台州市基本药物全额保障政策对糖尿病患者药品费用负担公平性的影响分析-中国药房

台州市基本药物全额保障政策对糖尿病患者药品费用负担公平性的影响分析

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篇名：	台州市基本药物全额保障政策对糖尿病患者药品费用负担公平性的影响分析
TITLE：
摘要：	目的：为完善我国基本药物全额保障政策及改善我国药品公平可及提供实证依据。方法：以台州市糖尿病类基本药物全额保障政策的实施情况为例，收集该市2011－2017年糖尿病患者的电子健康档案资料，以是否发生了家庭药品灾难性支出来评价患者的费用负担情况；采用集中指数分析家庭药品灾难性支出发生的公平性，并通过逐年比较基线年至政策实施第3年的相关参数来评估各影响因素在当地药品费用负担公平性变化中的作用。结果与结论：家庭药品灾难性支出的集中指数从基线年到政策实施第3年均为负数，说明台州市糖尿病患者家庭药品灾难性支出主要发生在低收入人群；从集中指数分解的分析结果来看，在影响糖尿病患者家庭药品灾难性支出公平性的各影响因素中，“服用免费基本药物”各年度的贡献率均稳定在前5位，且贡献值均为正数，说明政策实施有利于降低低收入群体家庭药品灾难性支出的不公平性。基本药物全额保障政策有效促进了患者药品费用负担公平性的改善，但还应推进科学合理的基本药物遴选机制，提高政策的保障水平，协同多方面因素共同发展，以全面促进基本药物的公平可及。
ABSTRACT：	OBJECTIVE： To provide the empirical basis for improving full coverage policy of essential medicines in China and promoting the fairness and accessibility of medicine. METHODS： Taking Taizhou diabetes essential medicines full coverage policy as an example， the electronic health records of diabetic patients in Taizhou city from 2011 to 2017 were collected， and the cost burden of patients was evaluated by whether catastrophic expenditure of family drugs had occurred. The concentration index was used to analyze the fairness of catastrophic expenditure on household medicines， and the effects of various influencing factors on the fairness of local medicine expenditure affordability were evaluated by year-by-year comparing the relevant indexes from baseline year to the third year of policy implementation. RESULTS & CONCLUSIONS： The concentration index of catastrophic expenditure on household medicines is negative from baseline year to the third year of policy implementation， which indicates that catastrophic expenditure on household medicines for diabetic patients in Taizhou mainly occurs in low-income groups. From the result of decomposition of concentration index， among the factors that affect the fairness of catastrophic expenditure on drugs in diabetic families， the contribution rate of “taking free essential medicines” keeps at top five places year by year， and the contribution value is positive， which shows that the implementation of policies is conductive to reducing the unfairness of catastrophic expenditure on household medicines in low-income families. Full coverage policy of essential medicines effectively improves the fairness of medicine expenditure affordability. In addition， scientific and reasonable essential medicines selection mechanism， the guarantee level of the policy， collaboration with multiple factors should be promoted so as to improve the fairness and accessibility of essential medicines.
期刊：	2019年第30卷第22期
作者：	张翕，周簪荣，郭志刚，史录文，管晓东
AUTHORS：	ZHANG Xi，ZHOU Zanrong，GUO Zhigang，SHI Luwen，GUAN Xiaodong
关键字：	基本药物；全额保障；糖尿病；药品费用负担；公平性
KEYWORDS：	Essential medicine； Full coverage policy； Diabetes； Medicine expenditure affordability； Fairness
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