医疗机构执行“两票制”政策过程中存在的问题及对策研究——以云南省为例

Study on Problems and Countermeasures in Implementing “Two-invoice System” in Medical Institutions:a Case Study of Yunnan Province

目的:了解"两票制"政策在云南省医疗机构的执行情况及存在问题,为该政策的调整完善提供参考。方法:基于国家及云南省"两票制"等政策文件和相关文献研究,自行设计调查问卷,以率先执行"两票制"政策的云南省省级公立医院及部分州市公立医院改革试点城市的三级公立医院为对象,在2018年1-2月期间进行调查;由受访医疗机构的药品采购负责人填写问卷,调查内容包括受访单位的基本情况、"两票制"政策执行的基本情况、"两票制"政策的影响程度、其他问题及意见建议。针对"两票制"政策在医疗机构执行过程中存在的问题进行分析并提出对策建议。结果与结论:受访医疗机构共有39家,共发放问卷39份,回收有效问卷39份,有效回收率为100%。受访医疗机构均已执行"两票制"政策,但在执行过程中存在医疗机构验票的合规性与合法性不足、政策执行压力较大,"两票制"政策对降低药品价格的影响尚不显著,部分临床必需药品暂时无法执行"两票制"政策、加剧了药品短缺等问题。针对以上问题,建议采取完善票据监管、建立统一的第三方验票平台以确保验票工作的规范性,持续关注"两票制"政策对药品价格的影响并做好生产企业监督核查,妥善解决部分药品不能执行"两票制"政策的问题等对策,以进一步深入推进和优化执行"两票制"政策。

OBJECTIVE:To investigate the implementation and problems of the“two-invoice system”in medical institutions of Yunnan province and provide reference for policy adjustment and optimization.METHODS:The questionnaire was designed based on national and Yunnan province’s policy and literature research of“two-invoice system”.The questionnaire survey was conducted during Jan.-Feb.2018 among Yunnan provincial public hospitals where the policy of“two-invoice system”was implemented firstly and third-level public hospitals in the pilot cities of public hospital reform in some prefectures.Drug purchasing managers of the interviewed medical institutions filled out the questionnaire which covered the basic situation of the interviewed medical institutions,the implementation of the“two-invoice system”policy,the impact of the“two-invoice system”policy,other issues and suggestions.The problems existing in the implementation of the“two-invoice system”policy in medical institutions were analyzed and countermeasures were put forward.RESULTS&CONCLUSIONS:A total of 39 medical institutions were interviewed,and 39 questionnaires were distributed.39 valid questionnaires were obtained,with an effective rate of 100%.The interviewed medical institutions had implemented the“two-invoice system”policy.During the implementation of the system,medical institutions have insufficient compliance and legality in ticket inspection work,and the pressure on policy implementation is relatively high.The impact of the“two-invoice system”on reducing drug prices is not significant.Some clinically necessary drugs are unable to implement the“two-invoice system”temporarily,which has aggravated the shortage of drugs.Based on the above problems,it is recommended to improve the supervision of the bills,establish a unified“third party”ticket inspection platform to ensure the standardization of the ticket inspection work;continue to pay attention to the impact of the“two-invoice system”on drugs price,and do a good job of supervision and verification of manufacturers;solve the problem that some drugs cannot implement the“two-invoice system”properly so as to further promote and optimize the implementation of the“two-invoice system”policy.