基本药物制度实施后云南省某市新农合患者就医流向变化

目的:研究基本药物制度实施后新农合患者就医方向变化,为制定相关政策提供参考。方法:采用有干预的时间序列研究设计,收集云南省某市2009年1月—2011年10月的新农合患者补偿相关数据并进行分段回归分析。结果:国家基本药物制度实施后新农合患者到乡村医疗机构门诊就诊的人次增长缓慢但到县级医疗机构门诊就诊的人次增长迅速,且占新农合患者总门诊人次的比例上升;新农合患者到乡医疗机构住院的人次减少但到县级及以上医疗机构住院的人次增加,且到县级及以上医疗机构住院的人次占新农合患者总住院人次的比例增加。结论:国家基本药物制度的实施可能由于限制了基层医疗机构的用药范围以及基层医疗机构补偿不到位、药品配送不及时等原因,使得新农合患者更加倾向于去县级及以上医疗机构就诊。因此在制定基本药物目录时应充分考虑到各地区多样化用药的需求,基本药物制度实施过程中要制定并落实完善的补偿政策,还要加强对医药供应、配送企业的考核。

The change tendency of visits among patients with New Rural Cooperative Medical Scheme after the implementation of essential medicines system in a city of Yunnan Province

Objective： To study the change tendency of outpatient visits and inpatient admission among pa- tients with New Rural Cooperative Medical Scheme （NRCMS） after the implementation of national essential medi- cines system, and provide reference to formulating relevant policies. Methods ： Using interrupted time series （ITS） study design, we collected the NRCMS data from Jan 2009 to Oct 2011 in one city of Yunnan Province and conduct segmented regression analysis. Results ： After the implementation of national essential medicines system, outpatient visits from patients with NRCMS at township medical institutions have slow growth but those at the county level med- ical institutions increased rapidly, and the proportion of outpatient visits at the county level medical institutions in total outpatient visits of patients with NRCMS increased; inpatients admissions from patients with NRCMS at township level medical institutions have reduced but those at or above the county level medical institutions have in- creased, and the proportion of inpatients admissions at or above the county level medical institutions in total inpa- tients admissions of patients with NRCMS increased. Conclusions ： The implementation of national essential medi- cines system may make the patients with NRCMS more inclined to seek a healthcare at or above the county level medical institutions because of a variety of reasons, such as it limited the number of medicines at township medical institutions, the compensation of primary medical institutions was not enough and the medicine for primary medical institutions was not serviced in time. Therefore, we must take full account of the diverse requirement for medicines of different regions when formulating essential medicine list , we should formulate and implement sound compensa- tion policies in the process of implementation of the essential drug system, but also to strengthen the assessment of the pharmaceutical supply and distribution enterprises.