国家基本药物制度下的村卫生室处方费用及影响因素分析

Analysis on the Prescription Cost and the Influential Factors of Village Clinics under National Essential Medicine System

目的:分析国家基本药物制度作用下的村卫生室处方费用变化情况及影响因素,为完善村卫生室基本药物制度提供政策建议。方法:对湖北省公安县两个乡镇12个村卫生室国家基本药物制度实施前3 813张(2011年)和实施后2 217张(2012年)处方进行分析。结果:基本药物实施前后村卫生室平均处方费用分别为29.89元和21.69元,平均降低了8.20元,降低了27.43%(P<0.05)。在制度实施前,村民实付费用的处方有86.94%在集中在30元以下,实施后,村民实付费用在20元以下处方占到90.40%。对数线性回归分析表明,有12变量(处方用药数、静脉注射和使用抗菌素等)影响村卫生室处方费用,决定系数R2=0.772。结论:国家基本药物制度对村卫生室处方费用增长起到抑制作用,今后要加强村卫生室合理用药,以控制处方费用的增长。

Objective：To analyze changes of prescription cost and its influential factors in village clinics under National EssentialMedicine System（NEMS）, so as to provide policy suggestions for improving NEMS in village clinics.Methods：The 3 813（beforeNEMS in 2011） and 2217（after NEMS in 2012） prescriptions were surveyed from 12 village clinics of 2 townships in Hubei.Results：The average prescription costs were 29.89 yuan and 21.69 yuan before and after NEMS. The prescription costs decreased by 8.20 yuan and 27.43%（P0.05）. Before the implementation of NEMS, the out of pocket（OOP） costs of prescriptions below 30 yuan accounted for 86.94% while those below 20 yuan accounted for 90.40% after implementation of NEMS. According to the liner-regression analysis, 12 variables（including the number of prescription drugs, intravenous injection, antibiotics use, et al.） effected the costsof prescriptions（R2=0.772）.Conclusion：NEMS played active role on controlling the increase of prescription cost. It is needed tostrengthen the reasonable usage of medicine in village clinics, so as to control the increase of prescription cost.