Investigation Of The Effect Of The Reform For The Separation Of Prescribing And Dispensing In Beijing

ObjectivesThrough the comparative study of the implementation of pilot hospital medicine separate policy and the implementation of medicine separate policy of non-pilot hospital, summarize and evaluate the implementation effect of Beijing medicine separate policy from three aspects of drug price, out-patient prescription costs, patient satisfaction, and provide basic data and reference for the further implementation of the policy and the promotion of medicine separate policy.MethodsThis study selected5hospitals implementing medicine separate policies of and3hospitals of non-implement medicine separate policies as the research object, through access to out-patient prescription drug information database, acquisition, out-patients satisfaction research data, to evaluate the implementation effect medicine separate policy, based on field survey, comparative analysis, statistical analysis and other methods. Application SPSS19.0statistical package for data statistical analysis, using frequency, percentage, mean, standard deviation, constituent ratio were described, measurement data using t test for between group differences in test, count data using test for between group differences in test.Results1Pilot hospital outpatient second all medical cost is lower than the non pilot hospital (P<0.05), the second all expenses for medicine than the non-pilot hospital low (P<0.05), the average technical service fee is non-pilot hospital increased (P<0.05), the average check fee without significant difference (P>0.05).2. Pilot hospitals drug accounted for more than12.85percent pilot hospitals is low, technical service fee is non-pilot hospital10.73percent;3. Pilot hospitals without drugs proportion pay than non-pilot hospital8.81percent, part pays and pays the proportion of drugs were lower5.24percent and3.57percent than the pilot hospital;4. Pilot hospitals0～to20～low price segment of the proportion of drugs than non-pilot hospital high7.4percent, while the60-to80-ratio of drugs high price segment than in the non-pilot hospital low10.34percent.5. The rational use of drugs per prescription drugs:pilot hospital average number is2.67species, lower than the non-pilot hospital average drug3.03species (P<0.05); prescription proportion pilot hospital of poly-pharmacy is10.37percent, proportion of non-pilot hospital is20.83percent (P<0.05); but the basic drug two group of hospitals use rates were not more than10percent (P>0.05).6.Results sample survey of6drug price display:26sampling drug prices lower than non-pilot hospital, the biggest difference rate is18.24percent, the minimum margin rate is14percent, the average spread rate was15.02percent; in addition, pilot hospital before and after medical reform an average decline of drug price13.04percent.7. Patient perception and evaluation of medicine separate policy:out-patient hospital of medicine separate pilot policy awareness rate is80.78percent; to cancel the drug support addition rate was84.94percent; not clear the connotation of medical services accounted for43.25percent of patients; think medicine separate policy to reduce the burden of medical expenses effectively accounted for only25.54percent the pilot; hospital patient selection of average out-patient service is relatively non-pilot hospital20.83percent, choose well-known expert out-patient service is relatively low and10.99percent non-pilot hospital.8. Satisfaction survey results show that:the overall satisfaction of out-patient pilot hospital rate was88.52percent, higher than that of non-pilot hospital83.27percent (P<0.05); specifically, the pilot hospital clinic patients to physicians and pharmacists service attitude, the total medical cost and drug cost and satisfaction with treatment were higher than non-pilot hospital (P<0.05); but the two groups of patients satisfaction for hospital out-patient waiting time and costs are relatively low.Conclusions and Recommendations:Medicine separate policy has reduced the price of drugs, patient burden of medical expenses, to promote rational drug use, reasonable distribution of patients, improve patient satisfaction has played a positive role, but there are also some problems:drug ratio is still high, repeated registration rate increases, the basic drug use rate is low, the treatment of patients with waiting time and medical care cost is still low, satisfaction. Therefore, the author proposes the following policy suggestions:promoting drug pricing system and the reform of the circulation system; continue to promote the reform of medical insurance system, to guarantee the sustainable reform; rational use of medical resources to improve the community, community service ability and the service level of the hospital; to accelerate the reform of the income distribution system, improve the appraisal system of hospital performance; optimize treatment process, improve work efficiency.