医改3年来基本药物制度实施成效的回顾性评价

目的：对医改3年来基本药物制度实施成效进行回顾性评价。方法：对18个省份共90家基层医疗卫生机构基本药物制度实施前后的状况进行监测与比较。结果：基本药物制度实施后，2009．2011年监测机构平均门急诊人次逐年上升，分别为4312．08人／月、5028．66人／月和5378．70人／月；2009—2011年监测机构平均门急诊次均费用逐年下降，分别为110．17元、86．40元和84．62元；合理用药情况改变，实施基本药物制度前后，抗菌药使用比例分别为50．80％和49．12％，抗菌药使用种类分别为0．58种和0．57种，抗菌药注射液使用比例分别为536％和3．49％，但激素使用比例上升，分别为8．33％和9．17％，抗菌药联合使用比例上升，分别为6．75％和738％：医疗机构收入增加。结论：以基本药物制度为契机启动的基层医疗机构综合改革初见成效。

Retrospective Evaluation of the Achievements of the Implementation of Essential Medicine System in Medical Reform of Past Three Years

Objective： To retrospectively evaluate the achievements of the implementation of the essential medicine system in the medical reform of past three years. Methods： To conduct the monitoring and comparison of the situations in 90 medical and health institutions at basic level of 18 provinces before and after the implementation of the essential medicine system. Results： After the implementation of essential medicine system, the average person-times of outpatient and emergency increased year by year in the monitoring medical and health institutions, the numbers per month during 2009 to 20l l were 4 312.08, 5 028.66 and 5 378.70 respectively, and the average cost for outpatient and emergency decreased year by year with the cost per time of 110.17, 86.40 and 84.62 yuan respectively. The rational use of antibiotics was improved. The application rate of antibiotics before and after the implementation of essential medicine system was 50.80% and 49.12%, the variety of antibiotics used was 0.58 and 0.57 and the injection administration rate was 5.36% and 3.49%. However the use proportion of hormones increased which was 8.33% and 9.17%, and the combined use rate of antibiotics was 6.75% and 7.38%. The incomes of those medical and health institutions increased. Conclusion： The initial success was achieved in the implementation of essential medicine system, which was a good start for the comprehensive reform of the basic medical and health institutions.