中国三明市医改下药品费用影响因素分析

目的：探讨三明市医药卫生体制改革期间药品费用变化情况,并分析药品价格、药品用量和用药结构对药品费用变化的影响,以期为今后药品费用改革决策提供视角和参考。方法：收集三明市1家医院（实验组）和福建其他地区18家医院（对照组）在2011-2016年期间的药品采购数据,采用"A.M"指数体系进行因素分析。结果：自2011年起实验组药品总费用保持平稳,年均增长率为1.4%,对照组涨速较快,年均增长率为6.4%;实验组和对照组价格因素及用量因素变化趋势一致、变化速度相近;在结构因素方面,实验组保持平稳,对照组涨速较快。结论：三明市医改明显降低了药品价格并抑制了"同类别药品高价药替代低价药"的趋势,控制结构因素是抑制药品费用上涨的有效手段。

Analysis of factors affecting drug expenditure during Sanming healthcare reform in China

OBJECTIVE To investigate the change of drug expenditure in Sanming healthcare reform,and analyze the impact of composition of drug consumption,drug prices,drug quantity on its cost,provide a reference for future research and policy on drug expenditure.METHODS Data on drug procurement were collected from one intervention hospital in Sanming City and 18 control hospitals in other parts of Fujian between 2011 and 2016 and the A.M index analysis system was used to do factor analysis.RESULTS Since 2011,the total drug expenditure remained steady for the intervention hospital in Sanming city,whereas rose faster for control hospitals (1.4% and 6.4% respectively).The trend of price and quantity changing was consistent and the changing speed was close between the intervention hospital and control hospitals.The change of composition of drug consumption was similar to the total drug expenditure.CONCLUSION Healthcare reform in Sanming city has obviously lowered the price of drugs,and restrained the trend of high price drugs substituting low price drugs.Meanwhile,the control of composition of drug consumption factors is an effective measure to curb the rising drug expenditure.