我国公立医院药房改革路径探讨-中国药房

我国公立医院药房改革路径探讨

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篇名：	我国公立医院药房改革路径探讨
TITLE：
摘要：	目的：评估我国公立医院药房改革的成效，探讨其改革路径，为相关政策制定者提供参考。方法：介绍自2000年以来我国公立医院药房改革的目标、进程、效果及存在的问题，比较分析美、英、日等国和我国香港地区的医疗卫生服务体系，提出我国公立医院药房改革路径的思路。结果与结论：我国公立医院药房改革的核心目标是推进“医药分开”，破除“以药补医”机制。在2009年实施新医改前，我国公立医院药房改革主要有药房托管和药管中心两种模式；2009年实施新医改后，主要包括药管中心、药房托管和医院药房社会化模式等。通过实施公立医院药房改革，尽管部分公立医院实现了形式上的医院和药房收支分离，就诊患者次均药品费用、药占比等指标均有所下降，但患者的负担并未减轻；提高诊疗收费、增设药事服务费成为弥补药品零差率损失的主要补偿途径。可见，单纯通过药房改革并不能从根本上解决医患信息不对称问题，企业参与公立医院药房托管仍难以扭转“以药补医”的现状，某些地区医院的药学服务质量为此还受到了影响。结合美、英、日等国和我国香港地区医院只提供住院诊疗不设门诊药房、医保机构进行严格的医疗费用支付审查、医院药房与药店分离等经验，建议我国应将医院药房改革视作公立医院改革的一个组成部分、实行渐进式改革、建立处方多重监督机制以解决医患信息不对称问题，同时强化医院药学的各项功能以提高药学服务水平，在分级转诊基础上逐步实现公立医院门诊药房的社会化改革。
ABSTRACT：	OBJECTIVE： To evaluate the reform achievement of public hospital pharmacy in China and explore the pathway of the reform so as to provide reference for policymakers. METHODS： The objective， progress and outcomes of pharmacy reform and problems in China were introduced since 2000； the pathway of public hospital pharmacy reform was put forward based on comparing health service system of USA， British， Japan and Hong Kong area. RESULTS & CONCLUSIONS： The reform’s objective is to promote “separation of pharmacy from medicine” and break down the mechanism of “drug-maintaining-medicine”. Before the new medical reform in 2009， pharmacy trusteeship and centers of pharmacy management were the main reform models； after the new medical reform， there were socialization of hospital pharmacy， pharmacy trusteeship and centers of pharmacy management and so on. The reform have achieved separation of income and expenditure of pharmacy from those of hospital， the decrease of average drug cost per time， drug ratio and others in some public hospital， but patient’s burden may not yet alleviate； the main compensation approaches for zero-profit drug supply is to increase the fees for diagnosis and treatment， and pharmaceutical care fee. So the reform merely aiming at pharmacy reform cannot solve information asymmetry between doctor and patient； pharmacy trusteeship may be difficult to cover up “drug-maintaining-medicine”， and the quality of pharmaceutical care may be declined. On the basis of the experience of USA， British， Japan and other countries and Hong Kong including only supplying hospital treatment but not setting up outpatient pharmacy， checking medical cost payment strictly by medical insurance department， separating hospital pharmacy from social pharmacy， etc.， it is suggested to consider pharmacy reform as one part of public hospital reform， implement incremental reform， build multiple prescription supervision system so as to solve the problem of information asymmetry between doctors and patients； at the same time， strengthen various functions of hospital pharmacy to upgrade pharmaceutical care， and gradually realize the socialization of public hospital outpatient pharmacy based on a grading treatment of medical units.
期刊：	2016年第27卷第13期
作者：	杨悦，宗毛毛，尤晓敏，赵瑞，柴倩雯
AUTHORS：	YANG Yue，ZONG Maomao，YOU Xiaomin，ZHAO Rui，CHAI Qianwen
关键字：	公立医院；药房；改革；以药补医；药房托管
KEYWORDS：	Public hospital； Pharmacy； Reform； Drug-maintaining-medicine； Pharmacy trusteeship
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