基本药物制度实施后村卫生室门诊服务变化比较——基于东、中、西部6省的抽样调查

Comparison on the change of outpatient service in village clinics after the implementation of essential medicines system: A sample survey of 6 provinces in eastern,central and western China

目的：比较基本药物制度实施前后东、中、西部6省村卫生室门急诊人次、次均药品费用和次均医药总费用的变化。方法：收集6省130个村卫生室2009--2011年连续36个月的门诊服务监测数据，使用分段时间序列模型进行回归分析。结果：2011年与2009年相比，6省村卫生室门诊次均药品费用、次均医药总费用均下降，降幅约在15％-70％之间，东部的浙江和中部的安徽降幅最大；门急诊人次变化的瞬时水平和长期趋势各省均不相同。结论：国家基本药物制度在村卫生室实施后，各省村卫生室次均药品费用和次均医药总费用的下降幅度存在较大差异，门急诊人次的变化也不尽相同，可能与补偿模式、“新农合”报销范围、乡村一体化管理实施进度、基本药物配备情况、乡村医生待遇等多种因素有关。

Objective：To compare the change and trend, before and after the implementation of national essen- tial medicines system, of outpatient and emergency visits, drug cost per time and total medical cost in village clinics of six provinces located in eastern, central and western China. Methods ： By means of segmented time series analysis, the surveillance data of 36 months from January of 2009 to December of 2011 on 134 village clinics were explored Results： In 2011, both drug costs per time and total medical cost in outpatient visit declined distinctly about 15% to 70% in each province, compared with the same index in 2009. Zhejiang and Anhui, respectively located in eastern and central China, presented the largest amplitude. While the instantaneous change and the secular trend of outpa- tient and emergency visits in each province presented huge differences. Conclusion： After the implementation of na- tional essential medicines system in village clinics, the decline of drug costs per time and total medical cost in outpa- tient visit had different situation among provinces and districts, so did the change of outpatient and emergency visits. It may be related to the provinces economic and social development level, the essential drugs system pilot model, the compensation mechanisms, and also associated with the implementation of rural health service integration management and the cooperation of the New Rural Cooperative Medical Scheme.