积极推进药品集中招标采购切实减轻群众药品费用负担

为提高医院药品采购透明度,纪正药品购销中的不正之风,保证药品质量,降低药品采购价格,减轻群众不合理负担,我省自1999年12月起,开展了药品集中招标采购改革,一年来, 完成了三次药品集中招标采购。由第一次招标采购时仅为省人民医院1家,扩大到现在的12家医院,三次招标,共采购药品319种,采购金额共计5300万元,目前正在开展第四次药品集中招标采购,参加招标的医疗机构扩大到县及县以上公立综合性医院,专科医院,中医院和妇幼保健院（所、站）,招标药品700多种,采购金额约8000万元。     

湖北：进一步强化纪检监察纠风工作力度

在最近召开的湖北省2005年卫生系统纪检监察暨纠风工作会议传出信息，2004年，湖北省医疗机构普遍实行了医疗服务社会承诺制，有7万多名医务人员向科室、1．4万多个科室向医院、1．500多所医院向社会作出了服务承诺；有495家医疗机构参加了药品集中招标采购，共招标采购药品23．3亿元，药品价格平均下降18％，医疗机构使用招标药品的金额占用药总金额72．5％，减轻患者药品费用负担4．3亿多元，     

认真推行药品焦点招标采购遏制医药购销中的不正之风

1999年以来，我市卫生系统按照国务院反腐倡廉纠风工作部署，结合我市医疗卫生单位的实际，认真开展了以推行药品集中招标采购制度为核心内容的纠正医药购销中不正之风工作。经过1年多的探索和实践，初步摸索和建立了一套切实可行的运行机制和管理制度，取得了较好的效果，目前，全市15所县级以上综合医院全部实行了药品集中招标采购制度，共招投标138次，涉及品种961个，金额达5116.91万元，与招标前相比，招标药品采购价格平均下降10.92%，零售价格平均下降13.65%，累计向群众让受678.19万元，通过实行这一制度，进一步强化了市场竞争机制，降低了药品购销成本，控制了药品虚高定价，有效地遏制了药品采购过程中的不正之风和腐败行为，保证了药品质量，药品收入占医院总收入比重明显降低，更趋合理，1999年，全市15家县以上综合医院药品收入占医院总收入的38.98%,较上年度平均下降4.8个百分点，2000年药品收入占总收入的比重继续回落，，每门诊人次平均收费68.7元，每床日平均收费125.9元，出院者平均医药费用828.3元，使患者医疗负担进一步减轻，为推动医疗卫生体制改革，建立城镇职工基本医疗保障制度奠定了基础。     

我院实行药品招标采购的做法和效果

为降低药品购买价,防止药品在医院流通过程中出现的不正之风,减轻病人经济负担,从1997年3月开始对药品采购进行公开招标。具体做法：（1）成立药品采购领导小组和药品采购小组;（2）制订和认真执行公开招标采购药品制度,把好“五关”;（3）规范医院常规用药范围;（4）坚持新药引是药事管理委员会审批制度。实行招标采购制度后,药品进价平均下降14.7%;单病种药品费用降低。     

医疗机构药品集中招标采购探索

根据《关于城镇医药卫生体制改革的指导意见》和卫生部等部门制定的《医疗机构药品集中招标采购试点工作若干规定》 ,在广泛调研 ,反复论证 ,并借鉴其他城市经验的基础上 ,宁波市积极开展了医疗机构药品集中招标采购工作的探索 ,基本形成一套科学、规范、行之有效的工作机制和操作方法。一、基本情况截止２００１年６月底 ,按目前国家规定零售价格计算 ,两次药品招标共推出的２２９只药品及其规格 ,占参加招标的１２家医疗机构同期销售的２５ %左右 ,累计向社会让利２４６万元。随着医疗机构药品集中招标采购的推广 ,我市参加药品招标的医疗…     

迁安：推进医疗药品器械采购见成效

近年来，河北省迁安市卫生局全力推进药品集中招标采购工作，自2000年至今，已集中招标采购药品及器械18次，总金额6393万元，节约资金767．16万元，总节支比例为12％。尤其是2004年，卫生局积极运作，增加招标品种，扩大集中招标采购范围，把新型农村合作医疗用药目录所列药品全部纳入公开招标采购，品种由开始的450种增加到现在的1181种。     

