国家基本药物制度实施对“靶心式”城市基层医疗卫生机构运营情况的影响调查—

国家基本药物制度实施对“靶心式”城市基层医疗卫生机构运营情况的影响调查——以成都市为例

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篇名：	国家基本药物制度实施对“靶心式”城市基层医疗卫生机构运营情况的影响调查——以成都市为例
TITLE：
摘要：	目的：为进一步完善国家基本药物制度提供参考。方法：以“靶心式”城市成都市为例，基于城市圈层视角，通过定量数据统计和定性访谈方法对当地基层医疗卫生机构国家基本药物制度实施过程中存在的问题进行分析，并提出应对策略。结果：从定量数据来看，成都市每千人城市人口医疗人员人数配比和每10万服务人口拥有基层医疗卫生机构数量一圈层均最少；2010－2012年，成都市基层医疗卫生机构门诊人次和住院床日分别增长109万人和16万床日，其中一圈层增幅最大，二、三圈层有增有减；每门诊人次和住院人次药品费用分别下降4元和109元，药占比下降6.7％，其中一圈层有所上升，而二、三圈层有不同程度下降。从定性访谈来看，基层医疗卫生机构服务能力作用增强，但仍不能满足服务量需求，尤其靠近中心城区的一圈层基层医疗卫生机构的压力仍然很重；药品费用得到控制，但补贴力度有待夯实，一圈层的人均药品费用居高不下；药品收入与药占比得到抑制，尤其二、三圈层降幅明显，但收入降低可能制约发展。结论：建议更针对性地扩充药品以满足服务需求，更精细化地完善支持政策以夯实补贴力度，更全方位地提升医疗条件以保障机构发展。
ABSTRACT：	OBJECTIVE：To provide reference for the further improvement of national essential medicines system. METHODS： Taking the “Bull’s-eye” city Chengdu as an example， based on the trading areas， the existing problems in implementing essential medicine system were analyzed by qualitative and quantitative research methods， and countermeasures were put forward. RESULTS：From the point of view of quantitative data， the first level trading areas of both proportions of medical personnel per thousand urban population and numbers of primary medical and health institutions per 100 thousands population in Chengdu were the lowest. From 2010 to 2012， the outpatient and inpatients increased 1.09 million people and 0.16 million beds per day in Chengdu primary health care institutions， the largest increase in the first level trading areas， and increase and decrease in the second and third level trading areas； outpatient and inpatient drug costs fell respectively 4 yuan and 109 yuan， medicine proportion declined 6.7％， increase in the first level trading areas， and decreased to varying degrees in the second and third level trading areas. From the point of view of qualitative interviews， the service ability got enhancement， but still could not meet the services demand， especially the pressure in the first level trading areas near center district remains heavy； drug cost was under controlled， but the subsidies needs to be increased， the per capita drug costs in the first level trading areas remains high； the drug income and medicine proportion were inhibited， especially the significant fell in the second and third level area， but the decrease of income may restrict development. CONCLUSIONS： It is suggested that more targeted drugs are needed for meeting the services demand， more sophisticated policy are needed for improving the subsidies， and more comprehensive medical conditions are needed for ensuring institutions’ development.
期刊：	2016年第27卷第12期
作者：	童峰，刘金华
AUTHORS：	TONG Feng，LIU Jinhua
关键字：	国家基本药物制度；“靶心式”城市；圈层；成都市；基层医疗卫生机构；运营情况；调查
KEYWORDS：	National essential medicine system； The “Bull’s-eye” city； Trading area； Chengdu； Primary health care institution； Operation； Survey
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