陕西省基本药物制度对基层卫生机构的影响——基于两市（县）4所基层医疗机构的抽样调查

目的：研究基本药物制度对基层卫生机构药品价格、收入和门诊服务的影响。资料与方法：抽取陕西省两县（市）4家基层卫生机构2009和2010年的药品购销数据、收入、服务量和次均费用进行分析,并对相关人员进行深入访谈。结果：样本机构的药品采购价格上升、不变和下降的比例各占1/3;样本机构总收入有增有减,财政投入不足和不及时影响到了基层机构的正常运转;有的机构门诊和住院服务量下降明显,有通过增加医疗服务种类和数量、延长住院日来增加医疗服务收入的现象。结论：理性看待基本药物制度实施前后药品价格的变化,在保证财政补助收入足额并及时到位的前提下,通过有效激励手段鼓励基层医务人员和患者使用基本药物,增强基层卫生服务需求和提供能力。

Analysis on the impacts of the essential medicines system on primary health institutions in Shaanxi Province: Based on a sample survey of 4 primary health institutions in 2 counties

Objective： To study the impacts of the essential medicines system on drug price, income and medical services in primary health institutions. Methods： Based on a sample survey of 4 primary health institutions in 2 counties in Shaanxi Province, we collected the data of drug prices, institution income and medical services from 2009 to 2010 and interviewed several key informants. Results： 1/3 of the essential medicines’ procurement prices are higher than that before the policy, 1/3 unchangeable and 1/3 lower. The total income of some sampling institutions decreased and some increased. Insufficient and faltering government investment hindered the institutions’ running. The outpatient visits and hospitalization admissions of some institutions decreased and the institutions had the potential incentives to rise the income by increasing types and quantity of medical service and extending lengths of stays. Conclusions： Then we proposed some recommendations which are rationally treating the changes of drug prices before and after the implementation of essential medicine policy, stabilizing the government financial investment, encouraging doctors and patients to use the essential medicine, enhancing both the demand and the supply in primary health institutions accordingly.