【作者】 杨显辉；

【导师】 于培明；

【作者基本信息】 河南大学 ， 药剂学， 2012， 硕士

【摘要】 基本药物和国家药物政策是WHO的全球基本药物行动计划的核心部分，我国一直致力于建立国家基本药物制度。我国的多次医药卫生体制改革已将建立国家基本药物制度作为重要组成部分，基本药物制度被认为是一项“为保障群众基本用药，减轻医药费用负担”的有效政策。目前，我国初步建立了国家基本药物制度的完整框架并开始逐步实施。随着国家基本药物制度的深入实施，需要对基本药物制度的政策方案、实施状况和实施效果进行监测评估。基本药物制度评估需要建立一套有效的指标体系，通过指标的获取来达到对制度评估的目的。本文正是通过对我国基本药物制度的研究，运用文献研究和专家咨询的方法，依据基本药物制度的政策框架设定了评估指标体系的框架；通过对我国基本药物制度的分析，并借鉴了WHO出版的国家药物政策领域的监测评价手册进行指标筛选；按照公共政策评估的基本理论构建了初步的指标体系和具体指标，通过专家咨询的方法确立最终的指标体系，利用层次分析法对每个指标进行了权重的设定。本文旨在构建完整的指标体系为我国基本药物制度的监测评估提供参考。研究显示，我国基本药物制度和WHO在全球推行的基本药物概念和国家药物政策是一致的。我国的基本药物制度根据国家药物政策的框架分析包括了目录管理、生产流通、配备使用等七个政策部分。WHO出版了药品使用、药品价格、药品状况等多部药物政策框架内的监测指标手册，部分指标可以用于我国基本药物制度评估指标体系的设计。依据政策评估的基本理论和对我国基本药物制度的分析初步构建评估模型。调查显示，本文根据政策评估理论构建的双重指标体系来同时监测评估国家基本药物制度元政策和子政策不被认同。在调查中，所有专家不认同将子政策制定和实施过程作为对元政策的评估输入，只认同子政策结果为元政策评估的输入。基本药物制度评估指标体系中过程指标和结果指标的权重分别为0.572和0.366，远远大于结构指标的权重0.062；在二级指标中，基本药物合理使用、配备使用政策效果、可负担性、可获得性、质量监管政策效果、目录管理政策效果和生产流通效果等七项指标的总排序远远大于其他二级指标。研究表明，基本药物制度是一项综合的公共卫生政策，其评估指标体系只能用于元政策综合效果评估和子政策效果评估，不能实现子政策全面评估的目的。在实施基本药物制度评估时应更多关注其过程指标和结果指标，重点评价基本药物的合理使用、配备使用、可负担性、可获得性等方面；实施基本药物制度应着重对基本药物制度配备使用、质量监管、目录管理和生产流通配套措施加大实施力度；指标体系中的三级指标各自的权重也存在一定的差别，因此，对综合评估结果输出时要考虑各指标的权重。本文主要内容有五个方面：第一部分为绪论，通过对本研究背景的分析，引出本文的研究目的和意义，介绍目前的研究现状。第二部分为国家基本药物制度评估概述，介绍了国家基本药物制度评估的基本理论；分析我国基本药物制度的政策框架，为指标体系框架构建奠定基础；对我国目前开展的基本药物制度监测评价进行分析，提出存在的问题；并对WHO的国家药物政策评估指南和实践进行了研究，作为初筛指标的来源；第三部分为基本药物制度评估指标体系模型的构建研究，运用公共政策分析和评估的常用方法，对国家基本药物制度评估的理论基础进行了探讨，并对指标体系的框架进行了构建，初步确立了指标体系的架构；第四部分为评估指标体系的构建与确立，运用专家咨询法确立指标体系及构成，并运用层次分析法，为每个指标的权重赋值，构建完整的综合指标体系；第五部分为指标体系的分析与应用，通过对构建的指标体系进行分析，提出了该指标体系存在的优点和不足之处，并简要介绍了指标体系的应用。本文的创新之处在于：（1）研究思路的创新：国内外现有国家药物政策评估指标体系，或者是从某一个方面进行评价，或者是对整个药物政策进行监测不能实现综合评价结果的输出。本文以我国现行基本药物制度框架确立评价指标体系模型，综合国内外研究的相关指标筛选指标，并确立各指标的权重，构建完整的综合评估指标体系。（2）研究方法创新：本文采用层次分析法，根据专家打分确定每个指标的单层排序和总排序，通过各指标层及具体指标的权重，对基本药物制度实施和评估的开展提供一定的参考。更多还原

