基本药物制度对江苏省某市乡镇卫生院经济运行的影响

目的：了解基本药物制度实施前后江苏省某市乡镇卫生院经济运行变化情况,并对存在的主要问题制定相应的对策.方法：对某市乡镇卫生院基本药物制度实施前后的收支结构、财政补助、结余情况、医疗服务提供量、平均门诊费用等指标进行分析.结果：乡镇卫生院总收入增加,财政补助增加明显,药品收入呈下降趋势,药占比明显降低,但总收支结余逐年减少,至2011年和2012年出现了亏损,门诊人次数和入院人次数总体呈减少态势,转诊人次数剧增.平均门诊费用逐年缓慢减少,平均住院费用则有较大幅度的增加.结论：基本药物制度实施后,该市乡镇卫生院在控制药占比,破除“以药养医”机制方面取得了良好的成效.但是,该制度对现有的乡镇卫生院经济运行机制冲击较大,在一定程度上降低了其盈利能力.因此,应加大财政投入,完善经济补偿机制,健全相应扶持政策,并合理调整基本药物目录,以提升乡镇卫生院服务能力.

Impacts of the Essential Medicines System on the Economic Operation of Township Hospitals in a City,Jiangsu

Objective： The paper aims to investigate changes of economic operation situations in township hospitals before and after the imple- mentation of essential medicines and explore countermeasures. Methods： Make analysis of indicators including the balance of payment structure, financial aid, and balance status, medical service providing amount and average outpatient costs before and after the implementation of basic drug system of a township hospital. Results： With the increase of township hospital revenue, the fiscal subsidies increased significantly, the drug in- come declined, the drug proportion reduced significantly, but the overall balance of payment decreased year by year, and showed loss in 2011 and 2012. The overall outpatient number and hospital admission number showed decreasing trend, with sharp increase of referrals. The average outpa- tient cost slowly decreases and the average cost of hospitalization had substantial yearly increase. Conclusion： The implementation of basic drug system has achieved good results in the control of drug proportion, and breaking down the mechanism of ＂ supporting hospital by drug＂ , but it has great impact to township hospital economic operation, which reduced its profitability to some extent. It is recommended to increase financial in- vestment, improve economic compensation mechanism, improve the corresponding support policies, increase policy advocacy and make rational adiustment of essential dru~ list, enhance the service capabilities of township hospitals.