药改新政背景下公立医院医疗费用结构变动研究

目的:分析药改新政背景下公立医院医疗费用结构变动情况,为完善控费政策提供参考。方法:利用结构变动度、结构变动值、结构变动贡献率及拉动力等指标,分析2015—2021年公立医院医疗费用结构变动情况。结果:2015—2021年,公立医院门诊次均费用增长36.4%、结构变动度19.11%,住院次均费用增长32.2%、结构变动度25.16%;药费的结构变动贡献率最大,但是对医疗费用的拉动力较小,对住院医疗费用的拉动力甚至为负。结论:药改新政背景下药费控制成效明显,但需接续发力,关注卫生材料费的变化,以药改推动医改持续深化。

药改建议探讨

我国是一个医药大国,有着数量众多的制药企业和药品种类,但是随着制药企业和医药行业的市场经济化,我国"就医难,买药贵"的现象逐渐凸显,并有愈演愈烈的趋势,严重影响和制约了我国广大人民生活质量的平均水平。如何完善药改制度,笔者提出自己的几点建议。

中国药改之“处方”——药改现在进行时

时至今日，医改已进行了整整20年，并且又一次站在了十字路口。在历史的节点上，或许可以看出：简单的否定和肯定，对于中国医改这一“疑难杂症”而言，只怕都过于轻率，它需要更大的耐心、智慧和勇气。那么到底医改该怎么改？中国的医疗改革的出路在哪里？人民的基本的医疗保障和法律赋予的生存权，下一步该如何保障？这是并非1＋1=2那么简单，需要全社会的智慧和参与。点击网页关于医改内容不计其数，我们且看各方谋略。

中国药改之“病理”——给药业“把脉”

都说药业病了，而且病得还不轻。按老百姓的话说，药价发高烧，并且持续不退。一段时间以来，政府关于药品的降价令、市场的平价药店的出现，医院的医药分家，似乎对高烧的药价都显得疗效不佳，看来这是一个不太好治的疑难病症。那么毛病到底出在什么地方呢？医药界人士、专家学者、媒体众说纷纭，归纳起来有以下几个方面的意见：

化学药口服改静脉注射给药非临床安全性研究评价要点

化学药口服制剂改为静脉注射制剂的非临床安全性研究中,如何利用已有的口服制剂的临床前和临床安全性资料,通过适当的非临床研究提示新途径下药物的安全性,是该类药物开发的重点。现结合审评经验和多次会议讨论情况,提出主要从活性物质改变、制剂改变和暴露量改变的角度考虑由口服改为注射带来的安全性担忧,并由此设计该类药物非临床安全性研究评价的思路。

医改前沿问题分析

医改是一个利益从新合理分配的问题,也就是医院、医务人员、生产商、配送商及患者五个关系的利益分配问题。建立和完善一整套科学规范体系是保障医改有效进行的关键性问题。

药品集中招标制度改革经济学思考

分析新医改推行的基本药品制度、药品集中招标制度、药品零差价制度、打击药品回扣、严格药占比考核等行政性改革举措,总结了药品集中招标制度改革中存在的9大问题,提出运用经济手段改善药品集中招标制度5个方面的建议。

Effect improvement of drug pricing reform based on multi-channel coordination

To improve the effect of the drug pricing reform,a business model of pharmaceutical e-commerce is introduced into the pharmaceutical supply chain.First,based on the measures of the drug pricing reform,a dual-channel model is established,consisting of a drugstore and a hospital.The analysis of the model indicates that the reform leads to higher costs for patients.Then,an e-pharmacy is added to the dual-channel supply chain.Meanwhile,to reduce the home-delivery cost of the e-pharmacy,a multi-channel coordination strategy called“order online,delivery by drugstore”is proposed.By comparing the optimal values under the two models with and without coordination strategy,respectively,the results show that the profits of the e-pharmacy and the drugstore increase while the retail prices of drugs drop,and a large number of patients are diverted from the hospital.Therefore,the business model of pharmaceutical e-commerce with multi-channel coordination can greatly improve the effect of the drug pricing reform.

Effect of Instant Asparagus Powder on Sleeping Disorder

[Objective] This study was to evaluate the efficacy of instant asparagus powder, a functional food made of asparagus, for improving sleep quality. [Method] A total of 60 volunteers were selected, and each of them consumed two bags of instant asparagus powder （24 g） once a day for 60 consecutive days. Then, the sleep quality of the volunteers was evaluated. At the same time, the safety indices and insomnia-related endocrine indices were determined. [Result] Instant asparagus powder significantly increased the sleep time of sleep disorders from 5.1 to 6.1 h, shortened the time to fall asleep from 50.4 to 25.3 rain, and reduced the time to fall asleep after being awake from 46.5 h to 19.5 h. The differences before and af- ter the consumption of instant asparagus powder were significant （P〈0.05）. The sat- isfaction of sleep quality was high. Instant asparagus powder had good safety with- out liver and kidney function influence. Instant asparagus powder could reduce the levels of cortisol and norepinepthrine and increase the levels of serotonin and dopamine. [Conclusion] Instant asparagus powder could improve the quality of sleep, characterized by safety and effectiveness. The sleep quality-improving effect of in- stant asparagus powder might be related to the regulation of HPA axis or the regu- lation of serotonin secretion.

