促进基本药物制度落实的杭州零自付方案评价及政策思考  

Evaluation on the key policy issues of zero out-of-pocket program implementation of essential medicines system in Hangzhou

作　　者：张新平[1] 谭亚莉[1] 田昕[1] 

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030

出　　处：《中国卫生政策研究》2010年第6期9-13,共5页Chinese Journal of Health Policy

基　　金：中国药学会资助课题

摘　　要：目的:了解基本医疗用药零自付方案的实施情况,分析基本药物的报销关键政策问题。方法:访谈了10名参与设计与实施零自付方案的专家,随机抽取两所医疗机构试点前后处方457张,开展了60人的居民调查。结果:杭州基本药物"零自付"制度设计科学、适宜、前瞻,实施平稳,各方对此方案的总体设计评价较好;但由于起付线、目录品种等原因在2008、2009两年间没有测量到处方基本药物使用率的改进,该指标处于30%左右;同时也发现在制度落实中存在一些亟待解决的问题,包括政策宣传力度不够,现有目录品种较少,起付线过高等。结论:基本药物零自付方案短期内促进基本药物的使用效果不明显,也说明基本药物制度目标的实现不可能一蹴而就。建议:基本药物报销应不设起付线,非基本药物报销应与基本药物相区别,不同人群应有不同报销政策。Objective：This article is to understand zero out-of-pocket program implementation of essential medicines,and to analyze key policy issues of reimbursement of essential medicines. Methods：10 experts,who were involved into the design and implementation of zero out-of-pocket program; two medical institutions were randomly selected to analyze 457 prescriptions before and after the pilot; and 60 residents were surveyed. Results：The zero out-of-pocket system design for essential medicines in Hangzhou is scientific,appropriate and foresighted. The overall design of this program was implemented smoothly and well appraised. However,for the deductibles,catalog lists and other reasons,the system was not successful to promote essential medicines use between 2008 and 2009,the indicator is about 30%,and there are some problems in the implementation of the system must to be resolved,including the poor policy promotion,fewer available amount of essential medicines list and high deductive. Conclusions：The zero out-of-pocket plan is not sure to promote essential medicines use in short time,in other words,this also explains the goals of essential medicines system can not be done overnight. Recommedations：The essential medicines＇ reimbursement should not be set deductive; ratio of reimbursement between non-essential medicines and essential medicines should be distinguished; different populations should have different reimbursement policies.

关 键 词：基本药物制度 报销 零自付 

分 类 号：R951[医药卫生—药学]