句容市实施药品集中招标采购的做法与体会

自2000年起，江苏省句容市卫生局推行药品集中招标采购，三年多来，集中招标采购总金额达9184万元，药品平均降价幅度达25％，实现了药品集中招标覆盖面、临床用药招标采购量、药品供应商进入招标采购中心、药品收支实行专户管理四个100％的目标，取得了群众、药品供应商、医疗机构三方满意的良好效果。     

药品集中招标采购实践与思考

2001年以来，为尽快改变药品采购过程中虚高定价、高额让利的不合理状况，遏制医疗费支出上涨势头，我们在本局卫生系统的5个医院、4个分院推行药品集中招标采购制度，先后进行了4次规模由小到大的药品集巾招标采购，到目前为止，招标药品品种达到697种，1062个品规，涵盖了临床常用药物的70％以上，预计年采购金额可达7100     

医疗机构药品集中招标采购的实践与思考

为了认真贯彻落实国家有关部门《关于医疗机构药品集中招标采购试点工作若干规定》 ,逐步规范药品采购行为 ,确保药品质量 ,降低药品采购价格 ,减轻群众医药费用负担。 3月 2 0日 ,我区区级 5个医疗单位在重庆三峡中心医院举行了首次药品集中招标采购。有 2 4家医药公司和药品生产厂家报名参与投标 ,其中 15家投递标书。通过公开、公平、公正的激烈竞标、评标 ,重庆医药股份新特药品公司等 9家中标。本次药品招标有 2 4个品种和规格 ,中标品种 2 0个 ,有 4个品种少于 3家医药公司投标而无效。这次药品招标品种价格降幅最高的为 71.6 4% ,最…     

谨防药品集中招标采购中的腐败

药品价格是广大群众关注的热门话题，总认为医院药品价格高于药店药价，这是不可否认的实事。为遏制医院药品虚高定价和药品购销中的不正之风，相关部门出台了不少的政策和措施，如顺价销售、最高零售价格限制、药品集中招标采购等。由于药品生产厂家不同，是否GMP认证及     

新疆某三甲医院取消药品加成前后一年的运营效果分析

[目的]分析新疆地区实行药品零加成与补偿机制改革后某三甲医院运营的短期效果,以期为推进新疆城市公立医院改革提供参考。[方法]收集医院取消药品加成前一年与后一年的收支情况、补偿情况、运营效率等的相关数据,对比其运营变化情况。[结果]改革后医院的总收入同比增长3624.10万元,财政补助同比增长778.50万元;调整医疗服务价格对取消药品加成补偿69.35%,政府财政弥补31.63%;药品费用占比从43.81%下降至药品零差率后的33.41%;医院的门诊人次增加了3.75%,急诊量增长了3.48%;患者次均费用变化不明显。[结论]改革后该医院运营平稳,补偿到位且收入结构优化,下一步在政府持续落实改革主体责任的同时,应着力关注减轻群众的医疗负担。     

艾滋病对农村高发地区患者家庭经济影响的调查分析

目的:通过研究艾滋病患者对家庭经济的影响,了解艾滋病的家庭疾病负担,为农村地区艾滋病防治工作合理配置资源提供基础数据资料。方法:采用问卷调查方法进行调查,通过测算家庭的直接花费和间接花费,计算家庭的经济负担;通过外推家庭费用计算患者生存期内家庭经济负担;并计算家庭经济负担占家庭收入百分比;进行2组家庭收支情况对比分析。结果:家庭直接花费为834.60元/年,间接花费为1073.76元/年,家庭疾病负担共计为1908.36元,外推家庭花费合计为6101.77元。家庭负担占家庭收入的36.70%;艾滋病病人家庭收入显著降低,在医疗消费支出方面比对照组高得多,而用在文化、娱乐和生活等方面的消费水平明显较对照组家庭低。结论:艾滋病影响着患者家庭经济的多个方面,使家庭收入降低,家庭总消费能力降低,家庭消费结构发生变化,从而影响了整个病人家庭的生活质量。政府免费抗病毒、抗机会性感染治疗和检查,政府的救助,大大减轻了患者家庭的经济负担。     

