医保总额预付改革对县级公立医院门诊用药影响研究

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。     

2013年我院制剂价格调整前后的临床使用分析

摘 要 目的：为医疗保险部门制定医院制剂报销政策提供参考。方法: 回顾性调查统计我院2013年4月制剂价格调整前后各15个月（2012年1月～2014年6月）的制剂使用情况,分析价格调整与临床用量的关系。结果: 价格调整后47种制剂中,9种制剂用量增加,占19.15%;38种用量减少,占80.85%。结论:临床用量与价格调整缺乏直接联系,医院制剂仍是临床用药不可缺少的部分,亟待医疗保险部门调整制剂的医保报销政策,以降低患者负担。     

The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan

BackgroundTaiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at “higher tiers” of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral.ObjectivesThis study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities.MethodsA segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0.ResultsThe overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely.ConclusionsDifferential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.     

药品分类补偿的他国及地区经验

目的 :为控制我国城镇职工医疗保险药品报销费用提供参考。方法 :参阅文献综述世界上一些国家和地区药品分类补偿的举措 ,从中总结可供借鉴的经验。结果与结论 :根据药品性质分类 ,采用不同支付比例是国际上通行的做法 ;大部分国家及地区不将非处方药品列入药品报销目录范围 ;药品分类给付的目的是增加个人自付的比例 ,减少当局在社会医疗保险经费上的负担 ;控制药品费用必须从控制价格、补偿比例和药品用量3个方面同时着手才能奏效 ;制订药品参考价格和增设处方费等改革措施时要注意利弊分析。     

Access to cancer medication in public hospitals in a middle-income country: The view of stakeholder

BackgroundAccess to cancer medicines is a core component of comprehensive cancer care; as such, it is included in Mexico's public health insurance: Seguro Popular de Salud (SPS). Learning about stakeholders' experiences on processes and barriers influencing access to essential cancer medicines within healthcare facilities allows identifying needed policies to improve access to cancer care.ObjectiveThe aim of this study was to obtain the insights of health professionals in public hospitals in Mexico on how SPS influences access to cancer medicines regarding medicine selection, financing, and procurement and supply systems. The purpose is to identify policy areas that need strengthening to improve access to cancer medicines.MethodsSemi-structured interviews were conducted with 67 health professionals from 21 public hospitals accredited by SPS across Mexico. A framework analysis was used with categories of analysis derived from the World Health Organization's Access framework.ResultsMost stakeholders reported that the availability of listed cancer medicines was sufficient. However, cancer specialists reported that medicines coverage by SPS was restrictive covering only basic cancer care. Public hospitals followed SPS treatment protocols in selecting and prescribing cancer medicines but used different procurement procedures. When essential cancer medicines were unavailable (not listed or stocked-out), hospitals reported several strategies such as prescribing alternative therapies, resorting to direct purchases, and assisting patients in obtaining medicines elsewhere. Other reported barriers to access to treatment were: distance to health facilities, poor insurance coverage, and financial restrictions.ConclusionsHealth professionals have encountered benefits and challenges from the implementation of SPS influencing access to cancer medicines and care in Mexico, pointing to areas in which action is necessary. Finding the right balance between expanding the range and cost of cancer treatments covered by insurance and making basic cancer care available to all is a challenge faced by Mexico and other middle-income countries.     

芜湖某区多家医院国家组织药品集中采购实施效果评价研究

目的:了解第一批国家组织药品集中采购(以下简称"国家药品集采")政策在芜湖某区多家医院的实施情况,为本区推动后续中选药品的合理使用及完善各项医保政策提供参考.方法:收集芜湖某区多家医院第一批国家药品集采政策执行前后的中选与同种非中选药物的相关信息.结果:第一批国家药品集采在3家医院使用的11个中选品种的单价(片/袋/支...     

我院2年来处方评价的实践与体会

目的总结处方评价的工作体会,与同行进行交流。方法2007年7月~2009年7月每月随机抽取处方120张填写处方评价表;计算各评价指标平均值。结果平均每张处方用药品种数为未超过WHO制定的标准,平均每张处方抗菌药物和注射剂使用百分率分别高于WHO制定的标准;内科平均每张处方用药金额为最高。结论从总结工作体会的角度出发,提出处方评价具有较强的操作性、灵活性及实用性;具有对处方动态监测的功能;评价指标体系符合各科用药的特点;体现了惠及百姓的国家医改政策的观点。     

陕西省19家医院《处方管理办法》实施情况调查

目的：了解陕西省有关医疗机构实施《处方管理办法》的情况。方法：回顾性调查陕西省19家三级和二级综合医院的处方开具情况和处方用药情况。结果：①在处方的开具、书写规范上,各个医疗机构对《处方管理办法》的重视程度不同。②调查的19家医院,平均药品通用名的使用率达到93．9％;单张处方平均用药2．19种;抗菌药使用率为30．2％;注射剂使用率为35．7％;处方平均费用为80．76元。结论：陕西省有关医疗机构执行《处方管理办法》整体较好。     

Expenditure on the treatment of drug and alcohol disorders in hospitals: How much and what explains it?