Pharmacist Integration into Transitions of Care at a Community Hospital： Skilled Nursing Facility Discharges

In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliation process and to involve pharmacists in the transition of patients to SNFs. The objective of the project was to work as an interdisciplinary team to improve the communication during transitions of care from our hospital to local SNFs by identifying key issues and initiating pharmacy practice change. This quality improvement project had a pre-post study design. Patients older than 18 years of age discharged to SNFs and/or readmitted from SNFs within 30 days were included. Baseline data was collected, specific pharmacist interventions were identified, educated on and implemented, and post-implementation data was collected. The number of interventions made and documented by pharmacists for patients being discharged from CMH to local SNFs did not significantly change during this quality improvement study. Clinically significant interventions were made on high risk medications, such as warfarin. Finally, a newly redesigned SNF workflow was implemented to include pharmacy, nursing, social work/case management to improve patient care and safety for discharges to SNFs.

Pesticide Contamination in Land Reform Settlements in Brazil： Empirical Evidences from Caiaponia, Goias State

Brazil is the largest consumer of pesticides worldwide. Public health studies in Brazil show that inadequate use of pesticides increases the incidence of accidents and contamination of poor rural communities. This study sought to identify factors that determine the occurrence of problems with pesticides in a typical Brazilian land reform settlement. The study was carried out in Caiaponia, Goias state. In the empirical analysis, the econometric model pro bit was used. The dependent variable was the existence of health problems in the family setting that are caused by pesticides. The independent variables were the family size; the attendance to any church, whether Catholic or Protestant; if farmers received any technical assistance; the current health condition of the family, and if there are exacerbated erosion problems on the farm. Data from 28 farmers were collected through a structured questionnaire. Among the main findings, larger families have a higher probability of accidents involving pesticides. The current healthy conditions of family and the problems of soiled gradation in the farm imply are duction in the likelihood of contamination with pesticides. These two results indicate that rural households that have good health condition and have experienced environmental degradation on their farm have higher environmental awareness.

Trends on medicine use in county public hospitals in Sanming,China from 2011 to 2017

Sanming model in healthcare reform has attracted much attention due to its comprehensive and efficient exploration,while its impact on physicians’prescribing behavior remains unknown.In the present study,we aimed to evaluate the impact of Sanming reform on physicians’medicine use in county-level public hospitals.We collected outpatient prescriptions in the internal medicine and pediatric departments from nine county public hospitals in Sanming from January 2011 to December 2017.We used six prescribing indicators to analyze physicians’medicine use.The Mann-Kendall test was used to examine trends in the study outcomes.A total of 1577904 outpatient prescriptions were included in this study.The average prescription rate of antibiotics and combined antibiotics were 57.5%and 12.2%in 2011,respectively,which were declined to 28.2%(P=0.007)and 2.9%(P=0.003)in 2017,respectively.The average prescription rate of injection was 30.2%in 2011 and declined to 5.3%(P=0.003)in 2017.As for the subgroup analysis of the internal medicine and pediatric departments,the average prescription rate of antibiotics was 39.3%and 71.4%in 2011,respectively,which was declined to 10.2%(P=0.003)and 47.3%(P=0.035)in 2017,respectively.The average prescription rate of combined antibiotics was 15.9%and 9.4%in 2011,respectively,which was declined to 2.9%(P=0.003)and 2.9%(P=0.016),respectively.The average prescription rate of injection was 17.8%and 39.6%in 2011,respectively,which was declined to 1.9%(P=0.003)and 9.0%(P=0.003),respectively.Our study showed a significant decreasing trend in antibiotic use in county-level public hospitals after the Sanming healthcare reform,indicating that the reform successfully promoted the appropriate use of medicine to some extent.

The impacts of national essential medicine policies on the rational use of medicines in China: A cross-sectional study in primary health care institution

Irrational use of medicines is a major problem worldwide, and it is believed there would be positive correlation between the National Essential Medicines Policies(NEMPs) and the level of rational use of medicines(RUMs). Though there is some early evidence on the NEMPs’ effects on RUMs in China, the evidence is scarce, and conclusions vary. In the present study, we aimed to evaluate the impacts of the NEMPs of China on the RUMs in the primary health care institutions(PHCs). A cross-sectional survey was conducted in 2010. A total of 201 PHCs from six provinces of China were selected, and 39 181 prescriptions were extracted from January to June, 2010. Six indicators were used and tested by independent-samples T test. We found that the average number of drugs per prescription in PHCs with NEMP implementation(the treatment group) was significantly higher than that of the group without NEMP implementation(the control group)(3.37 vs. 2.83, P<0.01). There was no significant difference in the average cost per prescription(81.43 vs. 75.02). The percentage of prescriptions, including an antibiotic(53.40% vs. 36.48%, P<0.01) or an injection(40.54% vs. 27.94%, P<0.01), was higher in the treatment group, and the percentage of drugs prescribed by general name was significantly lower(83.71% vs. 93.11%, P<0.01). For the percentage of drugs prescribed from essential medicines list, the treatment group exhibited the higher ratio(76.12% vs. 53.45%, P<0.01). From this study, the NEMPs were not likely to have a positive impact on RUMs. China still needed efforts to improve the selection, the absence of physicians’ active involvement, and the patients’ habits of irrational medication use.