取消药品加成对北京市公立医院用药结构的影响

目的 以全身用抗细菌药品为例，定量评估取消药品加成政策对北京市5家试点三级综合公立医院高价药使用变化的效果。方法 构建以药品限定日剂量为度量单位的高低价药品相互替代的用药结构指数分析体系，建立双重差分模型，对取消药品加成政策对北京市三级综合公立医院高价药使用变化的净效果进行评估。结果 取消药品加成政策实施后，5家试点医院中的1家试点医院对高价药的使用显著减少，且差异有统计学意义（P＜0.01），1家试点医院对高价药的使用变化不明显，3家试点医院对高价药的使用显著增加，且差异有统计学意义（P＜0.05）。结论 取消药品加成政策对北京市5家三级综合公立医院在全身用抗细菌类药品中高价药使用变化的影响效果与不同的医院有关，取消药品加成政策对公立医院减少高价药使用的有效性有待进一步研究。

Effects of Canceling Drug Price Addition Policy on the Change of Drug Structure in the Public Hospitals in Beijing City

Objective To quantitatively evaluate the effects of canceling drug price addition policy on the tendency of using high-priced anti-infective drugs in five general tertiary public hospitals in Beijing. Methods Difference-in-difference (DID) model was established to analyze the change of the use of high-priced anti-infective drugs in five general tertiary public hospitals in Beijing by using the unit of defined daily dose as an index. Results After the cancellation of drug price addition, the structure index of drug use did significantly decrease in one sample hospital, not significantly in the other one sample hospital, but not significantly in the other three sample hospitals. Conclusion There are different effects of canceling drug price addition policy on the use of high-priced anti-infective drugs among the five general tertiary public hospitals in Beijing. Further researches are needed to observe the effects of canceling drug price addition policy.