山东省公立医疗机构药品可获得性的动态评估
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摘要
目的分析山东省药品可获得性的变化,从可获得性角度评价山东省药品的可及性。方法采用世界卫生组织/健康行动国际组织的标准调查方法,对60种常用药品在山东省公立医疗机构的可获得性进行动态评价。样本数据来源于2012—2016年山东3市39家不同级别公立医疗机构的药品调查结果。结果各级公立医疗机构的药品可获得性均低于50%,5年总体可获得性为23.4%。各年度基本药物的可获得性均显著高于非基本药物,通用名药品的可获得性均显著高于原研药品,低价药品和非低价药品间的差异无统计学意义。从变动趋势上,5年间药品可获得性整体呈较平稳的波浪型变动,二级和三级医疗机构药品的可获得性明显上升,原研药品和低价药品的可获得性明显上升,基本药物的可获得性有所下降。结论 2012—2016年山东省公立医疗机构药品可获得性变动平稳,可获得性总体水平不高,但仍优于中高等收入地区平均水平。建议相关部门继续加强药品供应监管,通过价格杠杆等创新政策手段调控药品供给,同时注重发挥医保的费用控制作用和集团购买功能,进一步改善药品可获得性。
Objective To evaluate the accessibility of medicines in Shandong province from the perspective of medicine availability.Methods Based on WHO/HAI standardized approach,the availabilities of 60 generic medicines were investigated.Data were obtained from 39 public medical institutions.Results The medicine availabilities at each level of public medical institutions were less than 50%and the overall availability was 23.4%.The availability of essential medicines was significantly higher than non-essential medicines and the availability of generic medicines was significantly higher than that of originator brands.There were no obvious differences between low-cost medicines and non-low-cost medicines.As for changing trend,the medicine availability presented a smoothly wavy variation on the whole.The availability of medicines at second and tertiary hospitals and the availability of original bands and low-cost medicines showed increasing trends.The availability of essential medicines had a tendency to decrease.Conclusion The medicine availability at public medical institutions has been stable during past five years.Although the overall level is not high,it is still superior to the average level at middle and higher income regions.The supervision of drug supply should be continued based on more innovative policies in order to further improve the medicine availability.At the same time,more attention should be paid to the cost control and group purchase functions of health insurance.
Objective To evaluate the accessibility of medicines in Shandong province from the perspective of medicine availability.Methods Based on WHO/HAI standardized approach,the availabilities of 60 generic medicines were investigated.Data were obtained from 39 public medical institutions.Results The medicine availabilities at each level of public medical institutions were less than 50%and the overall availability was 23.4%.The availability of essential medicines was significantly higher than non-essential medicines and the availability of generic medicines was significantly higher than that of originator brands.There were no obvious differences between low-cost medicines and non-low-cost medicines.As for changing trend,the medicine availability presented a smoothly wavy variation on the whole.The availability of medicines at second and tertiary hospitals and the availability of original bands and low-cost medicines showed increasing trends.The availability of essential medicines had a tendency to decrease.Conclusion The medicine availability at public medical institutions has been stable during past five years.Although the overall level is not high,it is still superior to the average level at middle and higher income regions.The supervision of drug supply should be continued based on more innovative policies in order to further improve the medicine availability.At the same time,more attention should be paid to the cost control and group purchase functions of health insurance.
引文
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[13]医药地理.广东基药放开,药企迎来利好[EB/OL].(2017-07-30)[2017-08-24].http://www.sohu.com/a/161275137_170591.
[2]埃利亚斯·莫西洛斯.中国药品政策:改革的挑战和机遇[M].北京:中国发展出版社,2017.
[3]宋燕,甄天民,温楠,等.演化博弈理论视角下促进医疗机构优先使用基本药物的策略探讨[J].卫生软科学,2016,30(9):10-12.
[4]World Health Organization.Measuring medicine prices,availability,affordability and price components[R].Switzerland:World Health Organization,2008.
[5]张瑜,李歆.基于WHO/HAI标准调查方法的南京市基本药物可获得性及可负担性调查分析[J].中国药房,2015(30):4188-4192.
[6]Wang X,Fang Y,Yang S,et al.Access to pediatric essential medicines:a survey of prices,availability,affordability and price components in Shanxi Province,China[J].PLoS One,2014,9(3):e90365.
[7]Shanti M,Keiko F,Alexandra C,et al.The availability and affordability of selected essential medicines for chronic diseases in six low-and middle-income countries[J].Bull World Health Organ,2007,85(4):279-288.
[8]徐伟,李静.江苏省基本药物可获得性实证研究[J].中国药房,2013(8):676-679.
[9]管晓东,信枭雄,刘洋,等.我国基本药物可获得性评价实证研究[J].中国药房,2013(24):2216-2219.
[10]Cameron A,Ewen M,Ross-Degnan D,et al.Medicine prices,availability,and affordability in 36developing and middle-income countries:a secondary analysis[J].Lancet,2009,373(9659):240-249.
[11]中国医学科学院药物研究所,中国医药工业信息中心,中国食品药品检定研究院.中国仿制药蓝皮书[M].北京:中国协和医科大学出版社.2017.
[12]国际医学报道.大放开,基药制度突然瓦解[EB/OL].(2017-07-06)[2017-08-24].https://baijiahao.baidu.com/s?id=1571885073225174&wfr=spider&for=pc.
[13]医药地理.广东基药放开,药企迎来利好[EB/OL].(2017-07-30)[2017-08-24].http://www.sohu.com/a/161275137_170591.