BackgroundThe role of hospitals in providing treatment for drug and alcohol abuse varies markedly across countries. Knowing public expenditure on drug treatment in hospitals is an essential input for any cost-effectiveness and policy analysis. However, information on the level and trend in spending is often unavailable. This study aims firstly to estimate the expenditure on hospital treatment for illicit drug and alcohol use as primary diagnoses across Europe for the 2013–2015 period, secondly to explain recent expenditure trends and lastly to analyse their impact on policy.MethodsThe study uses annual health expenditure data from Eurostat which complies with the ‘System of Health Accounts’ framework and covers the countries of the European Union as well as Norway. Data on hospital activities exist for ‘Mental and Behavioural Disorders’, which includes a breakdown into disorders caused by the use of alcohol and other psychoactive substances. The study uses ‘attributable fractions’ to estimate the proportion of hospital expenditure allocated to drug and alcohol treatments, based on data about this activity. Last, but not least, a panel data approach for the 2006–2015 period is used to explain expenditure determinants.ResultsIn 2015, it is estimated that EUR 5.8 thousand million and EUR 2.9 thousand million were spent on the treatment of alcohol and drug disorders in hospitals as primary diagnoses, respectively, for a set of 24 European countries with available data. Cross-country differences can be explained by the level of income, the burden of disease and the structures of health systems – for instance, the proportion of public spending and the level (or share) of resources allocated for outpatient care.ConclusionThese estimates allow a better evaluation of treatment provision and, therefore, a better allocation of scarce resources. This information can support service providers, health policymakers and taxpayers. In this sense, it is a first step in developing policy evaluation and cost-effectiveness analysis.     

四川省各级医疗机构的门诊用药指标实证研究

目的 采用世界卫生组织/合理用药国际网络（WHO/INRUD）的用药监测指标（SDUIs）,通过实证调研评价分析四川省各级医疗机构门诊用药的现状。方法 于四川省共抽取6个样本市,各样本市抽取1~3家三级医院、1~3家二级医院、5家社区卫生服务中心、5家乡镇卫生院的医疗处方。收集样本医疗机构2012年1月-2015年4月,每年1、4、7、10月的每月30张门诊处方。结果 平均每张处方用药的品种数为3.02种,处方药物使用通用名的百分比为90.33%,处方药物含抗菌药的百分比为40.09%,处方药物含注射剂的百分比为14.46%,基本药物占处方用药的百分比为83.27%,基本药物使用百分比为93.05%,平均每张处方金额为66.04元。结论 总体来看,四川省各级医疗机构用药指标在2012-2015年间没有显著变化,部分指标的合理性较好,但仍存在不合理现象。     

Attitudes of house physicians concerning various antibiotic-use control programs

Medical and surgical house physicians at three teaching hospitals with different antibiotic control programs (ACPs) were surveyed to determine their attitudes about and preferences for these programs. Questionnaires were mailed to resident physicians who had trained at all three hospitals. One hospital had no antibiotic prescribing policy (open prescribing), one employed an infectious-disease physician consultant who discussed antibiotic orders for certain reserved drugs with prescribing physicians but did not otherwise restrict access to the drugs (educational ACP), and the third hospital required approval of an infectious-disease physician for dispensing of reserved drugs by the pharmacy department (restrictive ACP). The survey response was 77% after one follow-up mailing to nonrespondents. Regardless of hospital type, physicians preferred the educational ACP to either open prescribing or the restrictive ACP. Based on personal experiences, significantly fewer physicians encountered patient-care problems with the educational ACP than with either open antibiotic prescribing or the restrictive ACP. Significantly more physicians perceived that the educational ACP was more beneficial for patient antibiotic therapy and will be more beneficial for future antibiotic prescribing than the restrictive ACP. Most respondents believed that ACPs save hospitals money, that ACPs can be implemented without compromising either patient care or physician performance, and that they would encounter similar ACPs in the future. Educational ACPs should be considered at teaching hospitals with interested infectious-disease consultants.     

某三甲和二甲医院2012年门诊处方抗菌药物应用分析

目的对两家医院门诊处方抗菌药物应用情况进行统计分析,了解门诊患者抗菌药物应用情况,为规范抗菌药物合理应用提供依据。方法随机抽取2012年门诊处方各1200张,调查其用药情况。结果两家医院处方平均用药品种数分别为2．06种和1．94种,抗菌药物使用率分别为17．25％和11．42％,平均处方金额分别为184．60元和243．33元,平均抗菌药物处方金额为120．71元和188．92元,单用抗菌药物处方各占应用抗菌药物处方总数的96．78％和92．7％,联用抗菌药物处方各占应用抗菌药物处方总数的3．22％和7.3％。结论不同规模医院的抗菌药物指标差异较大,大医院处方平均金额、应用抗菌药物处方平均金额偏大,更应加强对抗菌药物应用的管理。