【作者】 李伦；

【导师】 叶露；

【作者基本信息】 复旦大学 ， 公共卫生， 2011， 硕士

【摘要】 近年来,我国提升了国家基本药物制度的推进速度,国家卫生部等九部委颁布了《关于建立国家基本药物制度的实施意见》,明确要求：实行基本药物制度的县(市、区),政府举办的基层医疗卫生机构配备使用的基本药物实行零差率销售。所谓药品“零差率”销售政策是指社区卫生服务机构将《基本药物目录》范围内的药品以购进价格销售给患者,取消药品加价。目录范围内的药品由政府统一招标采购、统一配送,药品加价部分由政府补偿,目的是减轻群众医药费用负担,降低基本药品的价格,规范合理用药,避免大处方,吸引患者“小病去社区,大病到医院,康复回社区。”上海市在2008年12月19日发布了《关于上海市社区卫生服务中心实施基本药品零差率的试行意见》,确定了《上海市社区卫生服务中心零差率收费西(中)药目录》,该政策自2008年12月28日起试行。本研究以上海市某社区卫生服务中心为研究案例,系统地分析该中心2009～2010年实行药品零差率政策运行的情况,综合医患双方的问卷调查和定性访谈结果,发现上海市试行两年的零差率药品销售政策效果并不理想。零差率药品的普及程度和利用程度均不高,零差率政策对于均次药品费用不能构成影响；临床合理用药的期望并没有达到；实施药品零差率,如果失去政府财政的支持,医疗机构将难以为继。研究认为影响零差率政策实施的主要问题包括：科学合理完善的财政补偿机制尚未形成;虚高的药价对零差率药品实施效果产生很大负面影响；医患双方对于零差率的认知程度不高。为使药品零差率政策真正起到效果,笔者建议要建立科学的适合社区卫生服务需要的零差率药品目录,同时建立合理的补偿机制,加强临床医师培训、加大基本药物宣传力度,并不断促使药品合理定价。更多还原

【Abstract】 In recent years, China speeded up the implement of the national essential medicine system. Nine ministries and commissions including Ministry of Health issued "The opinion about establishing national essential medicine system", which request clearly that the primary level health institution run without added profit in the county(city or zone) that implement national essential medicine system. The so-call "zero markup" policy which means that the community health center sale essential medicines to patients will not be able to added any markup on the medicines.The government centralizes the calling for bid openly, dispatching, and compensates for the part of addition, so as to reduce the people’s burden of medicine, decrease the drug price, regulate the reasonable usage of medicine and avoid the big prescription. This arrangement also help the slight sick patient treated in community, severe in hospital and convalescence in community.The opinion about implement zero markup policy in shanghai community health center" was issued on Dec.19 2008. The list of medicines with zero markup in shanghai community health center is decided and issued from Dec 28 2008.This case study based on certain community health center in shanghai systematically analyzed the operation under the zero markup situation from 2009-2010. Combined the questionnaire and qualitative interview, the study found the zero markup policy did not get the targeted results. The medicine with zero markup has not accepted and adopted popularly, zero markup did not show positively effective on the each drug expenditure, and the expectation of clinical rational drug usage has not realized. The community health center that runszero markup policy can not be operated without the financial support from government.The study recognized that the major problem of running zero markup policy include:the reasonable and scientific mechanism of compensation has not be built, the unreasonable high price of drug bring very negative effect, doctor and patient has not realize the importance of the zero markup policy. This study suggested that the list for drug with zero markup in community health center should be specified, and build the reasonable compensation mechanism in the meanwhile, enhance the clinician training and the promotion of essential drug, and make the drug price reasonable.更多还原