国家基本药物制度框架下的乡镇卫生院筹资测算方法研究:以S县为案例

目的:围绕乡镇卫生院执行国家基本药物制度面临的筹资困难问题,研究乡镇卫生院筹资测算技术方法,以服务决策、完善政策设计。方法:以S县乡镇卫生院筹资为个案,进行测算技术方法的研究。资料来源于2009年S县卫生财务年报数据库,并开展了关键人物访谈。结果:S县乡镇卫生院因取消药品加成减少2317万元收入,为弥补这一损失,经测算,财政补助收入和医疗服务收入分别需新增719万元和1598万元。为此,S县医疗服务数量若增长10%,则需将医疗服务价格提高40%。结论:实行基本药物制度并得到补偿后,整个社会福利得到改进;卫生筹资和经济补偿得到优化;地方政府财政供给能力面临挑战。建议:建立政府补助为主导的筹资机制;逐步提高新农合筹资水平;适当提高乡镇卫生院医疗服务收费水平。

Analysis on the measuring method of financing for township health center within the framework of national essential medicines system

Objectives：This paper aims to focus on the financing technical methods of the township hospitals to solve the problem of financing difficulties when the township hospitals implement the national essential drug system in order to service the decision-making and improve the policy design. Methods：Taking S county＇s financing to the township hospitals as a case,this paper disentangles the technical methods of the financing measuring. The data sources are derived from S county＇s health financial yearbook in 2009 and the key person＇s interviews. Results：The income is decreased 23.17 million RMB due to the implementation of zero-profit drug policy in the overall township hospitals in S county. In order to subsidy the deficit,the incremental of financial subsidy and medical service income should be 7.19 million and 15.98 million respectively. Thus,the medical service pricing should be increase 40% if the quantity of medical service is increased by 10%. Conclusions：The overall social welfare is to increase; The health financing and the economic reimburse is to be optimized; However,local government＇s financing ability is still in a stage of challenges. Recommendations：Establishing a financing mechanism dominated by government subsidy,increasing the funding level on New Rural Cooperative Medical Scheme gradually,and raising the medical service charges level of the township hospitals could be an important contribution to maintain the township hospitals sustainable development.