江蘇省世行衛(wèi)十一項(xiàng)目縣鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施基本藥物制度后的監(jiān)測評價(jià)
發(fā)布時(shí)間：2018-09-09 14:22
【摘要】：目的：通過分析六個(gè)項(xiàng)目縣鄉(xiāng)鎮(zhèn)衛(wèi)生院在基本藥物制度實(shí)施前后的經(jīng)濟(jì)運(yùn)行、基本醫(yī)療服務(wù)提供行為(包括服務(wù)數(shù)量、效率、費(fèi)用)、用藥合理性的變化,發(fā)現(xiàn)基本藥物實(shí)施效果與預(yù)期目標(biāo)之間的差距,并進(jìn)一步分析差距產(chǎn)生的原因,探討影響基本藥物實(shí)施效果的因素,提出進(jìn)一步完善基本藥物實(shí)施方案的政策建議,為深化我國醫(yī)藥衛(wèi)生體制改革提供建議。 方法：通過調(diào)查六個(gè)項(xiàng)目縣衛(wèi)生局衛(wèi)生統(tǒng)計(jì)數(shù)據(jù)信息、衛(wèi)生統(tǒng)計(jì)年鑒獲得相關(guān)數(shù)據(jù)資料,對六個(gè)項(xiàng)目縣實(shí)施基本藥物制度的所有鄉(xiāng)鎮(zhèn)衛(wèi)生院2009-2012年的基本醫(yī)療、財(cái)務(wù)收支狀況以及人力資源情況的各項(xiàng)指標(biāo)進(jìn)行縱向趨勢和同期橫向的比較與分析。隨機(jī)抽取兩個(gè)項(xiàng)目縣,每個(gè)項(xiàng)目縣的鄉(xiāng)鎮(zhèn)衛(wèi)生院采用分層抽樣法,按經(jīng)營狀況最好、中等、最差分層,每層抽取1家衛(wèi)生院。抽取上述六家樣本鄉(xiāng)鎮(zhèn)衛(wèi)生院基本藥物實(shí)施前一年和基本藥物實(shí)施后一年各100張?zhí)幏?進(jìn)行合理用藥情況的研究。 結(jié)果：江蘇省項(xiàng)目縣鄉(xiāng)鎮(zhèn)衛(wèi)生院在基本藥物制度實(shí)施后2012年與實(shí)施前2009年相比：①縣均總收入、財(cái)政補(bǔ)助收入、業(yè)務(wù)收入與醫(yī)療收入均呈上升趨勢�？h均總收入增長67.89%,縣均財(cái)政補(bǔ)助增長了542.55%,縣均業(yè)務(wù)收入增長了11.36%,縣均醫(yī)療收入增長了49.23%。藥品收入占業(yè)務(wù)收入的比例有所下降,但藥占比水平仍較高,超過51%。項(xiàng)目縣縣均總支出呈上升趨勢,其中縣均業(yè)務(wù)支出、醫(yī)療支出、藥品支出均增加。從支出結(jié)構(gòu)來看,醫(yī)療支出增長較快。收支結(jié)余中,縣均總收支結(jié)余減小,業(yè)務(wù)收支虧損嚴(yán)重。藥品收支結(jié)余大幅度下降�？h均總負(fù)債從3556.20萬元上升至6285.60萬元。②縣均基本醫(yī)療服務(wù)量增加,門急診人次上升33.79%,出院人次上升4.39%。縣均基本醫(yī)療服務(wù)費(fèi)用有所下降,次均門診費(fèi)用下降10.19%,次均門診藥品費(fèi)用下降21.43%,次均住院費(fèi)用下降8.3%,次均住院藥品費(fèi)用下降19.92%�？h均基本醫(yī)療服務(wù)效率則有所降低。③縣均職工總數(shù)、人員支出、人員支出占業(yè)務(wù)收入的比例、人員支出占業(yè)務(wù)支出的比例、人均人員支出以及每職工平均業(yè)務(wù)收入都有所增加。④每張?zhí)幏接盟幤贩N數(shù)、抗菌藥物使用率、激素使用率、不合格處方率均有所下降。 結(jié)論：江蘇省六個(gè)項(xiàng)目縣鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施基本藥物制度已經(jīng)有一定成效,但仍然存在一定問題,表現(xiàn)為業(yè)務(wù)收支虧損嚴(yán)重,醫(yī)療服務(wù)效率下降,資產(chǎn)負(fù)債率上升,不合理用藥情況依然嚴(yán)峻。建議繼續(xù)加大政府財(cái)政投入,調(diào)整醫(yī)療服務(wù)收費(fèi)價(jià)格,科學(xué)制定激勵(lì)方案,建立國家基本藥物制度的動(dòng)態(tài)考核評價(jià)機(jī)制,加強(qiáng)合理用藥的宣傳與培訓(xùn)。
[Abstract]:Objective: to analyze the economic operation, the behavior (including the quantity, efficiency, cost) of the basic medical service supply and the change of the rationality of the drug use in the township health centers of six project counties before and after the implementation of the essential drug system. To find the gap between the implementation effect of essential drugs and the expected target, and to further analyze the causes of the gap, to explore the factors that affect the implementation effect of essential drugs, and to put forward policy recommendations to further improve the implementation scheme of essential drugs. To provide suggestions for deepening the reform of medical and health system in China. Methods: by investigating the health statistics data of six project county health bureaus and obtaining the relevant data from the health statistics yearbook, the basic medical treatment of all township health centers in the six project counties that implemented the essential drug system in 2009-2012 was analyzed. Financial income and expenditure as well as human resources indicators of the vertical trend and horizontal comparison and analysis of the same period. Two project counties were randomly selected. The township health centers in each project county adopted stratified sampling method. According to the best, middle and worst levels of management, one hospital was selected from each level. One year before and one year after the implementation of essential drugs, 100 prescriptions were taken from the above six sample township hospitals to study the rational use of drugs. Results: after the implementation of the essential drugs system in Jiangsu Province, the average income, financial subsidy income, business income and medical income of county 1 