陕西省公立医院基本药物制度实施状况评估

摘要

目的 评估陕西省公立医院国家基本药物制度的实施状况.方法 利用2008年版WHO-Health Action International(HAI)标准化调查方法,于2012年3～5月间对陕西省10个城市120家一级、二级和三级公立医院的38种基本药物价格和可获得性状况进行调查.结果 陕西省公立医院基本药物的可获得性整体水平较低,原研药的平均可获得性仅为5.9％,最低价格仿制药的平均可获得性为23.9％；三级医院的可获得性高于其他等级医院.基本药物原研药的采购价明显高于国际参考价,仿制药的采购价略高于国际参考价；一级医院基本药物的采购价低于二级医院和三级医院.经济发展水平不同的地区,基本药物的零售价差异不大.基本药物原研药的可支付性较差,仿制药的可支付性较好.结论 建议完善国家基本药物目录,适度扩充基本药物品种；完善药品定价机制,深入推进公立医院改革.%Objective To evaluate the implementation of the national essential medicine system in Shaanxi Province.Methods Using a standardized methodology (2008 Edition) developed by the World Health Organization(WHO) and Health Action International(HAD,data on the prices and availability of 38 essential medicines were collected from 120 primary,secondary and tertiary public hospitals in ten cities of Shaanxi Province from March to May 2012.Results The availability of essential medicines is generally low at public hospitals in Shaanxi province,as the average availability of originator brands is but 5.9％,and that of generics of the lowest prices is but 23.9％,while this availability at tertiary hospitals is higher than hospitals of lower levels.The procurement prices of originator drugs within essential medicines are distinctly higher than the international reference prices for the originator brands,and slightly higher for the lowest priced generics.The procurement prices at primary care hospitals are slightly lower than that of other hospitals.Retail prices of essential medicine are not significantly different among regions of different income levels.Affordability of originator brands is poor,while that of their generic equivalents is good.Conclusion The government is recommended to adjust the national essential medicine list,expand the variety of essential medicine moderately,improve the medicine pricing mechanism,and deepen public hospitals reform.