药品集中采购政策改革试点效果评析——以福建省三明市为例

Policy effectiveness analysis of pilot reform in centralized drug purchasing: Case study of Sanming City,Fujian Province

目的：分析三明市2012--2014年公立医院药品采购政策并评价其成效，为完善我国公立医院药品采购政策提供参考。方法：通过三明市卫生局官方网站、实地调研和问卷调查获取相关资料；运用政策链理论分析其政策形成过程，定量与定性评价药品采购、药品费用及公立医院运营变化。结果：（1）三明市药品集中采购政策具有三个阶段性特征：强化药品集中采购管理体系；取消药品加成、理顺医疗服务价格；建立药品集中采购、统一配送方案。（2）药品集中采购价格方面，药品及时回款，量价挂钩；同口径l796个品规平均价格下降8％。（3）改革前2011年全市公立医院药占比为47％，改革后2012_2014年上半年分别为42％、31％和28％。（4）全市公立医院改革后2012_2014年门诊及入院人次年增幅介于4％～15％之间。结论：三明市通过“三医联动”，基本建立起以医保机构为主体，“两票制”、“招采合一”为特色的公立医院药品采购政策体系；改革后公立医院运行平稳，在降低药品价格与控制药品费用方面取得了初步成效。

Objective： This study takes drug purchasing reforms of public hospitals in Sanming City as an exam- pie to analyze policy formation and evaluate its effectiveness from 2012 to 2014, so as to provide reference for the im- provement of drug purchasing policies of public hospitals in China. Methods： Data was collected from the official website of the Sanming Bureau of Health, as well as field surveys and questionnaire research. The policy chain theory was applied to analyze the forming process of policies, and quantitative and qualitative evaluations were made on the variation of drug purchasing, expenditure and public hospital operations. Results： （ 1 ） There are three periodical characteristics of drug centralized purchasing policies, including the strengthening of management system of drug cen- tralized purchasing policies, the canceling of drug price additions, the rationalizing of medical service prices, and the establishment of centralized drug purchasing and distribution solutions. （2） In terms of the pricing of drug purcha- sing, the price of 1 796 types of drug in the same specification has decreased 8%. （3） Regarding the drug propor- tion of public hospitals in the entire city, before the reform it was 47% in 2011, and in the first halves of 2012-- 2014 the percentages were 42%, 31% and 28%, respectively. （4） Regarding the operation of public hospitals in the entire city, after the reform, the rise of attendances at outpatient and hospital admissions was within 4% -15%.Conclusions ： Through the three interactive reforms between medical insurance, hospitals ana arug OlStnOuuon, oan- ruing City has basically set up a policy system. After the reform, the public hospitals have been operating smoothly and achieved preliminary benefits in reducing drug prices and in controlling drug expenses, which can provide some reference to other regions.