The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals

In China, 44.4% of total health expenditures in 2001 were for pharmaceuticals. Containment of pharmaceutical expenditures is a top priority for policy intervention. Control of drug retail prices was adopted by the Chinese government for this purpose. This study aims to examine the impact of this policy on the containment of hospital drug expenditures, and to analyze contributing factors. This is a retrospective pre/post-reform case study in two public hospitals. Financial records were reviewed to analyze changes in drug expenditures for all patients. A tracer condition, cerebral infarction, was selected for in-depth examination of changes in prices, utilization, expenditures and rationality of drugs. In the two hospitals, a total of 104 and 109 cerebral infarction cases, hospitalized respectively before and after the reform, were selected. Prescribed daily dose (PDD) was used for measuring drug utilization, and the contribution of price and utilization to changes in drug expenditures were decomposed. Rationality of drug use post-reform was reviewed based on published literature. Drug expenditures for all patients still increased rapidly in the two hospitals after implementation of the pricing policy. In the provincial hospital, drug expenditures per patient for cerebral infarction cases declined, but not significantly. This was mainly attributable to reduced utilization. In the municipal hospital, drug expenditure per patient increased by 50.1% after the reform, mainly due to greater drug utilization. Three to five fold higher drug expenditure per inpatient day in the provincial hospital was due to use of more expensive drugs. Of the top 15 drugs for treating cerebral infarction cases after the reform, 19.5% and 46.5% of the expenditures, in the provincial and municipal hospitals, respectively, were spent on drugs with prices set by the government. A large proportion of expenditures for the top 15 drugs, at least 65% and 41% in the provincial and municipal hospitals, respectively, was spent on allopathic drugs without an adequate evidence base of safety and efficacy supporting use for cerebral infarction. Control of retail prices, implemented in isolation, was not effective in containing hospital drug expenditures in these two Chinese hospitals. Utilization, more than price, determined drug expenditures. Improvement of rational use of drugs and correcting the present incentive structure for hospitals and drug prescribers may be important additional strategies for achieving containment of drug expenditures.     

Price cuts and drug spending in South Korea: The case of antihyperlipidemic agents

Objective

To identify the effect of price control policies on drug expenditure in South Korea.

Methods

We retrospectively examined the effects of price-reduction policies on drug expenditures, in particular regarding anti-hyperlipidemic drugs. The National Health Insurance claims data for a 60-month period between 2006 and 2010 were analysed. A segmented regression analysis was conducted with three intervention variables: July 2008, April 2009, and January 2010.

Results

Despite three rounds of price cuts, monthly drug expenditures increased by KRW 599.67 million (USD 523,726) after the third intervention (p = 0.0781). The trend in volume increased consistently, but not significantly. The unit prices showed a steady downward trend over time, but rebounded after the third price cut. The number of patients with hyperlipidemia more than doubled to 3729 (p = 0.0801) per month after the entry of generics for atorvastatin in July 2008.

Conclusion

Extensive price controls did not effectively suppress the growth of pharmaceutical expenditures. The increased number of patients, attributable to the newly launched generic drug atorvastatin, and the increased use of expensive drugs were major factors affecting the increase in drug spending. Policies that regulate both drug prices and utilisation, and that reduce financial burdens via enhanced use of generics need to be introduced.     

药品价格改革对贵州省公立医院经济运行的影响

目的 分析2014 - 2018年贵州省公立医院的经济运行变化情况,为公立医院药品价格改革提供参考依据。方法 收集贵州省185所公立医院数据,采用描述性分析和结构变动分析法对贵州省公立医院的门诊和住院收入的结构变动情况进行研究。结果 2014 - 2018年贵州省公立医院药占比逐年下降,门诊收入中药品收入结构变动度贡献率为23.77%,呈负向变动,住院收入中药品收入结构变动贡献率为23.97%,呈负向变动。结论 药品价格改革对医院经济运行有影响,建议合理调整医疗服务价格,建立科学的药品补偿机制,提高技术性服务收入。     

A description of outpatient drug use in rural China: evidence of differences due to insurance coverage

This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2·56 and drug expenditures per visit was 16·9 yuan. Between insured and uninsured (out‐of‐pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti‐infectives, most of which were penicillin, gentamycin and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee‐for‐service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure. Copyright © 1999 John Wiley & Sons, Ltd.     

