基药政策变化对患者就医流向影响的实证研究  

Empirical Study on The Influence of Basic Drug Policy Changes on Patients’Medical Treatment

作　　者：张鑫苗 郝文丽 王思琦 原效国 关超 李建涛[1] Zhang Xinmiao(Shanxi Medical University,Taiyuan,P.R.China)

机构地区：[1]山西医科大学,山西太原030000 [2]山西省卫生健康委员会

出　　处：《中国卫生事业管理》2020年第7期514-517,共4页Chinese Health Service Management

基　　金：山西省卫生计生委科研课题“山西省县乡医疗卫生机构一体化改革理论研究”(2017003);山西省高等学校人文社会科学重点研究基地项目“山西省县域医疗卫生服务体系整合模式研究”(201801018)。

摘　　要：目的:研究基层医疗机构全面配备和使用基本药物对患者流向的影响,同时评估山西省县域综合医改中县级医疗集团内部县乡医疗机构药品采购"五统一"政策的实施效果。方法:采用分段时间序列回归对山西晋南地区某县"国家基本药物制度"和"药品采购五统一"两个关键时点前后患者就诊情况进行分析。结果:基本药物制度实施后县级医院每月增加153.63人次,门急诊人次占比不断上升,乡镇卫生院门急诊人次变化无统计学意义,门急诊人次占比每月下降0.44%;"五统一"实施后县级医院门急诊人次变化无统计学意义,门急诊人次占比逐月下降0.61%,乡镇卫生院每月增加211.63人次,门急诊人次占比每月增长0.72%。结论:实施基本药物制度导致患者流向县级医院,药品采购"五统一"有利于患者下沉到基层,建议实施县乡村一体化药品采购、配送与结算管理,加强对药品流通环节的监管,为构建合理的就医秩序提供保障。Objective To study the influence of comprehensive allocation and use of basic medicines on the flow of patients in primary medical institutions,and evaluate the implementation effect of the"five unified"policies in Shanxi Province.Methods Segmented time series regression method was used to analyze the patients’visiting before and after the two key points of the"National Essential Drug System"and"Five Unification of Financial Purchase"in a county of Shanxi.Results After the implementation of basic drug system,the person-time of patients in county-level hospitals increased by 153.63 per month.And the proportion of emergency department visiting kept increasing.While the person-time of patients had no significant change in township hospitals,in which the proportion of emergency department visiting decreased by 0.44%per month.After the implementation of"Five Unification of Financial Purchase",the person-time of patients had no significant change in county-level hospitals,in which the proportion of emergency department visiting decreased by 0.61%per month.And the person-time of patients increased by 211.63,in which the proportion of emergency department visiting decreased by 0.72%per month.Conclusion The implementation of basic drug system leads to the flow of patients to county-level hospitals.The"five unification"of drug procurement is conducive to patients choosing the grassroots clinics.It is recommended to implement integrated drug procurement,distribution and settlement management,and strengthen supervision on drug circulation,which can provide guarantee for reasonable medical order.

关 键 词：基本药物制度 就医流向 分段时间序列回归 山西省县域综合医疗改革 

分 类 号：R95[医药卫生—药学]