65 岁以上老年人在基层医疗机构享有基本药物全额保障的可行 性研究 目的： 通过对医疗卫生资源配置、患者医疗保险、基层医疗机构基本药物的使用 和配送情况等进行调查分析，研究 65 岁以上老年人使用基本药物种类，药物消 耗数量、金额，基本药物费用的构成比等情况，对老年人在基层医疗机构使用 基本药物享有全额报销的政策进行研究，为政府决策提供重要依据。此项目一 旦实施可以减轻老年患者家庭负担，促进分级诊疗和双向转诊，提高慢病管理 和合理用药水平。 方法： 采取描述性统计分析方法与规范性研究方法相结合的方式，查阅相关文献， 了解我国目前实施基本药物制度的情况，特别是在政府办基层医疗机构中基本 药物的供应和使用现状，总结基层医疗机构在基本药物实施过程中存在的问题 和解决对策。以辽源为例，对辽源市老年人在当地基层医疗机构基本药物的使 用现状从多个方面进行分析，了解 65 岁以上老人在基层医疗机构使用基本药物 的情况。 采用自填式调查问卷形式，分别对基层医疗机构的管理人员、医务人员、 群众进行了问卷调查。问卷内容涉及：基层医疗机构 65 岁以上老人免费使用基 本药物的可行性、基层医疗机构 65 岁以上老人免费使用基本药物的弊端、实施 免费的基本药物种类、如何消除基本药物的浪费、了解国家基本药物政策的程 度、医务人员对于基本药物的使用及规范等等。整理后，采用 Epidata3.1 进行 问卷数据录入，SPSS13.0 统计软件进行统计分析。全面了解基层医疗机构管理 人员、医务人员、群众对基层医疗机构 65 岁以上老人基本药物的使用实行全额 保障的认知情况。 结果： 调查问卷结果显示：II 辽源市老年人人口占比较少；乡镇卫生院、城市社区、村卫生室基本药物 所占比例较二级以上医院高，药品种数明显低于二级以上医院，基本药物费用 基层医疗机构明显低于二级以上医疗机构，说明基本药物在基层医疗机构覆盖 较好，而品种数有限，基层医疗机构基本药物种类及费用占比率较大，越基层 占比越大；门诊数据显示，二级以上医院的门诊人次高于城市社区与乡镇卫生 院，人均药费也明显高于城市社区与乡镇卫生院，住院数据显示，二级以上是 城市社区住院人数的 5 倍，分析认为基层患者多流向二级以上医疗机构，数据 表明国家应该加大力度，对城市社区以及乡镇卫生院给予资金、人员、技术等 各方面支持，从而起到分流患者的作用；老年人疾病使用基本药物支出结果显 示占占 82.93%的 6 种疾病，分别为冠心病、心脑血管疾病、糖尿病、呼吸系统 疾病、高血压、消化道疾病，说明 6 种疾病均为老年人多发病，在基本药物中 占比较高，老年人需求此类基本药物量大； 1. 对管理人员的问卷结果分析：说明基层医疗机构管理人员认为无论是在 政策上还是在资金保障上，65 岁以上老人在基层医疗机构使用的基本药物达到 全额保障水平可行性非常高，但仍有一定的弊端和问题，需及时解决，同时必 须加强老年人在基层医疗机构全额保障使用基本药物后的可获得性研究； 2. 对医务人员的问卷结果分析：医务人员更加关注的是全额保障免费使用 基本药物后，基本药物的滥用和资源浪费问题，结果也显示最好的方法是加强 医生考核、将基本药物合理免费使用与医生处方权和奖金挂钩，同时也应加强 医护人员及居民的合理用药的宣传教育，同时配套制定相关制度以约束和规范 患者就医行为及医生处方开具行为，基本药物获得全额保障使用最理想的措施 就是政府统一组织定点生产、统一采购； 3. 对群众人员的问卷结果分析：群众问卷体现群众对于基本药物全额保障 的态度以及实施后会如何做，70%以上群众认为全额保障能减轻经济负担，62% 的群众希望如不能够满足 65 岁以上老人所有疾病使用的基本药物均获得全额 保障的最终构想，暂时可以先实现上述 6 种疾病所需的基本药物进行全额保障。 结论： 根据老年人基层医疗机构就诊使用基本药物费用测算及评估数据分析，我 认为老年人在基层医疗机构享有基本药物全额保障政策实施，符合我国医改发III 展方向，可以施行: （1）社会整体对 65 岁以上老年人在基层医疗机构享有基本药物全额保障具 有良好的期望。 （2）基本药物在采购供应方面仍然存在不足，对于实行 65 岁以上老年人在 基层医疗机构享有基本药物全额保障制度仍有制约。 （3）国家现有财政补贴可以弥补实行 65 岁以上老年人在基层医疗机构享有 基本药物全额保障所产生的资金缺口。 （4）国家基本药物目录的变更会给 65 岁以上老年人在基层医疗机构享有基 本药物全额保障制度的实行带来一定风险。 （5）现有资金不足情况下，着重针对冠心病、心血管疾病等 6 种疾病实行 基本药物保障制度，对于降低老年人药品费可以起到明显的作用。 关键词： 老年人，基层医疗机构，基本药物，全额保障IV Abstract The feasibility research of basic drugs full amount guarantee for elderly people over 65 in primary medical institutions Purpose: Through the investigation and analysis of resources allocation, medical insurance, basic medical institutions, the use and distribution of medical and health in basic drugs. To study the use of essential drugs, the amount of drug consumption, the amount of the basic medical expenses, and the composition of the basic drugs for the aged over 65 for the government decision-making policy of the basic medical institutions in the basic medical institutions. Once the implementation of this project, it will reduce the burden on the elderly patients, promote the classification and diagnosis and treatment and improve the management of chronic diseases and rational drug use. Method: By using descriptive statistical analysis method and normative research method, referring to the relevant literature, we know that China's current implementation of the basic drug system, especially in the government run primary health care institutions in the supply and use of basic drugs, summarized the basic medical institutions in the implementation of the basic drug problems and solutions. In Liaoyuan, for example, the use of the basic medical health institutions in Liaoyuan, the local grassroots medical institutions to analyze the use of basic drugs, to explore the full support of 65 years of age and older medical institutions, free access to basic drug policy is feasible Through the establishment of the research group, the self-administered questionnaire forms, respectively for grassroots medical institutions management personnel, medical personnel, the masses of the questionnaire. The content of the questionnaire: basic medical institutions over the age of 65 free use of basic drugs, basic medical institutions