centers of a city, Guangxi Zhuang Autonomous Region from 2009 to 2011 are collected. Interrupted time-series analysis method is used to analyze the data. Result：After the implementation of national essential medicines system, for community health service centers, the level and slope of outpatient visits and outpatients medicine cost didn’t change, the level of outpatients medical cost declined and the slope increased, the level of outpatients cost declined and the slope didn’t change; for township health centers, the level of outpatient visits increased and the slope declined, the level of outpatients medicine cost declined and the slope didn’t change, the level of outpatients medical cost didn’t change and the slope increased, the level and the slope of outpatients cost didn’t change. Conclusion：After the implementation of national essential medicines system, the change of outpatient visits is quite different between community health service centers run by public hospitals and township health centers run by government directly, which may be related to the difference in service object, relationship with higher level hospitals, degree of limitation to non-essential drug, proportion of administrative establishment and wage system between two kinds of institutions.