| Objective:To comprehensively and objectively evaluate the status quo of townshiphospitals in Jiangxi Province after implementing the national essential drug system,identify and report to relevant health-related institutions emerging problems andaffecting factors to provide solid evidence for their further policy making.Methods:Seven township hospitals were selected in Guixi City and Xiushui County bothof which are pilot city or county of national essential drugs system. Field survey andinterview were conducted to investigate status quo of the seven township hospitals inJiangxi Province after implementing the national essential drug system. Baselinesurvey was conducted between September5and September20,2010, and a follow-upsurvey was conducted between March10and March25,2012. Influences of nationalessential drug system on township hospitals in Jiangxi Province were evaluatedthrough parallel and before-and-after comparisons.Literature review of theories on essential drug systems at home and abroad wasconducted, and questionnaire was designed based on the findings. Rural residents’understanding of township hospitals implementing national drug system wasinvestigated by questionnaire survey; directors and technical staff of townshiphospitals were interviewed about use of essential drugs and the finance of thehospitals, and then the questionnaire of National Essential Drug System in TownshipHospitals Survey was filled by interviewers;30outpatient prescriptions were alsorandomly selected from the seven township hospitals on June19in the years of2009,2010and2010for rational drug use analysis.Results:1. The township hospital of Jiangxi has implemented the National EssentialDrug System after. farmers ranked the pharmaceutical concern for efficacy(53.0%)、quality(19.4%)、safety(16.8%) and price(12.4%). The patient of farmers believed thatthe price of drug in2012was low-rise than2010years and the rate increased by11%, the rate of township health center of patient to choose medical site was from45.9%in2010to increase to71.9%in2012.2. Implemented the national basic drug system for three years. The proportionthat basic drug varieties took up the total number of drug varieties which has beenachieved the goal of the government regulations, general health hospital and centerhealth hospital was70%and80%, respectively. While the proportion that basic drugsales amount took up total sales amount was only four health hospital that has beenachieved the index of government rigid regulation. The proportion that drug incometook up the total revenues of business which has been achieved the goal of thegovernment regulations, center health hospital and general health hospital wasbelow50%and60%, respectively. In2011, the asset-liability ratio of center hospitaldecreased by6.25%than2009(20.30%<26.55%), general hospital from42.32%in2009to decreased to32.21%in2011. the financial of township hospital is workingwell.3. In2011, the mean of person-time of outpatient of center hospital comparedwith2009increased by33.34%, as well as the mean of general hospital in2011compared with2009increased by18.58%. The mean of the number of people fromdischarge in2011than2009increased by18.58%for center hospital, and generalhospital in2011than2009increased by14.63%. the average outpatient fee of thepatients with farmers of center hospital from80.3yuan in2009to decreased to61.3yuan in2011, general hospital from56.6yuan in2009to decreased to42.6yuan in2011, the outpatient fee has appeared downtrend; In2009-2011, the hospitalexpenses of patient with farmer of center hospital(999.1yuan、942.3yuan、984.2yuan) and general hospital(740.3yuan、666.5yuan、741.0yuan) change is not toomuch.4. Implement the national essential medicinal system after, in2009-2011, theaverage medication number of single prescription of township hospital was3.4、4.4and4.1(F value=5.04,P=0.01), respectively. The utilization ratio of essentialmedicinal prescription was75.83%、88.11%and90.95%(χ~2=15.57,P=0.00),respectively. The utilization ratio of antibiotics was46.67%、62.16%and53.81%(χ~2=18.97,P=0.00), the utilization ratio of injection was36.67%、46.81and 48.1%(χ~2=4.43,P=0.11), respectively, prescription quality is not high.Conclusion:1. Achievements of Township hospitals in Jiangxi Province to implement the nationalessential medicines systemTownship hospitals provide national essential medicines, make theimplementation of essential medicines zero sales slip; relevant systems has beenimproved step by step to enhance the accountability the responsibility of governmentin the process of implementing national essential medicines system; Townshiphospitals business was significantly increased; the phenomenon of “Drugs to supportmedical”hasGradually eased; there are kinds of essential drugs which has high usagerate; the hospitalization costs of peasant has been reduced; there are less complaintabou“tSee A Doctor Expensive”; the asset-liability ratio has been reduced; strengthenthe financial indemnifying measure; the peasants are satisfied with the townshiphospitals which have put into effect of the national system for essential medicines.2. Problem of township hospitals in Jiangxi Province to implement the nationalessential medicines systempeasant are poorly understood on the national essential medicines system; theessential drugs list has been unscientific used in township hospitals; do notdistribution and distribution of not in time have occurred sometimes in drugdistribution; national essential drug system has been biased in the process ofimplementation in township hospitals; financial compensation is not implemented;wages of medical staff has been reduced, management have to explore a new pathimmediately; the revenue of township hospitals has been impacted, it is insufficientfor township hospitals depend on financial compensation only; the averagemedication number of single prescription and the occupating coefficient of antibioticsand injection are on the high side; the increase of volume of Township hospitalsbusiness lead to the decrease of medical service quality; a sound legal system isurgently need.3. Suggestion for township hospitals in Jiangxi Province to implement the nationalessential medicines system:strengthen the propaganda and popularization of the knowledge of essential medicines; formulate the essential drugs list for China’s national conditions; make thepolicy adjustment of essential medicines timeliness and flexibility; reasonable choicethe dispatching enterprise, ensure the basic medical institutions have the drugs whichthey need; increasing the financial compensation to protect medical personnel income;take practical measures to improve the diagnosis and treatment of the basic medicalinstitutions; make the specification of the physician to use drug rational; receive thecharge of drug service cautious; speed up the regulation of essential medicines. |
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