| 翟琛琛,郭志刚,洪妍,李文胜,韩晟,管晓东,史录文.医保总额预付改革对县级公立医院门诊用药影响研究[J].中国药事,2019,33(2):217-221 |
| 医保总额预付改革对县级公立医院门诊用药影响研究 |
| On the Effect of Global Budget Reform on Outpatient Drug Use in County-level Public Hospitals |
| 投稿时间：2018-06-30 |
| DOI：10.16153/j.1002-7777.2019.02.017 |
| 中文关键词: 服务项目付费 总额预付 县级公立医院 用药行为 |
| 英文关键词: fee for service global budget county-level public hospitals prescribing behavior |
| 基金项目: |
| 作者 | 单位 | E-mail | | 翟琛琛 | 北京大学药学院, 北京 100191 | | | 郭志刚 | 北京大学药学院, 北京 100191 | | | 洪妍 | 北京大学药学院, 北京 100191 | | | 李文胜 | 北京大学药学院, 北京 100191 | | | 韩晟 | 北京大学药学院, 北京 100191
北京大学医药管理国际研究中心, 北京 100191 | | | 管晓东 | 北京大学药学院, 北京 100191
北京大学医药管理国际研究中心, 北京 100191 | | | 史录文 | 北京大学药学院, 北京 100191
北京大学医药管理国际研究中心, 北京 100191 | shilu@bjmu.edu.cn |
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| 中文摘要: |
| 目的：评估总额预付改革对县级公立医院门诊用药的影响。方法：研究采用方便抽样法在全国5省（自治区）选取39家县级公立医院，抽取2015年6月-2016年5月的儿科和呼吸科门诊处方数据进行统计分析。结果：总体上看，实施总额预付的医院每处方药品费用、含激素处方占比显著低于按服务项目付费医院，但其每处方用药品种、含抗生素处方占比和含注射剂处方占比更高（统计学有显著差异）；分科室看，总额预付方式下，儿科的含注射剂处方占比高于按服务项目付费医院，而呼吸科呈现相反趋势；儿科和呼吸科在其余4项与总体趋势一致。结论：总体结果显示，相对于按服务项目付费，总额预付在处方费用控制上有明显效果，但医生用药行为有待进一步改善；分科室结果显示，政策实施后不同科室之间医师用药行为变化存在差异。 |
| 英文摘要: |
| Objective: To evaluate the effect of global budget (GB) on outpatient drug use in county-level public hospitals. Methods: 39 county-level public hospitals in 5 provinces (autonomous regions) were selected by convenient sampling method, and the outpatient prescriptions from pediatric and respiratory department from June 2015 to May 2016 were collected and analyzed statistically. Results: In general, for those hospitals adopting GB, the cost of per prescription and the percentage of prescriptions with corticosteroids were lower than those adopting fee for service (FFS), but the number of drugs per prescription, percentage of prescriptions with antibiotics and percentage of prescriptions with injections were higher than those adopting FFS, showing significant differences. In pediatric department, percentage of prescriptions with injections was higher than those adopting FFS, but the respiratory department showed the opposite trend. The other four indicators were consistent with the overall trend in pediatric and respiratory departments. Conclusion: The overall results showed that, compared with FFS, GB had a significant effect on the control of prescription costs. However, prescribing behavior of doctors may need to be further improved. The results of the departments showed that there were differences in prescribing behaviors of doctors between different departments after the implementation of GB. |
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