从我国医疗机构退药文献看住院退药的隐性成本

目的:调研我国医疗机构退药相关文献,探讨医疗机构住院部退药的现状与隐性成本。方法:在国内主要数据库检索2004年1月1日-2014年6月31日发表的退药研究文献并进行荟萃分析,根据文献发表年限、数据调查年份、医院名称、部门、涉及的退药金额、同期药品销售金额等信息,重点分析住院部退药情况,并估算全国医疗机构住院部退药金额。结果:共纳入合格的研究文献84篇,进行研究的医疗机构来自东部地区的比率(61.92%)远高于西部(20.23%)及中部(17.85%)。住院部退药金额百分比在0.61%~12.57%之间,平均每张病床年退药金额在0.010 5~3.716 3万元之间,金额最高的在东部地区的综合医院。由此估算全国所有公立医疗机构住院部的年退药金额约为60亿元。结论:我国各地区不同类型医疗机构普遍存在退药行为,且金额较大。退药带来的隐性成本包括退药金额、来回搬运退药的劳动力成本和时间成本,以及由其带来的安全隐患及后续处置产生的各种成本。

Study on recessive cost of drug repercussion for inpatients in medical institutions by meta-analysis on drug repercussion literatures

OBJECTIVE To investigate the literatures on drug repercussion in medical institutions in our country, discuss the recessive cost of drug repercussion for inpatients.METHODS The literatures relating to drug repercussion from January 1^st, 2004 to June 31^st, 2014 were searched in domestic main databases and then meta-analyzed. The cost of drug repercussion in medical institutions in the country was estimated based on publishing year, data researching year, hospital name, department, cost of returned drugs, and drug sales amount during the same period were analyzed. Drug repercussion for inpatients were selectively discussed, the whole drug repercussion amount for inpatients in medical institutions in the country was estimated.RESULTS A total of 84 articles were retrieved, the ratio of medical institutions from the eastern region (61.92%) was much higher than the western (20.23%) and central (17.85%) areas. The percentage of average drug refund accounted for the cost of medicine consumption was 0.61%-12.57%. The average drug repercussion amount per bed was between 105 to 37 163 Yuan, the repercussion amount of the general hospital in eastern area was on the top. Thus the estimation of the drug repercussion on hospitalization in the public medical institutions of the whole country was nearly 6.0 billion Yuan according to the national amount of beds published by MOH. CONCLUSION Drug repercussion phenomenon really happens widely in all hospitals in the country, and the total amount of repercussion cannot be ignored. The recessive cost of drug repercussion includes amount costs, labor cost, time cost, potential safety hazard, and subsequent disposal costs.