我国基本药物制度改革的进展与挑战

本文总结了2009年深化医药卫生体制改革以来，我国实施基本药物制度取得的进展和面临的挑战，并提出了相关政策建议。一套完整的基本药物制度在我国已经基本建立，包括制定基本药物目录，组织生产、质量监管、定价、招标采购、配送销售、合理使用、监测和评价等方面取得了阶段性成果。98．8％政府举办的基层医疗卫生机构和41．5％的村卫生室已实行基本药物制度和零差率销售。但国家基本药物目录仅包含307个品种，不能满足病人需要，基层医疗卫生机构服务运行受到影响，需要地方政府的财政补偿。建议动态调整基本药物目录，在基本药物招标采购的过程中注意价格与质量的平衡，继续扩大基本药物制度的覆盖面，研究基本药物的定点生产问题，改进基本药物的科学定价方法。

Essential medicines system reform in China: Achievements and challenges

The paper has summarized the achievements, issues and policy recommendations for implementing essential medicines system in China since 2009. A series of national policies have been established which include essential medicine list, production, quality supervision, pricing, tendering and procurement, rational use of essential medicines, monitoring and evaluation. About 98.8% public primary health institutions and 41.5% village health posts have been conducted the essential medicines system and zero mark up on sale. However, the 307 essential medicines could not meet the need of medical service in the grass root health facilities, it will be impact on the volume and quality of health care services, local government was required to give financial subsidy for the loss caused by zero mark up. The coverage of essential medicine system needs to be expanded into secondary and tertiary hospitals as well as private health sector. The essential medicines list needs to be dynamically adjusted. The balance between the price cutting and quality assurance of essential medicines should be paid more attention. The scientific method of pricing of essential medicines and designated manufacturer to produce some essential medicines needs to be exploited.