国家基本药物制度实施对乡镇卫生院影响的调查分析

Study on the Effect of Implementation of National Essential Drug System on the Township Hospitals

目的:了解国家基本药物制度实施前后乡镇卫生院服务量和收入的变化趋势,为进一步推进该项制度的实施提供参考。方法:从2008-2013年卫生统计年鉴中摘取乡镇卫生院有关数据进行分析;并对山东省4所乡镇卫生院院长进行定性访谈,将访谈结果与年鉴分析结果加以对比验证。结果:卫生统计年鉴显示,乡镇卫生院服务量2007-2009年持续上升,2009-2011年下降趋势明显,2011-2012年又有显著回升;而乡镇卫生院收入在2008-2012年保持持续上升。实地调研的4所乡镇卫生院中有3所在服务量和收入的变化上与卫生统计年鉴中全国总体数据保持一致。结论:乡镇卫生院实施国家基本药物制度经过一段适应期后,该项制度的优越性开始显现,群众医疗需求得到初步释放;收入结构中政府财政补助收入占比逐渐增加,药品收入占比下降明显。财政补助必须及时、到位发放;国家基本药物制度及其配套政策仍有待继续完善。

OBJECTIVE：To study the change of patients＇ visits and income trends in township hospitals before and after the implementation of national essential drug system（NEDS） and provide reference for further improvement of NEDS. METHODS：Relevant data from health statistics yearbook（2008-2013）was collected and analyzed;qualitative interview was conducted for the heads of 4 township hospital in Shandong,the results were comparatively validated with yearbook analysis results. RESULTS：Health statistics yearbook showed that the patients＇ visits in township hospitals were continually increased from 2007 to 2009. It had a significant decline trend from 2009 to 2011 and a significant rebound from 2011 to 2012. The income in township hospitals kept continually rising from 2008 to 2012. The change of patients＇ visits and income in 3 township hospitals among the field research of 4 township hospitals were consistent with the health statistics yearbook data. CONCLUSIONS：The superiority of NEDS begins to emerge after the adjustment period of the NEDS implementation in township hospitals,medical needs of people have been initially released. Besides,the proportion of government financial assistance income in the income structure is gradually increased and the drug income is significantly decreased. The financial assistance must be in time and in place. The NEDS and its supporting policies still need to be further improved.