北京医药分开试点成效及启示——以北京朝阳医院为例

目的:以北京市朝阳医院为例,分析北京市医药分开改革试点三年来所取得的成效,为公立医院改革提出建议。方法:收集医药分开试点前后门诊和住院的相关数据,对药占比、次均药费、业务量、医疗质量、收入及结构进行比较分析。结果:改革第三年与改革前一年相比,门诊、住院药占比分别下降16.98个百分点和13.3个百分点,年均降幅分别为25.57%和36%;门诊、住院患者次均/例均药费分别下降21.39%和34.8%。医疗收入较改革前增加68.1%;药品收入较改革前下降14.29%。医事服务费收入达到24 350万元。检查、化验收入增加52.60%。讨论:试点医院医药分开对于控制药品费用效果良好。建议:公立医院改革下一步应朝着"医检分开"、调整医疗服务价格等方向推进。     

A re-examination of the impact of reference pricing on anti-hypertensive drug plan expenditures in British Columbia

Reference pricing (RP) limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest-cost interchangeable drug; any cost above that is borne by the patient. Much of the evidence of the effects of RP comes from 'before and after' studies of the RP scheme adopted by Pharmacare, the publicly funded drug plan for seniors and others in British Columbia, Canada. We critically assess the identifying assumption inherent in the before and after design - namely, that pre-RP trends accurately predict counterfactual outcomes - in the context of estimating the impact of RP on Pharmacare's expenditure on anti-hypertensive drugs for its senior beneficiaries. We use similar data from a public plan that has not introduced RP to estimate the effects on drug expenditures of patent expiration, secular changes in prescribing patterns and various other factors common to all Canadian public drug plans that could potentially confound the before and after estimates of the effect of RP on drug plan expenditures. We find that controlling for such factors reduces estimates of drug plan savings attributable to RP of the Calcium Channel Blockers by about half.     

Provider responses to a global budgeting system: The case of drug expenditures in Taiwan hospitals

In July 2002, a global budgeting system was imposed on hospitals in Taiwan. This system set a fixed budget for all hospitals within a region but included special provisions that sheltered reimbursements for drug expenditures. We study the size and nature of changes in hospital physicians' use of drugs for outpatient care following this budgetary change and find that drug expenditures for outpatient care increased by 11.7%. Our results suggest that physicians began prescribing more expensive drugs, more drugs, and drugs for longer periods but that these different responses did not all occur at the same time. The overall response was strongest in for‐profit hospitals, but drug‐related decisions changed in all hospital types.     

重庆市男男性行为人群新型毒品使用现状及其影响因素分析

目的 了解男男性行为人群（men who have sex with men, MSM）新型毒品使用现状及其影响因素。方法 采用方便抽样的方法对重庆市MSM进行自填式匿名问卷调查,采用二分类非条件logistic回归对该人群新型毒品使用进行影响因素分析。结果 本研究共招募合格调查对象1 151例。调查对象以35岁以下青壮年、未婚、重庆户籍、高中以上文化程度、服务或个体职业及较高收入水平者为主。18.9%的调查对象报告近6个月使用过新型毒品,Rush为MSM最常使用的新型毒品,占17.7%。logistic回归显示,年龄≤35岁（OR = 2.232, 95% CI: 1.218～4.090）、月收入≥3 000元（OR = 1.652, 95% CI: 1.051～2.596）、性角色为被插入方（OR = 1.874, 95% CI: 1.154～3.043）或双重性角色（OR = 2.462, 95% CI: 1.612～3.761）、初次肛交年龄＜18岁（OR = 1.664, 95% CI: 1.144～2.422）及近6个月发生过群交性行为（OR = 13.597, 95% CI: 7.341～25.183）是MSM使用新型毒品的影响因素。结论 重庆市MSM使用新型毒品情况比较普遍,应根据使用人群的社会人口学及行为特征制定针对性的干预策略,从而降低该人群中艾滋病及其他性传播疾病的感染风险。