总额预付制对药品消耗的影响研究

Study on the Effects of Total Cost Prospective Payment System on the Consumption of Drugs

目的:了解总额预付制实施后的药品消耗情况,为控制医院药品费用提供参考。方法:采集2007-2014年9家样本医院的处方数据,按照总额预付制实施时间分为A、B、C 3组,统计汇总各组样本医院药品总销售金额增长率,大类药品销售金额占比,门诊、急诊、住院患者次均药费和自费药品销售金额占比,并计算2009-2013年高血压、糖尿病用药单次处方剂量。结果:实施总额预付制后,各样本医院药品总销售金额增长趋缓;大类药品销售金额占比基本稳定,抗感染药销售金额占比下降;急诊患者次均药费实现负增长,门诊、住院患者次均药费略有上升;自费药品金额占比相对稳定;高血压、糖尿病药品单次处方剂量稳定。结论:总额预付制有助于控制药品费用的过快增长,在一定程度上促进了药物合理利用,且对自费药品销售金额控制较好,但门诊、住院患者次均药费的上升应引起相关部门的注意。总额预付制不影响高血压、糖尿病患者用药量。

OBJECTIVE：To investigate the consumption of drugs after the inplementation of total cost prospective payment system（PPS）,and to provide reference for hospital drug cost control. METHODS：The data of prescriptions collected from 9 hospital during 2007-2014 were divided into group A,B and C according to PPS,and then summarized statistically in respects of increase rate of total consumption sum,consumption sum ratio of major category;the drug cost per time of outpatient department,emergency department and inpatient department were calculated as well as consumption sum ratio of self-paid drugs;the dosage per time of drugs in blood pressure and diabetes prescription were also calculated. RESULTS：The total consumption sum of drug increased slowly after the implementation of total cost PPS;the consumption sum ratio of major category kept stable,while that of anti-infective agent decreased;the emergency drug cost per time achieved a negative growth,and outpatient and inpatient drug cost per time increased slightly. The proportion of self-paid drugs was relatively stable. The dosage per time of drugs in hypertension and diabetes prescriptions was stable,too. CONCLUSIONS：Total cost PPS is useful in controlling the rapid growth of drug costs,and promote the reasonable drug use. The consumption sum of self-paid drugs are well controlled. The increase of drug cost per time in outpatient and inpatient should arouse the attention of the relevant departments. In addition,it has no effect on drug dosage for the patients with hypertension and diabetes.