目的: 分析国采药品在云南省的执行情况,发掘政策利益相关者所关注的问题并提出针对性建议。方法: 统计分析3个批次共计118个品规的国采药品,选取政策实施前后的时间段进行比较。以政策目标为导向,研究分析政策文件和官媒新闻,确定“可及性”“医药影响”“医疗影响”和“医保影响”4个一级指标;通过查阅文献及咨询专家等方式,引入并研究确定“负担水平”“次均门诊药品费用”等19个二级指标。利用Excel及spss statistics等软件对收集到的指标数据进行清洗整理,采用方差分析、卡方检验等统计学手段,对政策实施前后数据进行差异性、变化趋势等方面的分析。结果: 国采政策实施后,药占比、药品价格、药品不良反应上报件数占比共计3个指标下降,降幅分别为1.00%、81.14%、2.44%。另外6个指标的数据均有所上涨,具体增幅为：配送率6.00%、次均门诊药品费用9.87%、人均住院药品费用2.71%、行业集中度0.60%、仿制药替代金额率29.03%、仿制药数量替代率37.99%。结论: 云南省药品集中采购政策目标基本达成。国采药品的执行助推了药品可及,产业行风得到净化,企业规模逐步重构,减轻了医保基金负担。但是,次均门诊药品费用和人均住院药品费用均是增长趋势,与国家总体趋势相同。国采虽降低了药品价格,但次均门诊药品费用反而上升,说明集采对药品总费用的控制效果并不理想,对云南省行业集中度的提升效果不明显。建议始终坚持政府主导,不断扩大集采范围,同时发挥交易平台大数据优势,科学指导医院采购报量工作;国采药品执行后,需要逐步加强对药品交易的监测力度,完善并落实政策的配套措施,而药品集采节约出的医保基金,需要合理测算使用比例和用途,逐步促进医疗技术的进步发展。

Objective: The paper analyzes the implementation of the national centralized drug procurement in Yunnan Province, explores the problems concerned by policy stakeholders and puts forward suggestions accordingly. Methods: We conducted statistical analysis of 118 drugs of centralized procurement with a total of 3 batches, selecting the time period before and after the policy implementation for comparison. Guided by policy objectives, we analyzed policy documents and official media news, and selected four primary indicators, i.e. accessibility, impact on drugs, impact on medical treatment, and impact on medical insurance. By literature review and consulting experts, 19 secondary indicators such as affordability and average outpatient drug cost per visit were introduced. Based on the execution time of national centralized drug procurement, the first three batches of centralized drug procurement were selected as the research objects. A longitudinal analysis was conducted before and after the implementation of policies, and a horizontal analysis was conducted on the overall situation of Yunnan Province and the country. We selected some representative varieties for analysis and judgment based on indicators such as resident prevalence, medication, procurement volume, procurement completion rate, and generic drug substitution rate. Excel, spss statistics and other software were used to clean and integrate the data collected, and statistical means such as the variance analysis and Chi-square test were used to analyze the differences and trends of the data before and after the implementation of the policy. Results: After the implementation of the national centralized drug procurement policy, the proportion of drugs, the drug price and the proportion of adverse drug reactions reported decreased by 1.00%, 81.14% and 2.44%, respectively. The cost of the other 6 indicators increased, specifically, the growth rate of delivery rate was 6.00%, the average outpatient drug cost was 9.87%, the average inpatient drug cost was 2.71%, the industry concentration rate was 0.60%, the generic drug replacement sum rate was 29.03%, and the generic drug quantity replacement rate was 37.99%. Conclusions: The policy target of centralized drug procurement in Yunnan Province has been basically achieved. The drugs of national centralized drug procurement have promoted the accessibility of drugs, purified the industry conduct, gradually restructured the enterprise scale, and reduced the burden on medical insurance funds. However, the average outpatient drug costs and average inpatient drug costs are both increasing, consistent with the overall national trend. Although the national drug procurement reduced the drug price, the average outpatient drug cost per time increased instead, indicating that the control effect of centralized procurement on the total drug cost was not ideal, and the improvement effect on the concentration ratio of the industry in Yunnan Province was not obvious. It is suggested to always adhere to the leading position of the government, constantly expand the scope of national procurement, and give full play to the advantages of big data trading platform to scientifically guide the procurement and reporting work of hospitals. After the implementation of drugs, it is necessary to gradually strengthen the monitoring of drug trade, improve and implement supporting measures of policies, andcalculate of the proportion of medical insurance funds saved from centralized procurement, so as to gradually promote the progress and development of medical technology.