Comparative Analysis And Policy Improvement On The Implementation Of Essential Drug System In Primary Medical Institutions Of Different Ownership In Nantong

Background:In 2001,Nantong government carried out property ownership reform in the township hospitals of six counties(cities and distriets)of the city.In the reform,except some township central hospitals which maintain public ownership,all health centers have been replaced by private township hospitals.In order to implement the basic public health service dominated by government and the need to establish a essential drugs system in the new round of medical reform,in April 201 1,the Nantong municipal government bought back the property rights of all township hospitals in the southern three counties(cities and distriets)(including Tongzhou distriet,Qidong city and Haimen city,hereinafter referred to as 3 southern counties),being state-owned.And three counties((cities and distriets)in the north(including Rugao,Rudong,Haian county,hereinafter referred to as 3 northern counties)keep private ownership in towns and townships by the way-Nantong government purchases basic medical service.In In April 2011,the essential drugs system was implemented in all township hospitals in 6 counties(cities and districts)of Nantong.Objective:Through the collection,sorting and analysis of the relevant monitoring indexes of the public and private grass-roots medical institutions in Nantong region before and after implementing the essential drugs system,to investigate the effects of the essential drugs system implemented in the medical and health institutions with different ownership systems.Methods:The sampling mechanism was selected by multi-stage stratified random sampling for the comparative analysis of changes in the indicators of institutions(including the allocation and use of essential drugs,the financial operation of primary health care institutions,the availability of essential drugs and the rational use of drugs)and the effectiveness of the implementation of the essential drug system.A questionnaire survey was conducted among doctors in public and private primary care institutions,including the basic situation of the individual,the essential drug system familiarity and attitudes,the satisfaction with the implementation of the system,as well as opinions,suggestions and so on.At the same time,self-made questionnaire was used to carry out the occasional questionnaire survey method on the patients in the public and private primary medical institutions,which included patients' understanding of the essential drug system,satisfaction with the implementation of the system,satisfaction with drug services in public and private medical institutions,and acceptance of essential drugs.Results:(1)The institutional income of the primary medical institutions of different ownership have undergone structural changes.The rate of essential drug delivery in public and private medical institutions increased by 51%and 40.3%respectively.The number of outpatient and emergency services increased rapidly by 25 thousand and 100 persons/year and 9 thousand and 900 persons/year respectively;In the indicators of rational use of drugs,the proportion of sale of injection by private institutions has increased by 4.7%,which was higher than that in the public institutions,and the difference was statistically significant(P<0.05).(2)268 valid questionnaires from the doctors were obtained.The degree of increase in income,familiarity with the essential drug system,training frequency of essential drugs,the number of varieties of essential drugs,the extent to which the quantity meets the needs of the grassroots,the perception of the degree of doctor of grass-roots public medical institutions should be higher than private institutions,and the the difference was statistically significant(P<0.05).only 13.4%of surveyed doctors were satisfied with the current income situation;92.54%of the surveyed doctors agreed to improve the compensation mechanism,and 85.07%agreed to improve the basic drug policy supporting measures.(3)272 valid questionnaires from the patients were obtained.92.2%and 97%of surveyed patients believed that public and private medical institutions can meet the needs of patients.The surveyed patients in the private institutions rated the service and overall satisfaction as 4.18 and 3.97,which were higher than those in public institutions.Public institutions scored 3.62 on drug quality,higher than private institutions,and the difference was statistically significant(P<0.05).Conclusions:The effect of the essential drugs system of the primary medical and health institutions in Nantong region appeared preliminarily,and the implementation effect in public primary medical institutions was better than that in the private primary medical institutions.The primary medical institutions should increase the effect of drug fee control,and by optimizing financial subsidies,promote the full use of health service information,and promote the improvement of rational drug use in combination of various means.The private primary medical institutions should optimize the government subsidy mechanism,improve the positivity of doctors,strengthen publicity and training,establish a regulatory system,improve the selection mechanism of essential drugss and guarantee the supply of essential drugs.To improve the role of private primary medical institutions in the distribution of patients in large hospital make the medical resources reasonably configured,in order to guarantee the right of everyone to gain medical and health care.