西北某县级公立医院药品使用情况、价格水平及可负担性分析

Analysis of Drug Use,Price Levels and Affordability of a County-level Public Hospital in Northwestern Area

目的:为公立医院药品价格改革提供参考。方法:对西北某县人民医院2011年的药品销售情况进行描述性分析,借鉴世界卫生组织和国际健康行动组织推介的中位价格比值(MPR)方法评价药品进销价格水平,并计算加成率,以该县2011年农村居民和城镇居民的收入作为购买力划分标准,评价药品的可负担性。结果:该医院非基本药物、注射剂与抗菌药物的销售金额在药品销售总金额中占有较大比重,药品采购价格MPR值为8.3977,销售价格MPR为9.6571,西药与中成药的加成率为15%,中草药为25%,1个疗程的药品费用为农村居民14.70天的收入或城镇居民4.38天的收入。结论:县级公立医院存在非基本药物大量使用,注射剂与抗菌药物可能滥用的现象,药品价格水平相对国际参考价格较高,居民用药经济负担较大。尽管取消药品加成政策和实行"零差率"销售促进了药品销售价格下降,但由于药品采购价格水平比较高,药品销售价格可能仍将处于一个较高的水平,民众用药经济负担仍然较大。

OBJECTIVE ： To provide reference for drug price reform in public hospital. METHODS ： Drug sales of the hospital in 2011 were analyzed descriptively, and purchasing and sale price levels of drug were measured with median price ratio （MPR） recommended by WHO/HAI; and the ratio of drug price mark-up was calculated. The drug affordability was evaluated with the income of rural and urban residents in 2011. RESULTS： Consumption sum of non-essential drugs, injections and antibiotics accounted for large proportions of total consumption sum. MPR for drug purchasing and sale prices was 8.397 7 and 9.657 1 respectively, and drug price mark-up ratio of western medicines and Chinese patent medicines was 15% and the ratio of traditional Chinese medi- cine was 25%. The expenditure of a treatment course equaled to income of a rural resident in 14.70 days and that of an urban resi- dent in 4.38 days. CONCLUSION： There might be some abuse of non-essential drugs, injections and antibiotics in county-level public hospital. The drug price in the hospital is at a higher level than international reference price, and the people suffer from a great economic burden of drugs. Although the drug zero-profit sale policy may reduce the drug sale price, it is likely to remain at a high level since the drug purchasing price level is relatively high, and drug economic burden of the public is still heavy.