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

#药物政策#

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

于风华*孟庆跃王健孙强左根永

山东大学卫生管理与政策研究中心山东济南250012

=摘要>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。

=关键词>基本药物;乡镇卫生院;筹资;测算方法

中图分类号:R951文献标识码:A do:i10.3969/.j i s sn.1674-2982.2010.10.007

Analysis on t he m easuring m et hod of financing for towns hip health center w ithin t he fra m e-work of national essentialm edici n es syste m:a case in S County

YU F eng-hua,MENG Q ing-yue,WANG J i a n,SU N Q iang,ZUO G en-yong

C en ter for H ealt h M anage m ent and P olicy,Shandong University,Shandong J inan250012,China

=Abstract>Ob j e ctives:Th is paper ai m s to focus on t h e fi n anci n g technicalm ethods of t h e townsh i p hosp ita ls to so l v e the pr oble m o f fi n ancing difficulties when the to wnsh i p hospitals i m p l e m en t the nati o na l essen tial drug syste m i n order to serv ice the dec i s ion-m ak i n g and i m pr ove the policy design.M ethods:Tak i n g S county.s fi n anci n g to the to w nship hosp ita ls as a case,this paper d isen tang les the techn ica l m ethods o f the fi n ancing m easuri n g.The data sources are derived fro m S county.s healt h fi n ancia l year book i n2009and the key person.s interv i e w s.R esults:The inco m e is decreased23.17m illion RMB due to the i m p le m entation of zero-profit drug po licy i n the overa ll to w nsh i p hospitals i n S county.In order to subsidy the defici,t the i n cre m enta l of fi n anc ial subsidy and m ed ical serv ice i n co m e shou l d be7.19m illi o n and15.98m illi o n respecti v ely.Thus,the m ed ical service prici n g shou l d be i n crease40%if the quantity ofm ed ical ser v ice is i n creased by10%.Conclusi o ns:The overall socialw elfare is to i n crease;The hea lth f-i nancing and the econo m ic rei m burse is to be opti m ized;H o w ever,local governm ent.s fi n anc i n g ab ility is still i n a stage o f cha llenges.R eco mm endations:E stablishi n g a fi n anci n g m echanis m do m i n ated by governm ent subsi d y,increasi n g the funding level on Ne w Rura lCooperativeM ed ica lSche m e gradua ll y,and raisi n g the m edica l ser v ice c har ges level of the to wnsh i p hosp ita ls could be an i m portant contributi o n to m a i n ta i n the to w nsh i p hosp itals sustainab l e developm en.t =K eyW ord>Essentia lm edic i n es;Townsh i p hea lth center;F i n ancing;M easuring m ethod

建立国家基本药物制度是深化医药卫生体制改革近期五项重点工作之一,涉及体制机制深层次变革,机遇与挑战并存。从各地实施情况看,由于基本药物实行零差率销售,乡镇卫生院补偿问题比较突出,影响了政策执行的整体效果。如果补偿问题解决不好,不仅影响到改革的顺利推进,更令人担忧的

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*作者简介:于风华,女(1969年-),高级会计师,博士研究生,主要研究方向为卫生经济政策管理。E-ma i:l yfhcn@