Measuring Access to Medicines: A Survey of Prices,Availability and Affordability in Shaanxi Province of China

Objective

To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009.

Methods

Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions.

Findings

The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day’s wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days’ wages for losartan. For originator brands, the costs rise to 1.2 days’ wages for salbutamol inhaler and 15.6 days’ wages for omeprazole.

Conclusions

The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.     

我国公立医院绩效评价研究述评

在对国内公立医院绩效评价文献研究的基础上,从医院、科室和员工3个层面,分析了公立医院绩效评价指标体系构建的研究现状,进而对公立医院绩效评价的系统考核技术、指标筛选方法和权重设置方法进行了述评,最后提出并探讨了我国公立医院绩效评价中存在的问题。     

公立医院现金持有量水平评价分析

在借鉴公司现有持有相关研究的基础上,结合我国公立医院实际情况,构建实证模型,以B地区171家二级医院和三级医院2006—2009年数据验证。实证结果表明：公立医院并不像感性认识的那样不重视财务管理,就现金管理来说,医院积极进行现金管理,对其现金持有量进行动态调整,以实现目标现金持有额。以现金持有量满足日常运营的时间判断,公立医院现金持有水平是合理的。     

公立医院开展项目支出预算绩效评价的探讨

目前,我国大部分公立医院尚未广泛开展内部项目支出预算绩效评价工作。随着财政部与国家卫生和计划生育委员会的预算项目绩效管理的深入开展,公立医院通过加强多部门的合作,以战略发展为导向开展项目支出预算绩效评价工作对提高资金使用效益具有重要意义。     

安徽省县级公立医院参与远程会诊情况调查分析

目的 分析安徽省县级公立医院信息化基本建设情况、医务人员参加远程会诊的意愿及其影响因素,为推进远程会诊持续发展提供意见。方法 通过文献复习,初步设计了远程会诊调查表,以无记名方式对安徽省8家开展远程会诊的县级公立医院进行调查。结果 （1）8家县级医院的信息化建设各不相同。（2）8家县级医院医务人员对远程会诊知晓率为76.2%。（3）对远程会诊相关问题理解不同,使用远程会诊意愿也不用。结论 从提高县级医院信息化平台建设,加强远程会诊宣传工作,以点带面,推进远程会诊发展,创新远程会诊服务模式等方面入手,提高县级公立医院和医务人员的参与度。     

公立医院院长绩效考核与评价研究

目的 通过对哈尔滨市14家公立医院院长2010年工作绩效进行考核和评价,完善公立医院院长绩效评价工具和方法。方法 运用专家咨询法构建院长绩效考核评价指标体系,运用专题小组法制订评价方案,采用直接评分法对14家医院的绩效进行评价。结果 构建了包含6个关键维度、27个指标的公立医院院长绩效考核指标体系,通过绩效评价发现薄弱环节,对体系的适用性与可操作性进行验证。结论 考核体系具有良好的适用性与可操作性。     

县级公立医院综合改革效果评价指标体系研究

目的 通过构建符合该省实际情况的县级公立医院综合改革效果评价指标体系,对县级公立医院综合改革效果进行评价。方法 利用德尔菲法结合模糊综合评价法建立县级公立医院综合改革效果评价指标体系,并运用TOPSIS法对选取的样本医院进行评价。结果 建立县级公立医院综合改革效果评价指标体系,包含一级指标3个、二级指标7个、三级指标27个。结论 建立县级公立医院综合改革效果评价指标体系,为县级公立医院改革政策的进一步完善提供理论基础与导向。     