【Abstract】 National essential mdicine system is a core part of the WHO global plan of action of essentialdrugs, China has been committed to the establishment of a national for essential mdicine system. Manymedical and health system in China will establish a national essential medicines system as an importantpart of the basic drug system, system for basic drugs is considered to be the effective policy of a "for theprotection of the masses of basic drugs, to reduce the burden of medical expenses". At present, Chinainitially established a complete framework of the national essential mdicine system and progressivelyintroduced. With in-depth implementation of the national essential mdicine system, policy options for thebasic mdicine system, the status of implementation, and results monitoring and evaluation is needed.National essential mdicine system of assessment need to establish an effective indicator system,through the acquisition of indicators to achieve the purpose of system assessment. This article is by ourcountry’s basic medicine system, using the methods of literature research and expert advice, set up theframework of the evaluation index system in accordance with the policy framework for basic mdicinesystem; through the analysis of essential mdicine system, and learn from the WHO published in thenational drug policy monitoring and evaluation manual for index selection; Preliminary indicator systemand the specific indicators constructed in accordance with the basic theory of public policy evaluation, andexpert advice to establish the final index system, using the analytic hierarchy process for each indicator aweight set. This article aims to build a complete system of indicators to provide a reference for monitoringand evaluation of China’s basic drug system.Studies have shown that the essential medicine system in China and the WHO in the globalimplementation of essential medicine concept and national drug policy is consistent. China’s essentialmedicine system under the framework of the national drug policy, including catalog management,production and distribution, with the use of seven policy part. WHO published a manual of the monitoringindicators within the framework of multi-drug policy, drug use, drug prices, drugs status, some indicatorscan be used for the design of the evaluation index system of essential medicines system. Evaluation modelis constructed based on the basic theory of policy evaluation and analysis of essential medicine system. The survey shows that the double index system built according to the theory of policy evaluation,while monitoring the assessment of national essential medicine system policy and child policy is not to berecognized. In the survey, all the experts do not agree with the sub-policy formulation and implementationprocess as the assessment of the basic policy input, only agree with the input of sub-policy outcomes basicpolicy assessment.The evaluation index system of the basic drug system, process and outcome indicators,the right weight, respectively0.572and0.366, far greater than the weights of the structure index0.062; twoindicators, the basic rational use of medicines, with the use of the effects of policies, affordability, the totalranking of the seven indicators of access, monitoring the quality of the effects of policies, catalogmanagement, the effects of policies and the production and circulation effects far greater than the other twoindicators.Studies have shown that the system of essential medicine is a comprehensive public healthpolicies, to assess the combined effect of the index system can only be used for policy evaluation andsub-policy impact assessment, can not achieve a comprehensive assessment of the purpose ofsub-policies.Assessment of the essential medicine system should be more concerned about the process andoutcome indicators, the focus on evaluation of the rational use of essential medicine, with use, affordability,and other aspects; the essential medicine system should focus on the essential medicine system with the use,quality control, directory management and the production and circulation of complementary measures tointensify; index system of the three indicators of the respective weight there are some differences, therefore,the weight of each indicator to consider the results of the comprehensive assessment of output.The main content of this paper has five aspects: the first part is an introduction, through theanalysis of the background of this study, leads to the purpose and significance of this study, the currentresearch status and the structural arrangement.The second part is the assessment of the national essentialmedicine system overview of the basic theory of the assessment of the national essential medicine system;policy framework for essential medicine system, lay the foundation for the framework of the index systemto build; essential medicines system to monitor the ongoing evaluationanalyzed and put forward theproblems; and national drug policies in the WHO assessment guidelines and practices have been studied asa screening refers to.The third part is a basic drug system evaluation index system model to build theresearch, the use of public policy analysis and evaluation of commonly used methods, the theoretical basis of the national essential drug system assessment, and indicator system framework to build, initiallyestablishedthe structure of the index system. The fourth part is the construction and establishment ofevaluation index system, the use of expert advice to establish the index system and composition, and usingthe analytic hierarchy process, for each indicator of the right to re-assignment, and build a complete indexsystem; The fifth part is the index system analysis and application, through analysis of the index systembuilt strengths and inadequacies exist in the index system, and briefly describes the application of the indexsystem.The innovation of this paper is to:(1) the idea of innovation: the evaluation index system of theexisting essential medicine policies at home and abroad, or from a evaluation or monitoring of the entiredrug policy can not achieve the comprehensive evaluation result output. Establish the evaluation indexsystem model to the current institutional framework of essential medicine, relevant indicators of foreignand domestic screening indicators, and to establish the weight of each indicator, and build a completecomprehensive evaluation index system.(2) research methods innovation: by means of AHP, experts scorethe single layer of each of the indicators sorting and sort through the weights of the index level and thespecific indicators, implementation and evaluation of essential medicine system to carry out to provide acertain reference.更多还原