Exploration On Mechanism Of Separation Of Drug Prescribing And Dispensing In Wuhan Community Health Service

【Background】In recent years, some special measures like separation of drug prescribing and dispensing have been taken according to Wuhan community health service development strategy. These measures are not only an exemplification of national community health service development strategy, but also some of creativity on practice. Despite that community health service development research and practice have been carried out abroad in an earlier stage and successful modes of separating medical care from pharmaceuticals have already been developed, special assessment combining national or even regional characters is still in need because of the difference of social politics, culture, economy, health service conditions , especially the weakness of our country in fund raising and compensation, which are all closely related to community health service development.【Objective】This subject took wuhan , which behaved excellent in community health service innovation and practice in the recent two years as the researched field, combined qualitative and quantitative methods and on a basis of overall analysis of implementation of national health policy, focused on the operational mode , achievement, experience and problems and explored its feasibility and popularizing value, aiming at summarizing the experience of wuhan separating medical care from pharmaceuticals, finding out the deficiency , proposing political advice to refer to, not only for the community health service institution's popularization of separating medical care from pharmaceuticals reform in our country , but also for the health administrative departments'decision making on it.【Methods】To combine qualitative and quantitative methods, mainly as literature review, field survey, interview and so on. Statistical methods like descriptive analysis, t-test, stakeholder analysis and SWOT analysis were applied.【Results】A total of 18 community health service center (CHSC) in Wuhan city (96 in all) has separated medical care from pharmaceutical. After this reform, the price of general pharmaceutical in the reformed CHSC was lower than the other CHSC that did not practice the reform by 24.52%. The clinic expenditure per patient in reformed CHSC was lower than average of Wuhan city by 38.86% during July to September in 2006. The increasing rate of clinic patients was higher than average of Wuhan city. The amount of clinic patients in September increased 12.92% compared with August ( average is 4.79% in Wuhan city). The salary of staffs in reformed CHSC increased by 43.75% averagely. There were 9 CHSC that were excess of receipts over expenditures in all reformed CHSC. Another ones were to the bad, but the mensal turnovers were still increasing stably. There were counterbalance between support and object force that capability score of employing resource were 2.55 and -2.45 separately.【Conclusions】Achievements have been acquired in the reform of separating medical care from pharmaceuticals by Wuhan community health service centre, such as decrease of medicine price, increase in clinical volume and income of the centre and the staff. A situation of"three wins"has realized, that is, common people gaining benefit, centers obtaining development and pharmacists getting profit. However, deficiency also exists at the same time, like shallow understanding, the too simple one mode, lack of compensation and offence to the system and other unrealized problems, which altogether have a bad influence on the continuance and popularization of the reform.【Suggestion】Based on the existing problems, suggestions as below are put forward: to change view and raise understanding of the reform; to improve related laws and optimize the outside environment; to explore more modes of separating medical care from pharmaceuticals; for the government, to enforce surveillance on pharmacists'practice and for the centers and drug companies to improve their service and management.