| In April2009, the CPC Central Committee and the State Council issued "to deepen about the views of the medical and health system", requested to speed up the establishment of medicine supply security system based on the essential medicine system, protected the people’s safe drug use. In August, the ministry of health, the national development and reform commission and other seven departments jointly issued " implement views about establishment of national essential medicine system", requested the government held primary medical institutions to equip and use the essential medicine lists drugs,and carry out "zero slip" policy. As the hub of China rural medical and health service system, the rural hospitals are responsible for the rural areas primary medical and diseases prevention, equipment essential medical lists drugs and "zero slip" policy can influence the rural hospitals’medicine equipment and medicine price, then influence the medical service and at last influence the hospital financing.Study objectiveTo study the impact of essential medicine system on the rural hospitals patient visits, financing and rational drug use, propose scientific policy and suggestions to Shandong essential medicine system.Study MethodologyThe datum of this study come from second-hand materials and field survey materials. Second-hand materials are Shandong province essential medicine policies and2009,2010the rural hospitals’scale, patient visits and financing datum. Field survey materials are data about medicine warehousing list, medicine price, prescriptions and interview data from nine rural hospitals of country Ninyang, linzi, and jiaonan, chosen by economic development level.The researcher and students from the center for health management and policy of Shandong University are data collectors. Quantitative and qualitative analysis methods are used in the study. The quantitative datum are analyzed by descriptive statistical analysis and signal factors analysis. Before the analysis of the second-hand materials, using propensity score matching to balance the difference between the treatment and the control group, then using difference in difference method to calculate the net influence of the essential medicine system to the patient visits and business income. For the qualitative interviews, the analysis method is sum up of living recording and notes for the research objectives.Study resultsFrom the analysis of the second-hand materials, about the patient visits, the research found after the implement of essential medicine system, the treatment group out-patient visits rise by5.36%, the control one rise by27.73%, the treatment group hospitalized patient visits rise by7.38%, the control one rise by10.28%. difference in difference method show the essential medicine system make the hospital log out-patient visits descend0.01, log hospitalized patient visits descend0.03, and have no significance at10%test level, the purpose of essential medicine system sinking the health service is not achieved. About the financing, the treatment group financial aid rise by70.46%, the control one rise by44.97%, the business income of the treatment group descend by1.89%, and the control one rise by16.25%. With the further analysis, about the financial aid, the research found94%of the2010rural hospital’s financial aid comes from local financial, this increase the local financial burden. About the business income, the treatment group drug income descend by3.97%, the control one rise by27.99%, the treatment group medical income rise by22.19%, the control one rise by9.17%. The difference in difference method show essential medicine system make the rural hospital log drug income descend0.24, and have significance at10%test level, the log medical income rise0.03, but have no significance at10%test level. The implement of essential medicine system descend the drug income but do not ascend the medical income.From the analysis of the field survey materials, about drug rational use, after the implement of essential medicine system, Jiaonan county drug rational use become a little better, but three field counties’injection prescription proportion are respectively28.61%,35.63%,54.50%, antibiotic prescription proportion are respectively45.95%,52.43%,46.68%, percentage of drugs prescribed from essential drugs list are respectively87.78%,87.24%,89.81%, belong to not rational use category. About the drug equipment, Jiaonan county lost the drug warehousing list, so just analysis other two counties, compare with before the implement, Niningyang county drug equipment descend by3.8%, Linzi district descend by15.03%. Ningyang county just equip48.95%of the essential medicine list, Linzi district equip40.34%. About drug price, there are671samples in analysis,58.27%samples’ procure price descend, descend by22.67%,89.42%samples retail price descend, descend by44.35%.Conclusion and suggestionsBecome of essential medicine system, the rural hospital drug equipment descend, part of drug procure price rise, drug retail price descend. Essential medicine list is not suit for rural hospital, and the rule of only equipment essential medicine list drugs restrict the health service provision, accompany with the essential medicine procurement and distribution do not perfectly solve the supply of drugs, the purpose of sinking health service is not achieved. The essential medicine system change rural hospital "raise the medicine by the medicine" operation style, mainly depend on local financial aid increase the financial burden of underdevelopment district, and the doctors trend to provide irrational medical services to compensate the medicine income lost, this behavior against the purpose of relieving patients economic burdens. Some districts drug rational use improved but stall belong to irrational category, there have essential medicines manual, but lack of effective promoting measures. In order to promoting implement of essential medicine system, the study put forward the following suggestions:1) In the short term, adjust the essential medicine list, in the long term, formulate the standardization list selection procedure to ensure the list application.2) Complete the procurement and distribution system.3) Ensure the financial aid on time, take advantage of medical insurance fund, establish sustainable financing ways.4) Strengthen the rural hospital electronic prescription construction and standardization management, take advantage of the basic norms and guidelines for clinical applications, promote drug rational use. |
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