四川省县级公立医院药品零差率政策效果评价研究

Analyzing the Effects of Implement the Zero-markup Drug Policy in County-level Public Hospital in Sichuan Province

目的：评价和分析四川省县级公立医院实施药品零差率政策后对降低医药费用和医生用药行为的影响,为完善相关政策提供依据。方法：从四川省27家试点县级公立医院随机抽取6家试点县级公立医院进行现场调查,并抽取了6家医院2012~2013年共计720张门诊处方进行分析。结果：实施药品零差率政策后,县级公立医院药品加成率大幅度下降;次均住院药品费用及其构成下降;门诊次均费用和门诊次均药品费用绝大多数医院有所上升,门诊处方药品费用略有增加。医生用药行为仍然逐利,处方中自费用药的构成比上升,而基本药物构成比下降。结论：控制药品价格关键还是在于消除药品＂返点＂和＂回扣＂,提高医生待遇,加强医生不道德行为的监管,推进医疗费用支付方式改革,规范医院和医生行为。

Objective To study the impact of zero-markup drug policy on medical expenditure reduction and prescribing behav- ior of doctor in county-level public hospital, and provide references for the implement of relevant policy. Methods Field survey was conducted in six county-level public hospital in Sichuan province which was selected randomly form 27 reform hospitals. About 720 outpatient prescriptions were selected as sample to compare the prescription charges before and after zero-markup drug policy im- plement. Results After the zero-markup drug policy was implemented, the average medical expenditure per outpatient visit, the aver- age drug expenditure per outpatient visit and the average drug expenditure per prescription have increased in most county-level public hospital. The average drug expenditure per inpatient visit has decreased in some of county-level public hospital. Doctors still prescribe the receipt according to their profit. The constituent ratio of self-funded medicines has decrease and the constituent ratio of essential medicine rose. Conclusion The most important measure to reduce drug prices is to cleanse commercial rebate of drugs. We should develop the salary system of doctor in public hospital, improve prescription management and promote reasonable drug and implementation payment reform.