基于国际经验的我国“医药分业”研究及启示

Study and Enlightenment on “Separation of Prescribing and Dispensing” in China Based on International Experiences

目的:为进一步推进符合我国国情的"医药分业"政策实施提供参考。方法:基于文献研究、知情人访谈及实地考察和调研等研究方法,比较东、西方典型国家"医药分业"的不同发展状况,探讨我国实施"医药分业"的制约因素,总结"医药分业"的国际经验对我国的启示。结果与结论:我国实施"医药分业"存在着以下四方面制约因素:药师职业化发展缺乏法律体系支撑;医药价格体系和医院筹资体系不合理;患者处方所有权和调剂选择权被医院垄断;患者用药安全难以保障。我国"医药分业"改革需遵循社会和经济发展规律,适时、因地制宜地推进,但仅靠"医药分业"一项措施不可能实现控制医疗费用和合理用药的目标。要更好地实现改革既定目标,还应加速《药师法》立法,明确药师责任,通过经济杠杆引导医师用药行为。

OBJECTIVE： To provide reference for further promoting the implementation of ＂separation of prescribing and dispensing＂ policy which fit China＇ s national conditions. METHODS： Based on literature review, informant interview, and filed investigation the development of ＂separation of prescribing and dispensing＂ were compared between typical eastern and western countries. Constraints of ＂separation of prescribing and dispensing＂ in China were explored, international successful experiences were summarized to inspire appropriate implementation of this policy in China. RESULTS ＆ CONCLUSIONS： There are four constraints in the implementation of ＂separation of prescribing and dispensing＂ in China. Firstly, the legal foundation is yet established for the professional development of pharmacists. Secondly, the medicine pricing and hospital financing systems are unreasonable. Thirdly, patients＇ ownership of prescriptions and right of dispensing options are monopolized by hospitals. Fourthly, safety of medicines use is yet ensured. ＂Separation of prescribing and dispensing＂ should follow the rules of social and economic development and should be adjusted to adapt local conditions. ＂Separation of prescribing and dispensing＂ policy itself may not help to achieve the objectives of cost containment and rational use of medicines. To achieve the intended objectives, legislation of Pharmacist Law should also be accelerated to clearly define the role of pharmacist and guide the behavior of prescribers with economic levers.