山东省民营与公立医院医疗质量管理典型调查比较分析

目的 通过对民营医院与公立医院的医疗质量管理情况进行比较分析,找出2类医院存在的不足及它们之间的差别,并提出改进建议。方法 采用方差分析及Kruskal-Wallis H检验、SNK法及Games-Howell法,对民营医院、公立二级医院和公立三级医院之间的典型调查数据进行比较分析。结果 民营医院与公立二级医院相比,除2个方面单项得分无统计学差异外,其余6个方面单项得分及总得分均有统计学差异;民营医院与公立三级医院相比,8个方面单项得分及总得分均有统计学差异;公立二级医院与公立三级医院相比,只有“各医院总得分”1项有统计学差异,8个方面单项得分均无统计学差异。结论 民营和公立医院在医疗质量管理方面都存在不足,但民营医院总体上差于公立医院;民营医院管理水平参差不齐,也有部分民营医院管理较规范。应加强对医院,特别是民营医院的监管,继续完善医院监督检查制度,建立完善医疗质量管理信息公开制度。     

上海市公立医院门诊医疗服务质量的观察性调查

对上海市公立医院门诊医疗服务质量进行了观察性调查。结果显示,观察员对上海市公立医院门诊医疗服务质量的总体评价较高,但部分项目较病人评价低。研究表明,经培训的观察员更容易发现公立医院门诊服务质量存在的关键问题,且观察性调查有助于消除病人个体特征和期望对门诊服务质量评价的影响。     

军队医院中患者对医护工作的评价及需求调查

目的：本文通过调查部分军队医院患者对护理工作的评价及需求,为提高军队医院的护理服务质量提供有利资料。方法：随机抽取四所三级甲等军队医院的380名住院患：考进行问卷调查,调查患者对护理工作的满意程度及需求。结果：患者对护理服务技术满意度为43．2％,对态度满意度为37．3％,对环境和健康教育满意度分别为59．5％和55％;患者最需要的知识为康复知识,占46．1％;患者对护理人员热情工作态度的期许和需求最高,达到38．2％;其次为熟练工作技能,占28．4％。结论：从患者角度出发,真正落实以民文本的原则,切实为患者服务,改善护理服务质量已经成为护理领域的核心内容,应得到各个军队医院的重视,落实优质护理服务工作。     

湖北省县级公立医院综合改革试点医院运行效率评价

目的 评价湖北省县级公立医院综合改革试点医院运行效率,为后续改革提供相应政策建议。方法 运用数据包络方法,分别使用CCR、BCC模型测量2014年湖北省73家县级公立医院运行效率。结果 总体有效的医院有15家（20.5%）,平均总体效率值是0.814;技术有效的医院有33家（45.2%）,规模有效的医院15家（20.5%）;规模报酬递增的有4家（5.5%）,规模报酬递减的有54家（74.0%）。结论 湖北省县级公立医院总体效率有待提高,特别是需进一步控制医院规模,从而提高整体运行效率。     

公立医院财政预算项目绩效评价结果应用研究

我国启动了公立医院财政预算项目绩效评价试点工作,但绩效评价结果应用上尚处于探索阶段。介绍了财政部和主管部门对公立医院财政预算项目绩效评价结果应用的政策要求,提出了加强项目绩效评价结果应用的建议,包括结果反馈、结果公开和结果挂钩。

     

广州市县级公立医院综合改革实施效果评价

目的 评估广州市县级公立医院综合改革政策实施效果。方法 收集广州市5家县级公立医院2010—2014年收入及业务数据,对增长率、构成比进行分析。结果 改革后财政收入增长,每职工平均门诊量增长,每职工平均住院日下降,门急诊次均医药费用及药品费下降,次均住院医药费用增长,次均住院药品费下降,药品收入占比下降。结论 广州市县级公立医院较好地执行了药品零差率政策,但综合改革尚未达到提高医院运营效率、减轻患者医疗负担的目的,需要进一步完善和推进综合改革措施。

     

香港特区公营医院运行机制评估及对内地的启示

回顾香港医疗融资的发展历程并简述香港公营医院的运营状况与开支构成比,重点分析香港公营医院的管理机构——香港医院管理局,研究其宗旨任务与目标策略相结合的管理医院管理战略,跟踪其主要经费来源的变化趋势,对其财务状况进行深入探究并进行预测。在对香港公营医院运行机制进行评估的基础上,探讨香港公营医院存在的问题以及对内地的启示,为内地医院管理机构借鉴香港逐步建立以政府投入为主体的医疗融资体系提供参考。     