over the age of 65 free use of basic drugs, the implementation of free basic drug types, how to eliminate the waste of basic drugs, understanding of the extent of the national drug policy, medical personnel for the use of basic drugs, and so on. After finishing, using Epidata3.1 to carry on the questionnaire data entry, the SPSS13.0 statistical softwareV carries on the statistical analysis. Comprehensive understanding of the basic medical institutions, medical personnel, the masses of the basic medical institutions over the age of 65 years of basic drugs for the use of the full guarantee of the full support of the cognitive situation. Result The survey results showed: The elderly population in Liaoyuan accounted for less; for township hospitals, city community, village health room of basic drugs proportion is more than two hospitals, drug number was significantly lower than that in more than two hospitals, primary health care institutions basic drug costs were significantly lower than the more than two medical institutions, basic drug coverage is better in the basic medical institutions, the limited number of species and varieties, the cost of basic medical institutions of basic drugs accounted for the larger proportion of larger, more grass-roots; clinic data, outpatient visits more than two hospitals above the city community and township hospitals, the per capita medical expenses were significantly higher than those in City community and township hospitals, hospital data show, more than two is 5 the number of times the city community hospital, analyzed that the multiple flow direction more than two medical institutions at the grassroots level in patients, data show that the state should be strengthened, the city Community and township hospitals to finance, personnel, technology and other aspects of support, so as to play the role of patients with diversion, the elderly disease using basic drug expenditure results show that 82.93% of the 6 diseases, respectively, coronary heart disease, cardiovascular disease, diabetes, respiratory diseases, hypertension, gastrointestinal diseases, 6 diseases are elderly people, in the basic drugs accounted for a relatively high demand for such basic drugs. 1. Analysis of the results of the management staff: the basic medical and health institutions in the policy or on the financial security, the basic medical health institutions in the primary health care level 65 years of use of basic drugs to achieve full protection level is very high, but there are still some drawbacks and problems, need to be resolved, and must strengthen the basic medical institutions in the primary medical institutions can be obtained after the use of basic drugs; 2. Medical staff questionnaire analysis: medical personnel pay more attention to the full use of basic drugs, basic drugs abuse and waste of resources, the results also show that the best way is to strengthen the medical examination, the basic drugVI reasonable free use and medical prescription, but also to strengthen the relevant system to restrict and regulate the behavior of patients and doctors prescription, the basic drug use the most ideal measure is the government unified organization, unified procurement; 3. To the people of the questionnaire results analysis: the masses questionnaire reflects the full support of the people's attitude and how to do, more than 70% people believe that full support can reduce the economic burden, 62% of the people who want to meet the 65 years old and older than the basic drugs used in all diseases are the ultimate idea, can be achieved for the first time to achieve the basic drugs needed for the 6 kinds of diseases. Conclusion: According to the survey and assessment data analysis of the basic medical institutions, I think the old people in the basic medical and health institutions to enjoy the full support of the basic medical insurance system was conformed to the China's current policy, which can be implemented. 