in 2012 were higher than those in 2009. The county average income increased by 67.89, the county average financial subsidy increased by 542.55, the county average business income increased by 11.36, and the county average medical income increased by 49.23. Drug revenue as a proportion of business income has declined, but the drug proportion level is still high, more than 51. The total expenditure of project county and county is on the rise, among which county average business expenditure, medical treatment expenditure and drug expenditure are all increasing. From the expenditure structure, medical expenditure growth is faster. In income and expenditure balance, county average income and expenditure balance decreases, business income and expenditure loss is serious. The balance of income and expenditure on drugs fell by a large margin. The average total debt of county increased from 35.562 million yuan to 62.856 million yuan. 2. The amount of basic medical service increased, the person-time of outpatient and emergency increased 33.79%, and the number of people discharged from hospital increased 4.39%. The cost of basic medical service decreased, the average outpatient cost decreased 10.19%, the average outpatient drug cost decreased 21.43%, the average hospitalization cost decreased 8.3%, and the average hospitalization drug cost decreased 19.92%. On the other hand, the efficiency of basic medical services at county level decreased to a certain extent. 3. The total number of staff and workers per county, the proportion of personnel expenditure to business income, and the proportion of personnel expenditure to business expenditure, The per capita personnel expenditure and the average business income per worker increased by 4. 4 per prescription variety, antimicrobial use rate, hormone use rate and unqualified prescription rate were all decreased. Conclusion: the implementation of the essential drugs system in the township hospitals of the six project counties in Jiangsu Province has achieved some results, but there are still some problems, such as the serious loss of business income and expenditure, the decline of medical service efficiency, and the increase of the ratio of assets and liabilities. Unreasonable use of drugs is still serious. It is suggested that the government should continue to increase government financial input, adjust the price of medical service charges, scientifically formulate incentive schemes, establish a dynamic assessment and evaluation mechanism of the national essential drug system, and strengthen the propaganda and training of rational use of drugs.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R95
本文編號：2232640
[Abstract]:Objective: to analyze the economic operation, the behavior (including the quantity, efficiency, cost) of the basic medical service supply and the change of the rationality of the drug use in the township health centers of six project counties before and after the implementation of the essential drug system. To find the gap between the implementation effect of essential drugs and the expected target, and to further analyze the causes of the gap, to explore the factors that affect the implementation effect of essential drugs, and to put forward policy recommendations to further improve the implementation scheme of essential drugs. To provide suggestions for deepening the reform of medical and health system in China. Methods: by investigating the health statistics data of six project county health bureaus and obtaining the relevant data from the health statistics yearbook, the basic medical treatment of all township health centers in the six project counties that implemented the essential drug system in 2009-2012 was analyzed. Financial income and expenditure as well