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目的:通过设计和实施新型农村合作医疗新的支付体系,评价按人头支付改革对村医处方行为的干预效果。方法:非随机对照实验设计,以平阴县作为空白对照组,对山东省莒南县和梁山县村卫生室进行政策干预,利用DID模型评价干预效果。结果:试验组村医开大处方、联用抗菌药物、处方激素、输液的行为概率降低,单张处方费用下降2.32元。结论:新型农村合作医疗门诊统筹基金按人头支付并和质量考核挂钩显著促进了村医的合理用药行为。
OBJECTIVE: To evaluate the intervention effect of the reform of prescribing payment on the prescription of village doctors by designing and implementing the new payment system of new rural cooperative medical system. Methods: In a non-randomized controlled trial design, Pingyin County was used as a blank control group to carry out policy intervention on the village clinics in Junan County and Liangshan County in Shandong Province. DID model was used to evaluate the intervention effect. Results: In the experimental group, the village doctor prescribes large prescribing combined with antimicrobial agents, prescription hormones and infusion, reducing the probability of behavior and the cost per leaflet decreased by 2.32 yuan. Conclusion: The new rural cooperative medical outpatient co-ordination fund paid by head and linked with the quality assessment significantly promoted the rational use of drugs by village doctors.