总额预付对基本药物费用的控制效果评析

Evaluation of the Control Effect of Total Prepayment to Essential Medicine Cost

目的:探讨总额预付报销模式对基本药物费用的影响,为进一步完善基本药物报销模式提供参考。方法:通过我省医药集中采购平台统计全省基层医疗卫生机构2012年1-10月交易数据,分析总额预付制度实施前后全省基本药物交易金额、药品使用结构的变化;采用非概率分层抽样调查法,分别选取3个样本县,对辖区内2012年1-10月基本药物网上采购数据进行分析,并对辖区内患者在基层医疗卫生机构就医的次均住院药品费用和次均门诊药品费用进行综合测算。结果:自2012年5月我省新型农村合作医疗实施总额预付报销以后,全省基层医疗卫生机构基本药物网上采购金额及以往采购金额排名前10位的基本药物使用比例均逐月下降。3个样本县基本药物采购金额及采购金额排名前10位的药品使用比例均逐月下降;次均住院药品费用和次均门诊药品费用呈总体下降趋势。结论:总额预付报销模式对基本药物费用具有明显控制效果,但需要进一步完善和提高。

Objective： To investigate the effect of the reimbursement mode of total prepayment to the essential medicine cost so as to provide a reference for the further improvement of the essential medicine reimbursement mode. Methods： The drug transaction data of the basic medical and health institutions in our province during January to October of 2012 was col- lected statistically through the centralized drug procurement platform. The changes were analyzed both in the trading amount of essential medicines of the whole province and the drug use structure before and after the implementation of total prepay- ment system. Using non-probability sampling survey method in three selected sample counties, the online purchasing data of essential medicines in the area during January to October of 2012 was analyzed, and a comprehensive calculation was made on the average hospitalization cost and outpatient drug fee per time of the patients in the area. Results： Since the implemen- tation of the reimbursement of total prepayment system in the new rural cooperative medical service of our province（May of 2012）, the online purchasing amount of essential medicines and the drug use ratio of the top 10 in purchasing amount of the basic medical and health institutions declined month by month. The essential medicine purchase amount and the drug use ra- tio of the top 10 in purchasing amount in three sample counties declined month by month too. The average hospitalization cost and the outpatient drug fee per time decreased. Conclusion： The total prepayment reimbursement mode was proved ef- fective for the control of the essential medicine cost, and a further improvement needs to be made.