基本药物价格上涨的现况调查及因素分析-基于合肥某三级综合医院的调查

目的：探索公立医疗机构基本药物供应价格现状,分析药品价格上涨原因,为该领域的相关研究提供参考。方法：收集安徽省某三级综合性医院2016年1月1日-2017年9月30日期间内价格上涨的基本药物,用DDDc（药品日均费用）反映涨价药品对患者负担的影响,并通过咨询采购主管及联系药品经营商来调查药品涨价原因。结果：样本点在调查期间共使用1243种药品、366种国家基本药物及840种省基本药物。调查发现共有91种省基本药物（包括64种国家基本药物）在调查期间发生价格增长;DDDc涨幅为1.30元人民币,涨幅前20名的基本药物有17种为针剂,DDDc涨幅均大于7元人民币。导致药品涨价的主要原因有原辅料价格上涨、生产成本上涨、原供应生产企业无法供应、生产厂家供应价格上涨、配送企业供应价格上涨、配送企业无法供应和原配送企业无法满足“两票制”要求。结论：我国正致力解决人民群众用药贵的问题;但是,药品价格在招标后的上涨与我国医疗卫生体制改革及基本药物制度的目的相悖。因此,本研究建议我国继续完善药品招标制度,制定合理的定价机制及科学的补偿机制,充分发挥基本药物在使用中价格相对低廉的作用。

Investigation into the Current Status of the Price Increase of Essential Drugs and Analysis of the Reasons Based on a Survey of One Tertiary General Hospital in Hefei

Objective: To explore the current status of supply price of essential drugs of public medical institutions, to analyze the reasons for drug price increase and to provide references for relevant researches in this field. Methods: The essential drugs with increased prices in one tertiary general hospital of Anhui province from January 1st, 2016 to September 30th, 2017 were selected. The impact of the drugs with increased prices on patients'' burden was reflected in DDDc. The reasons for the price increase were investigated by consulting the purchasing manager and contacting the drug dealers. Results: A total of 1243 drugs, including 366 national essential drugs and 840 provincial essential drugs were used during the investigation. It was found that, the prices of 91 essential drugs (including 64 national essential drugs) were increased during the investigation. DDDc was increased by 1.30 yuan, and 17 of the top 20 essential drugs with increased prices were injections, of which DDDc was increased by more than 7 yuan. The main reasons for the increase of drug prices were as follows:the increase of raw materials and production cost, incapability of supply by the original manufacturing enterprises, the increase of supply prices of the manufacturing enterprises and the distribution companies, incapability of supply by the distribution enterprises, as well as failure of the original distribution enterprises to meet the requirements of "two-ticket system". Conclusion: Our country has been taking up measures to solve the problems of expensive medicines for people. However, the increase of drug prices after bidding is contrary to the aims of China''s health care system reform and essential drug system. Therefore, it is suggested that the drug bidding system should be further improved in China, the reasonable pricing mechanism and scientific compensation mechanism should be developed, and the relatively low prices of the essential drugs should be brought into full play.