北京市严重精神障碍患者免费服药现况分析及展望

Analysis and prospect of free medication for severe mental disorders in Beijing

目的分析2013—2020年间北京市免费服药服务情况与变化趋势,提出政策和服务改善措施。方法采用回顾性调查,收集和分析各区近年来免费服药服务对象、服务流程、药品目录、经费投入等情况。结果北京16区中,81.25%的区将《精神卫生法》第三十条第二款第(二)项情形患者纳入免费服药范围,75%的区突破服务对象为北京户籍的限制。56.25%的区提供多种免费服药模式,81.25%的区提供就近在社区服务的模式。各地区免费服药目录仍以北京市目录为蓝本,仅有18.75%的区对目录进行增补。2020年,免费服药药品和补助总投入为8837.68万元,人均投入为1616.02元,总费用呈逐年增长趋势;2013—2020年间,分区人均年度药品和补助财政投入经费差异有统计学意义(F=9.248,P<0.001),人均费用除个别年度外,基本呈现逐年增长势态。2020年北京市免费服药服务参与人数达54688人,参与率为67.23%;2013—2020年间,分年度患者参与率差异有统计学意义(χ^(2)=37098.759,P<0.001),患者参与人数及参与比例呈逐年增长趋势。结论扩大免费服药服务对象范围、优化服务流程,区级实践已证明可行,北京市在今后政策调整中可予重点关注。随着政策和服务不断推进,各地患者参与水平在逐年上升后将趋于相对平衡。

Objective To analyze the situation and changing trend of free medication service in Beijing from 2013 to 2020,and to propose policies and service improvement measures.Methods A retrospective survey was conducted in Beijing to collect and analyze the service subjects,service process,drug catalog,fiscal investment and patient participation of free medication in each district in recent years.Results Among the 16 districts of Beijing,81.25%of the districts included the patients listed in Item(2)of Paragraph 2 of Article 30 of the Mental Health Law into the scope of free medication,and 75%of the districts broke the restriction that the service targets were registered residents in Beijing.56.25%of the districts provided a variety of free medication modes,and 81.25%of the districts provided a mode of nearby community service.The catalog of free medications in various areas was still based on the Beijing catalog,and only 18.75%of the districts supplemented the list.In 2020,the total investment of free medicines and subsidies was 8837.68 million RMB,and the per capita investment was 1616.02 RMB.The total cost showed an increasing trend year by year.From 2013 to 2020,the difference of per capita annual financial investment in drugs and subsidies was statistically significant(F=9.248,P<0.001).The per capita cost basically showed an increasing trend year by year except for individual years.In 2020,54688 patients participated in the free medication service in Beijing,and the participation rate was 67.23%.From 2013 to 2020,the difference of annual participation rate of patients was statistically significant(χ^(2)=37098.759,P<0.001),and the number and proportion of patients increased year by year.Conclusion The practice of the district level has proved feasible to expand the scope of free medication service and to optimize the service process,which should be paid more attention in the future.With the continuous advancement of policies and services,the level of patient participation in various areas will tend to be relatively balanced after rising year by year.