A Survey of Psychiatric Units in General Hospitals in Canada

The Canadian Psychiatric Association recently recommended that all general hospitals over 200 beds should have psychiatric in-patient units. Questionnaires were sent to the administrators of the 52 existing general hospital psychiatric units in Canada. Most administrators expressed approval of these units, although some noted the existence of problems. Statistics are given on the staffing of the units. Although the number of beds was small, these facilities accounted for a very large number of admissions. Most had active teaching programs. The advantages of implementing the C.P.A. recommendation are many. General hospital psychiatric units should be encouraged to undertake comprehensive psychiatry, that is, to accept all types of psychiatric patients, and to retain responsibility for long-term care.     

Selection of Essential Medicines for Diabetes in Low and Middle Income Countries: A Survey of 32 National Essential Medicines Lists

Aim

Diabetes is a growing burden especially in low and middle income countries (LMICs). Inadequate access to diabetes care is of particular concern and selection of appropriate diabetes medicines on national essential medicines lists (NEMLs) is a first step in achieving adequate access. This selection was studied among LMICs and influences of various factors associated with selection decisions were assessed.

Methods

Countries were studied if they employed NEMLs for reimbursement or procurement purposes. Presence and number of essential diabetes medicines from different classes, both insulins and oral blood glucose lowering medicines, were surveyed and calculated. Data were also analyzed by country income level, geographic region, year of last update of the NEML and purpose of NEML employment. The effect of prevalence and burden of disease on the number of essential diabetes medicines was also studied. Non parametric tests and univariate linear regression analysis were used.

Results

Nearly all countries (n = 32) had chosen fast (97%) and intermediate acting insulin (93%), glibenclamide and metformin (100% both) as essential medicines. The median number of essential diabetes medicines was 6, equally divided between insulins and oral medicines. 20% of the countries had selected insulin analogues as essential medicines. Among all the studied factors, an increase in burden of diabetes and wealth of countries were associated with selection of higher numbers of essential diabetes medicines (p = 0.02 in both cases).

Conclusions

Nearly all the studied LMICs had included the minimum required medicines for diabetes management in their NEMLs. Selection can still be improved (e.g. exclusion of insulin analogues and replacement of glibenclamide by gliclazide). Nevertheless, the known suboptimal and inconsistent availability of essential diabetes medicines in LMICs cannot be explained by inadequate selection of essential medicines. Countries should therefore be encouraged to give precedence to implementation of NEMLs to make essential diabetes medicines more accessible.     

公立医院临床医师对临床路径实施工作及效果的评价

目的 了解我国公立医院临床医师对临床路径实施工作及效果的评价。方法 对我国东、中、西3省（直辖市）1638名临床医师进行问卷调查。结果 我国公立医院临床医师对临床路径实施工作和实施效果的总体评价分别为3.16分和3.41分。并且,不同地区、等级公立医院临床医师的评价存在一定差异。结论 我国公立医院临床医师对临床路径实施工作的认可度不高;西部地区和二级医院的临床医师更偏好实施临床路径;临床医师对临床路径实施可提高医疗服务过程质量的认同度相对较高。     

关于我国公立医院经济效率的探讨

目的 分析我国公立医院的经济效率。方法 以总服务人次数为产出指标,以卫生技术人员数和政府投入金额为投入指标,分别使用柯布道格拉斯生产函数中的指数及相关系数代表技术效率与配置效率。结果 全国的整体技术效率为1.206,配置效率为1.659,东、中、西部分别为1.168、1.685,0.986、0.866,1.001、1.867。结论 整体技术效率高于各地区的技术效率,东、中、西部对比分析发现效率差异与经济发达程度关系不大。