南宁市基本药物制度实施前后十七家乡镇卫生院卫生服务变化分析  

Analysis of Health Service Change in Township Hospitals of Nanning, Guangxi Province Beofre and After the Implementation of National Essential Drug System

作　　者：赵锋[1] 杨洪伟[2] 林郅中 左延莉 田磊磊[1] 杨莉[1] 

机构地区：[1]北京大学公共卫生学院,北京100191 [2]卫生部卫生发展研究中心,北京100191 [3]广西省卫生厅药政处,南宁530021

出　　处：《中国卫生经济》2013年第1期28-30,共3页Chinese Health Economics

基　　金：国家自然科学基金面上项目71273016;教育部人文社会科学研究青年基金项目(10YJC630332);中澳卫生与艾滋病项目(HSS0907)

摘　　要：目的:研究国家基本药物制度实施前后乡镇卫生院服务量和患者费用的水平和趋势变化。方法:收集广西南宁市两区一县17家实行国家基本药物制度的乡镇卫生院2009—2011年连续36个月的月服务量和患者费用数据,使用分段时间序列回归分析估计乡镇卫生院医疗服务的变化,并结合关键人物访谈进行分析。结果:国家基本药物制度实施后,乡镇卫生院门急诊人次和出院人数水平增加趋势减小,门诊病人次均药品费用和出院病人人均药品费用水平下降趋势不变,门诊病人次均医疗费用水平不变趋势增加,出院病人人均医疗费用水平下降趋势增加。结论:国家基本药物制度实施后,禁止使用非基本药物而基本药物无法满足用药需求导致乡镇卫生院服务量出现下降,住院服务相对门诊服务受到更大冲击;患者药品费用下降,但医疗费用出现增加,患者看病负担并未减轻,可能与乡镇卫生院增加医疗服务种类和数量有关。Objective： To study the change of level and trend of patient visits and cost in township hospitals before and after the implementation of national essential drug system. Methods： Monthly patient visits and cost of 17 national essential drug system pilot township hospitals in two districts and one county, Nanning, Guangxi Province from 2009 to 2011 are collected, using interrupted time- series analysis to estimate the change of medical service and combining key person interviews. Results： After the implementation of national essential drug system, the level of outpatient visits and inpatient visits increased and the slope declined; the level of outpatients medicine cost and inpatients medicine cost declined and the slope didn＇t change; the level of outpatients medical cost didn＇t change and the slope increased; the level of inpatients medical cost declined and the slope increased. Conclusion： After the implementation of national essential drug system, that non-essential drugs cannot be used, essential drugs cannot meet the demand made patient visits decrease, and inpatient service was influenced more than outpatient service. Patients medicine cost decreased but patients medical cost increased, so the burden of patient cannot be lightened, which may be related to the increase of medical service amount and type.

关 键 词：基本药物制度 乡镇卫生院 分段时间序列回归分析 服务量 次均费用 南宁 

分 类 号：R197.6[医药卫生—卫生事业管理]