江西省县级公立医院取消药品加成政策利弊分析

Research on the Positive and Negative Effects of Cancel Drug Addition in the Pilot Public Hospital in Jiangxi Province

目的:分析江西省县/市级公立医院取消药品加成的正负效应,探讨解决问题的对策。方法:根据江西省不同地区人均GDP水平,在取消药品加成试点的13个县/市中抽取兴国、贵溪、新干三县/市的公立医院进行问卷调查和座谈。结果:试点县/市调查对象对取消药品加成措施持赞成态度者为79.05%,45.27%的人认为该措施可减少患者医药负担;与取消加成前(2011年)比较,2013年药品收入占业务总收入的比例净降4.87%;医疗收入比例,净增3.43%,其中相对增长比最高的前三位依次是诊疗费(115.44%)、卫生材料与其他收入(99.72%)、治疗费(71.10%)。结论:取消药品加成对规范医生用药行为、减轻患者药费负担、切断药商与医院不正当的利益链、实现"以药养医"向"以技养医"转变等有一定作用;但医疗收入中有些项目增长过快;部分人认为该措施对公立医院降低医疗费用的效果不明显或没有效果,文章就如何推进县级公立医院改革提出了针对性建议。

Objective This article intended to analyze the positive and negative effects of cancel drug addition and its counter- measures. Methods Pilot public hospital of 13 county/city have cancelled drug addition reform in Jiangxi province, and we did sur- vey and discussion in three of them according to different GDP per capita level, by random sampling. Results 79.05 % persons sup- ported this reform and 45.27% of them thought it could reduce the medical burden of patients, the proportion of drug income ac- counted for total income dropped 4.87% ,while the proportion of medical income gained 3.43%. The top three fee grew fast were the diagnosis （ 115.44% ）, medical supplies and other income （99.72%） , treatment （71.10% ）. Conclusion It had certain effect to regulate the behavior of a doctors medication, reduce the patients＇ medical burden, cut off the benefit chain of drug seller and the hospital improper ,realize shift from ＂drug revenue support hospital operation＂ to＂technology revenue support hospital operation＂, but some other medical income were growing too fast than expected ; a lot of people thought that it had no effect on reducing health care costs in public hospital. This article proposed how to push on the reform.