严重精神障碍患者服药补贴政策执行效果研究

目的 评估深圳市宝安区严重精神障碍患者服药补贴实施效果，为政策调整提供思路。方法 回顾性收集2016—2018年患者服药补贴和登记情况，共2 685名患者41 104次服药补贴数据纳入分析。结果 2016—2018年，患者服药补贴申请率为20.00%、28.03%和32.32%，服药补贴执行率为92.53%、82.42%和80.02%，人均补贴15.31次，平均每次补贴209.51元，51.73%的服药补贴患者“0自费”。非户籍患者服药补贴申请率高于户籍患者（χ2 = 274.043，P＜0.001），服药补贴申请率呈上升趋势（户籍:χ2趋势 = 31.161；非户籍:χ2趋势 = 274.043。P＜0.001）；非户籍患者服药补贴执行率呈下降趋势（χ2趋势= 133.536，P＜0.001），非户籍患者服药补贴执行率高于户籍患者（χ2 = 278.417，P＜0.001）；户籍患者人均补贴次数高于非户籍患者（t = 5.797，P＜0.001），非户籍患者补贴次数逐年增加（χ2趋势 = 139.251，P＜0.001）；服药补贴“0自费”率呈上升趋势（户籍:χ2趋势 = 7.844；非户籍:χ2趋势 = 66.196。均P＜0.001）。结论 服药补贴政策有效缓解患者的经济负担，超过一半服药补贴患者门诊取药“0自费”；提升服药补贴的可及性是下一步工作重点。

Implementation effect of medication subsidy policy for patients with severe mental disorders

To evaluate the implementation effect of medication subsidy policy for patients with severe mental disorders in Bao’an District, Shenzhen, and provide reference for policy improvement. Methods The medication subsidies and registration of patients in the same period from 2016 to 2018 were collected retrospectively. A total of 2 685 patients and 41 104 medication subsidies were included in the analysis. Results From 2016 to 2018, the application rates of medication subsidies for registered patients with severe mental disorders were 20.00%, 28.03%, and 32.32%, and the implementation rates were 92.53% , 82.42% , and 80.02% , respectively. The per capita subsidy frequency was 15.31 times, with average subsidy sum of 209.51 yuan each time, and 51.73% of patients enjoyed fully free medication. The application rate of medication subsidies of non-registered patients was higher than that of household registered patients (χ2 =274.043, P<0.001) and showed an upward tendency (registered: χ2 trend=31.161; non-registered: χ2 trend=274.043. P<0.001). The implementation rate of non-registered patients showed a downward trend (χ2 trend=133.536, P<0.001), higher than that of registered patients (χ2 = 278.417, P<0.001). The per capita subsidy frequency of registered patients were higher than that of non-registered patients (t=5.797, P<0.001), but subsidy frequency of non-registered patients had seen an yearly increase (χ2 trend=139.251, P<0.001) and the fully free medication subsidy also showed increasing trend (registered: χ2 trend=7.844；non-registered: χ2 trend=66.196. P< 0.001). Conclusion The medication subsidy policy is effective in relieving the financial burden of patients, and more than half of the medication subsidy patients have “0 self-payment” for outpatient medication. The next step is to improve the accessibility of medication subsidy.