| 引用本文：李力, 张卓然, 孟开, 王辰, 陈瑶.新医改以来我国公立医院医药分开策略及效果的系统综述[J].中国卫生政策研究,2014,7(1):59-64 |
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| 新医改以来我国公立医院医药分开策略及效果的系统综述 |
| 投稿时间：2013-06-25 修订日期：2013-12-05 PDF全文浏览 HTML全文浏览 |
| 李力1, 张卓然1, 孟开1, 王辰2, 陈瑶3 |
1. 首都医科大学卫生管理与教育学院 北京 100069;
2. 卫生部北京医院 北京 100730;
3. 中国医学科学院卫生政策与管理研究中心 北京 100020 |
| 摘要:目的：描述新医改中我国公立医院的“医药分开”策略，并对其实施效果进行初步评价。方法：采用系统综述法，对文献进行检索和筛选；以卫生改革的五个控制柄(筹资、支付、组织、规制、行为)为框架进行分析。结果：纳入文献35篇，其中，21篇描述具体措施和策略，14篇评价策略。芜湖、北京、深圳、上海是研究热点城市。北京和深圳以调整全部控制柄为策略，芜湖和上海以调整除行为外的四个控制柄为策略。短期内，各地虽产生了医保患者药品费用负担有所减轻等成效，但医生与药品之间的经济联系仍然存在。结论：“医药分开” 的本质是使医院、医生利益与药品脱钩，着重调整补偿机制，兼顾适时提升筹资水平、主动完善组织结构、配合加强规制力度的综合改革,现阶段虽取得一些成效，但医生利益与药品未脱钩。建议在反映医疗服务价值的价格形成机制基础上，建立更加公平的院内薪酬分配制度，完善医保总额预付制，更直接地控制医生趋利行为。 |
| 关键词:医药分开 公立医院 卫生改革 系统综述 |
| 基金项目:首都医科大学卫生管理与教育学院研究生自主探索研究项目(wgx1205) |
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| The strategy and effects of separating drug sales from medical services in public hospitals since health care reform in China |
| LI Li1, ZHANG Zhuo-ran1, MEMG Kai1, WANG Chen2, CHEN Yao3 |
1. School of Health Management and Education, Capital Medical University, Beijing 100069, China;
2. Beijing Hospital of the Ministry of Health, Beijing 100730, China;
3. Center for Health Policy and Management, Chinese Academy of Medical Sciences, Beijing 100020, China |
| Abstract:Objective: To describe the effects of separating drug sales from medical services in public hospitals since health care reform in China. Methods: Using academic databases and official websites at home and abroad, this paper reviewed the policys regulations, measurements, and effects since health care reform in China. We analyzed the policy based on control-knob theory. Results: There were thirty-five articles, 21 of which described the measurement and strategies and 14 of which described effects. After 2009, Wuhu, Beijing, Shenzhen and Shanghai were the focus of research. Beijing and Shenzhen both used the five control knobs whereas Wuhu and Shanghai used four (the behavior knob was excluded). In the short term, these strategies have produced some good results, such as reducing the burden on patients. However, there is still an economic relationship between doctors and drug sales. Conclusion: Separating drug sales from medical services is a synthetical and comprehensive policy that focuses on reimbursement and highlights the necessity of properly increasing funding, perfecting organizational structure, and strengthening regulation. Recently, there have been some good results, but an economic relationship still exists. This paper recommended that more equal compensation system should be established based on a pricing mechanism that reflects medical service value. The medical insurance of total prepayment should also be refined. |
| Key words:Separating drug sales from medical services Public hospital Health system reform Systematic review |
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