1.The whole society to the policy of basic drugs full amount guarantee for elderly people over 65 in primary medical institutions with good expectations 2.Due to the procurement and supply of essential drugs are still insufficient ,it is restricted to implementing the policy of basic drugs full amount guarantee for elderly people over 65 in primary medical institutions. 3.The country's existing financial subsidies can compensate the shortfall arising whice generated by implement the policy of basic drugs full amount guarantee for elderly people over 65 in primary medical institutions. 4.The change of National Essential Drugs List will bring some risks for the policy of basic drugs full amount guarantee for elderly people over 65 in primary medical institutions. 5.Under the current situation about lack of available funding.Focusing on the implementation of essential drugs safeguards against heart disease, cardiovascular disease and other six kinds of diseases can play a significant role for reducing the drug cost of the elderly people over 65. Key word: Old people, primary medical institutions, basic drugs, full guaranteeVII 目 录 第 1 章 绪 论...........................................................................................1 1.1 课题的研究背景及意义 .................................................................1 1.1.1 研究背景 ..................................................................................1 1.1.2 国际经验 ..................................................................................4 1.1.3 研究意义 ..................................................................................4 1.2 相关概念的界定 .............................................................................5 1.2.1 基本药物 ..................................................................................5 1.2.2 老年人.......................................................................................5 第 2 章 资料与方法 ................................................................................6 2.1 研究对象........................................................................................6 2.2 调查方法 .........................................................................................6 2.2.1 文献法.......................................................................................6 2.2.2 问卷调查法 ..............................................................................6 2.3 数据统计分析方法 .........................................................................7 第 3 章 结 果.........................................................................................8 3.1 辽源市人口分布基本情况 .............................................................8 3.2 辽源市医疗机构基本药物使用情况 .............................................9 3.3 问卷调查结果 ...............................................................................13 3.3.1 管理人员对 65 岁以上老人免费使用基本药物情况的认知 ..13 3.3.2 医务人员对基层医疗机构 65 岁以上老人免费使用基本药 物的认知情况 ........................................................................17 3.3.3 群众对基层医疗机构 65 岁以上老人免费使用基本药物的 认知情况 ................................................................................22VIII 第 4 章 讨论及建议 ..............................................................................25 4.1 65 岁以上老年人对使用基本药物全额保障的认知情况 ..........26 4.2 65 岁以上老年人使用基本药物全额保障的可行性 ..................27 4.3 65 岁以上老年人使用基本药物全额保障各层面分析 ..............27 4.3.1 基本药物采购供应层面分析 ................................................27 4.3.2 基本药物资金保障层面分析 ................................................28 4.3.3 基本药物支出占比层面分析 ................................................29 4.3.4 基本药物合理使用层面分析 ................................................29 第 5 章 结 论.......................................................................................31