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目的调查新添中心卫生院基本药物(EML)政策一年来的实施绩效,了解该院EML实施中存在的问题,为乡镇卫生院基本药物配送、存储、补偿机制等研究提供依据。方法采用问卷调查和专题访谈相结合的方法,调查该院EML配备和使用情况、EML政策实施前后诊疗业务和收支变化等情况。结果新添中心卫生院EML配备率呈递增趋势,由实施前的62.2%增至87.3%。EML药物所占药品销售额的比例也由39.3%增至90.6%。但存在配送品种不全、品种落后的问题。EML实施后,卫生院门诊人次数、出院人次数均有所上升,次均门诊费用、次均住院费用均有不同程度的下降。EML实施后,医院总收入略有增加,但限于财政补助额度,卫生院经营尚处于亏损。医药比持续降低,卫生院药品费用与检查费用比例呈上升趋势。尤其2010～2011年检查费用所占比例较2009年增长30%左右,且EML实施后检查费用并未降低。结论 EML的实施并未根本改善“以药养医”的现状。药物零差价销售,卫生院补偿机制尚未健全,卫生院财务仍处于亏损状况。建议开展药物的循证遴选,并开展针对欠发达地区政府补偿机制的研究。
Objective To investigate the implementation performance of the new central hospital (EML) policy over the past year and to understand the problems existing in the implementation of EML in the hospital so as to provide the basis for the research on the distribution, storage and compensation mechanism of essential medicines in township hospitals. Methods The methods of questionnaire survey and special interview were used to investigate the EML equipment and usage in the hospital, the changes of medical service and income and expenditure before and after the implementation of EML policy. Results The new center hospital EML equipment rate showed an increasing trend, from 62.2% before implementation to 87.3%. EML drug sales accounted for the proportion of drugs increased from 39.3% to 90.6%. But there is distribution of incomplete species, the problem of backward varieties. After the implementation of EML, the number of outpatients and the number of discharged persons in hospitals increased, the average outpatient costs and the average hospitalization expenses decreased in varying degrees. After the implementation of EML, the hospital’s total income slightly increased, but limited to the financial subsidies, hospitals are still operating at a loss. The ratio of medicine and medicine continued to decrease, and the ratio of the cost of medicine and examination in hospitals was on the rise. In particular, the proportion of inspection expenses from 2010 to 2011 increased by about 30% over 2009, and the examination fees after the implementation of EML did not decrease. Conclusion The implementation of EML has not fundamentally improved the status quo of “taking medicine as medicine”. Drug zero difference sales, health institutions compensation mechanism is not perfect, the hospital is still in financial condition of loss. It is recommended to conduct evidence-based drug selection and carry out research on government compensation mechanisms in underdeveloped areas.