目的: 分析比较集中带量采购政策实施后不同等级医疗机构药品采购量变化的贡献率差异。方法: 选取国家药品供应保障综合管理信息平台2018年1月至2020年12月的药品采购数据,分析7个试点城市不同等级公立医疗机构药品采购量及其变化量的贡献率。结果: 从试点期集采品种采购量增长情况来看,三级医疗机构贡献率最高(58.03%),接续期则是基层医疗机构贡献率最高(103.29%)。可替代品种采购量增加,试点期、接续期均是基层医疗机构贡献率最高(54.87%和72.88%)。B01抗血栓形成药在试点期中选药品采购量增长,基层医疗机构贡献率最高（45.62%）。C08钙通道阻滞剂、C09作用于肾素-血管紧张素系统在试点期、接续期中选药品采购量增长,均为基层医疗机构贡献率最高。L01抗肿瘤药在试点期、接续期中选药品采购量增长,均为三级医疗机构贡献率最高。结论: 在接续期,基层医疗机构对采购量增加的贡献率进一步增加,部分治疗类别药品采购量增加,其中基层医疗机构贡献率最高。

Objective: The paper analyzes and compares the differences in the contribution rate of different levels of public medical institutions to the change of drug procurement volume after the national centralized volume-based procurement (NCVBP). Methods: Data on the drug procurement records of from January 2018 to December 2020 were obtained from the China Drug Supply Information Platform (CDSIP). The contribution rate of different levels of public medical institutions on drug procurement volume and procurement expenditure from 7 pilot cities was analyzed. Results: The contribution rate of tertiary medical institutions was the highest (58.03%) during the pilot period on the increase in the purchase volume of centralized varieties, but the contribution rate of primary medical institutions was the highest (103.29%) during the continuation period. The contribution rate of primary medical institutions during the pilot period and the continuation period was the highest on the increase in the procurement volume of substitute varieties (54.87% and 72.88%). The contribution rate of primary medical institutions during the pilot period was the highest (45.62%) on the increase in the procurement expenditure of B01 antithrombotic bid-winning drug. The contribution rate of primary medical institutions during the pilot period and continuation period was the highest on the increase in the procurement volume of C08 calcium channel blocker, C09 acting on the renin-angiotensin system bid-winning drug. The contribution rate of tertiary medical institutions during the pilot period and the continuation period was the highest on the increase in the procurement volume of L01 anti-tumor bid-winning drug (89.21% and 61.85%). Conclusion: During the continuation period, the contribution rate of primary medical institutions to the increase in procurement volume increased during the continuation period. The procurement volume of some therapeutic drugs has increased, among which the contribution rate of primary medical institutions was the highest.