Prescribing behaviour of village doctors under China's New Cooperative Medical Scheme
Prescribing behaviour of village doctors under China's New Cooperative Medical Scheme
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DOI：
10.1016/j.socscimed.2009.02.043
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发表时间：
2009-05-01
影响因子：
5.4
通讯作者：
Sleigh, Adrian C.
中科院分区：
文献类型：
--
作者：
Sun, Xiaoyun;Jackson, Sukhan;Sleigh, Adrian C.
2003年，中国推出了一项新的以社区为基础的农村医疗保险，称为新型合作医疗计划（NCMS）。2005年，评估新型农村合作医疗对村医处方行为的影响。对山东省一个新型农村合作医疗县和一个非新型农村合作医疗县进行了比较研究。我们收集了30个村卫生站的2271名有代表性的患者就诊的信息（每个县15个）。处方药物的平均数量（新农合县4.6，非新农合县3.1）和抗生素使用两个县的预防接种率（72.4%比59.3%）和注射剂（65.1%比56.3%）均较高，且以新农合县较高。在新型农村合作医疗村，为参保患者和未参保患者开处方的模式相似，参保患者使用更多的药物、抗生素和注射剂。总体而言，对于新农合患者，处方超额的价值约等于其20%的费用折扣。我们得出结论，过度处方是常见的，在农村和更糟糕的是与新农合医疗保险，提高了人们对卫生服务质量和用药安全的关注。我们建议，应重新设计新型农村合作医疗与激励服务质量的改善。中国农村需要对医生处方进行更严格的监管，以打击不合理用药。(C)2009爱思唯尔有限公司保留所有权利。
In 2003, China introduced a new community-based rural health insurance called the New Cooperative Medical Scheme (NCMS). In 2005, to assess the NCMS effects on village doctors' prescribing behaviour. we compared an NCMS county and a non-NCMS county in Shandong Province. We collected information from a representative total of 2271 patient visits in 30 village health stations (15 per county).The average number of drugs prescribed (4.6 in the NCMS county vs. 3.1 in the non-NCMS county) and use of antibiotics (72.4% vs. 59.3%) and injections (65.1% vs. 56.3%) were high in both counties, and higher in the NCMS county. Within NCMS villages, prescribing for insured vs. uninsured patients showed a similar pattern with more drugs, antibiotics and injections for those insured. Overall, for NCMS patients, the prescription excess was about equal in value to their 20% fee discount.We conclude that over-prescribing is common in villages and worse with NCMS health insurance, raising concerns for health service quality and drug-use safety. We propose that the NCMS should be redesigned with incentives for service quality improvement. A stricter regulatory environment for doctors' prescriptions is needed in rural China to counter irrational drug use. (C) 2009 Elsevier Ltd. All rights reserved.