作　　者： (周雪）; (李雪梅）; (孙涛）; (张曦月）; (时宇）; (谢奉哲）; (王景慧）; (张淑娥）;

机构地区： 牡丹江医学院卫生管理学院,黑龙江省牡丹江市157011

出　　处： 《中国全科医学》 2017年第22期2715-2719,共5页

摘　　要： 目的构建我国基本药物制度实施失效节点的多级递阶结构模型,阐释各阶层的内在逻辑,从而为我国基本药物制度提供精准的治理策略。方法于2017年1月,参考既往研究范式和文献,借助4名卫生政策领域专家头脑风暴,筛选出我国基本药物制度实施环节的失效节点;采用解释结构模型法(ISM)分析各节点的层级关系和传导环路。结果共筛选出16个我国基本药物制度实施环节的失效节点,分别为:基本药物遴选目录;基本药物生产供应;基本药物采购配送;基本药物合理使用;基本药物价格管理;基本药物支付报销;基本药物质量安全;医生处方率;患者接受度;医院推行力度;监管体系;制度衔接;法律约束;筹资、补偿机制;激励机制;竞争环境。ISM分析结果显示,该16个失效节点存在1个四阶梯结构(分别命名为:输出终端、作业单元、协同联动、规则建设)和1条纵向传导环路;直接要素为医生处方率、患者接受度、医院推行力度,内隐要素为法律约束。我国基本药物制度实施受困于"规则建设缺失-协同机制失灵-作业实效欠佳-终端输出低效"四层环路的逐级影响。结论我国基本药物制度需要协同型综合改革,治理策略包括:健全基本药物制度需立法先行,形成全品种、全过程完整追溯与监管链条;借助基本药物制度配套机制的联动效应,发挥基本药物制度作业单元的执行实效,提升基本药物制度在终端的输出效率。 Objective To build a multi-hierarchical structure model for demonstrating the failed nodes in the implementation of China＇s essential medicine system and identifying the internal logical relationships between all failed nodes and transmission pathways,and based on this,to offer some relevant precise coping strategies.Methods In January 2017,we identified the failed nodes in the implementation of China＇ s essential medicine system based on referring the previous research paradigms and studies combined with experts＇ opinions obtained through brainstorming.The hierarchical relationships between various failed nodes and the transmission loops were analyzed by using Interpretative Structural Modeling.Results The identified16 failed nodes associated with the implementation of the essential medicine system are as follows：essential drugs in the Essential Medicines List;production and supply of essential drugs;procurement and distribution of essential drugs;reasonable use of essential drugs;price regulation of essential drugs;reimbursement rules for cost of essential drugs;quality and safety of essential drugs;prescription rate of essential drugs;level of acceptance of the concept and using of essential drugs in patients;status of promoting the implementation of the essential medicine system in hospitals;the supervision and management system for the implementation of the essential medicine system;links between management systems for the implementation of the essential medicine system;legal restrictions for the implementation of the essential medicine system;financing and reimbursement mechanisms for the implementation of the essential medicine system;incentive mechanism for the implementation of the essential medicine system;competitive status of using essential drugs versus non-essential drugs.ISM analysis found that,there is a ＂ four-ladder structure＂（ output terminal,operation unit,cooperative linkage,rules construction） and a ＂ longitudinal transmission loop＂ among the nodes.The explicit failed nod

关 键 词： 基本药物制度 失效节点 解释结构模型 治理策略