as human resources indicators of the vertical trend and horizontal comparison and analysis of the same period. Two project counties were randomly selected. The township health centers in each project county adopted stratified sampling method. According to the best, middle and worst levels of management, one hospital was selected from each level. One year before and one year after the implementation of essential drugs, 100 prescriptions were taken from the above six sample township hospitals to study the rational use of drugs. Results: after the implementation of the essential drugs system in Jiangsu Province, the average income, financial subsidy income, business income and medical income of county 1 in 2012 were higher than those in 2009. The county average income increased by 67.89, the county average financial subsidy increased by 542.55, the county average business income increased by 11.36, and the county average medical income increased by 49.23. Drug revenue as a proportion of business income has declined, but the drug proportion level is still high, more than 51. The total expenditure of project county and county is on the rise, among which county average business expenditure, medical treatment expenditure and drug expenditure are all increasing. From the expenditure structure, medical expenditure growth is faster. In income and expenditure balance, county average income and expenditure balance decreases, business income and expenditure loss is serious. The balance of income and expenditure on drugs fell by a large margin. The average total debt of county increased from 35.562 million yuan to 62.856 million yuan. 2. The amount of basic medical service increased, the person-time of outpatient and emergency increased 33.79%, and the number of people discharged from hospital increased 4.39%. The cost of basic medical service decreased, the average outpatient cost decreased 10.19%, the average outpatient drug cost decreased 21.43%, the average hospitalization cost decreased 8.3%, and the average hospitalization drug cost decreased 19.92%. On the other hand, the efficiency of basic medical services at county level decreased to a certain extent. 3. The total number of staff and workers per county, the proportion of personnel expenditure to business income, and the proportion of personnel expenditure to business expenditure, The per capita personnel expenditure and the average business income per worker increased by 4. 4 per prescription variety, antimicrobial use rate, hormone use rate and unqualified prescription rate were all decreased. Conclusion: the implementation of the essential drugs system in the township hospitals of the six project counties in Jiangsu Province has achieved some results, but there are still some problems, such as the serious loss of business income and expenditure, the decline of medical service efficiency, and the increase of the ratio of assets and liabilities. Unreasonable use of drugs is still serious. It is suggested that the government should continue to increase government financial input, adjust the price of medical service charges, scientifically formulate incentive schemes, establish a dynamic assessment and evaluation mechanism of the national essential drug system, and strengthen the propaganda and training of rational use of drugs.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R95
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 高開焰;;貫徹國家基本藥物制度 推行基層衛(wèi)生綜合改革[J];安徽醫(yī)學(xué);2010年04期
2 周綠林;范馨;詹長春;楊揚(yáng);;實(shí)施國家基本藥物制度對基層醫(yī)療機(jī)構(gòu)的影響研究[J];重慶醫(yī)學(xué);2013年05期
3 唐露露;丁宏;何振仿;孫昕;;我國基本藥物制度實(shí)施現(xiàn)狀 問題及建議[J];安徽醫(yī)學(xué);2013年03期
相關(guān)博士學(xué)位論文 前1條
1 葉露;國家基本藥物政策研究[D];復(fù)旦大學(xué);2008年
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