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1、.华 中 科 技 大 学 硕 士 学 位 论 文医院药品直供模式研究44 / 44.研究生：梁俊.导师：姜摘卫要刘国庆.为了改革以药养医的机制,缓解看病难、看病贵的现状,XX市某三甲医院于 2006 年 8 月 10 开始进行药品购销领域的直供模式改革试点。本研究目的在于通过对该三甲医院药品直供模式的调研,对医院药品直供模式进行比较全面的阐述,同时分析直供模式对药品和医疗费用的影响,评价直供模式的优缺点,判断直供模式推广的可行性,进而针对调研结果提出建议。在查阅文献的基础上,采用定性和定量资料结合的方法,收集有关直供医院药品直供的各方面资料和数据,对资料进行理论分析,运用 SPSS15.0 软
2、件对数据进行统计学分析。研究发现,实施药品直供后,来院就诊患者增多,药品费用降低,但是医疗费用却逐年升高,导致患者医药负担在直供后第 1 年得到缓解,第 2 年反而超过直供前。对直供前后 3 年药品价格、使用量和费用变化的统计分析显示,直供后药品价格虽然下降了,但是药品使用量却逐年上升,以致药品费用先下降后回升,没有持续下降。实施药品直供后,药品价格下降了,医务人员合理治疗和合理用药水平提高了,商业贿赂行为得到有效遏制,医院社会效益显著增强。但是直供模式在医疗费用代偿性增加、药品使用量不合理增长、独家供货的垄断性和供货能力的有限性、价格制定和医院补偿机制不完善等方面,都或多或少存在一些问题。权
3、衡直供模式的利弊,针对药品直供模式在控制医疗费用、药品使用量,直供中间环节设计,价格制定方式,以及完善医院补偿机制等方面提出了建议,认为药品直供模式暂时不适合在大范围推广。关键词：医院药品、直供模式、药品费用、医疗费用1.华 中 科 技 大 学 硕 士 学 位 论 文The Study of Medicines Direct-Supply Pattern in HospitalPostgraduate: Liang JunSupervisor: Jiang Wei, Liu GuoqingAbstractIn order to reform the mechanism of medical c
4、are service supported by dealingwith drug, to relieve the situation of difficult and high cost of getting medical service,the reform of medicines direct-supply pattern in the field of purchase and sale washeld in a certain first class of third level general hospital in Wuhan City in August 10th,2006
5、. Through the study of medicines direct-supply pattern in this hospital, thepurpose of this research is to fully represent medicines direct-supply pattern inhospital, to analyze its influence on expenses of drugs and medical care services inhospital, to estimate its strengths and weaknesses, to judg
6、e the feasibility topopularize this pattern, and to advance some recommendations based on the result ofstudy.The method of combining the qualitative data and the quantitative data wasadopted based on referring to documents possessed at hand. After gathering the datain all aspects about medicines dir
7、ect-supply pattern in this hospital, the qualitativedata was analyzed theoretically and the quantitative data was analyzed statistically byusing SPSS15.0 software.The research finds that after this reform the sum of patients coming to thishospital is increased and the expenses of drugs are reduced,
8、but the expenses ofmedical care services are raised. The burden of expenses to cure the diseases isrelieved in the first year but aggravated in the second year after the reform. Thestatistical analysis to the variation of prices, usage amounts and expenses of drugs in3 years before and after the ref
9、orm shows that after the reform the prices of drugs are2.华 中 科 技 大 学 硕 士 学 位 论 文reduced, but the usage amounts of drugs are increased year by year, so as that theexpenses of drugs recover after firstly lowering. The expenses of drugs are notpersistently reduced.After the reform of medicines direct-s
10、upply pattern, the prices of drugs arereduced, the capacities of curing diseases and using drugs reasonably by doctors areimproved, the behaviors of commercial bribery are restrained effectively and thesocial benefits are enhanced remarkably. But there are more or less problems in someaspects such a
11、s the increase of the expenses of medical care services instead, theunreasonably increase of the usage amounts of drugs, the monopolization ofsingle-supplier and the limitedness of its capability of supplies, the imperfectionabout the establishment of prices and the mechanism of the compensation to
12、thehospital.Balancing the strengths and weaknesses of medicines direct-supply pattern,some suggestions are proposed on controlling the expenses of medical care servicesand the usage amount of drugs, designing the middle-sections of medicines supply,the mode of prices establishment and consummating t
13、he mechanism of thecompensation to the hospital. The conclusion is drawn that medicines direct-supplypattern is not suitable to popularize on a large scale at present.Key Words: medicines in hospital, direct-supply pattern, expenses of drugs,expenses of medical care services3.独创性声明本人郑重声明,本学位论文是本人在导师
14、指导下进行的研究工作及取得的研究成果的总结。尽我所知,除文中已经标明引用的内容外,本论文不包含任何其他个人或集体已经发表或撰写过的研究成果。对本文的研究做出贡献的个人和集体,均已在文中以明确方式标明。本人完全意识到本人将承担本声明引起的一切法律后果。学位论文作者签名：.日期：年月日.学位论文版权使用授权书本学位论文作者完全了解学校有关保留、使用学位论文的规定,即：学校有权保留并向国家有关部门或机构送交论文的复印件和电子版,允许论文被查阅和借阅。本人授权华中科技大学可以将本学位论文的全部或部分内容编入有关数据库进行检索,可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。保密 ,在_年解密后
15、适用本授权书。本论文属于不保密。请在以上方框内打 .学位论文作者签名：指导教师签名：.日期：年月日日期：年月日.华 中 科 技 大 学 硕 士 学 位 论 文.1 引言.1.1 研究背景与目的看病难、看病贵是我国现行医疗体制下存在的突出问题,老百姓对看病就医常诸多抱怨,这不利于我国建设和谐社会。我国各类医疗机构以药养医现象非常严重,药品收入占医院业务总收入的比例居高不下。新出台的医改方案把建立完善的药品供应保障体系作为近 3 年要解决的重要问题。本课题欲结合XX市某三甲医院药品直供试点工作,对医院药品直供模式进行调查研究,目的在于对医院药品直供模式进行较全面的阐述,同时评价分析这种模式对药品费用的影响,判断药品直供模式在解决药品价格虚高方面的可行性,进而针对具体调研结果提出建议。目前,虽然有些地区和医疗机构在进行不同药品购销模式的试点,但是较少对这些模式进行详细实证研究。我国对医院药品直供模式的研究报道也较少,且缺乏大量样本现场调研。所以本课题的研究,对于积极贯彻国家坚持医药分开的政策,寻找一种适合推广的有效医院药品供应模式,以降低医院药品费用,都具有重要意义。1.2 研究对象与
