目的：通过分析某地级市二级以上公立医院采购使用基本药物方面存在的问题及其成因，提出深化基本药物制度改革的对策举措。方法：利用某地级市二级以上公立医院在药品（耗材）网上集中采购监管平台上的采购数据，结合医院药学工作实践，开展相关讨论，查找问题产生的原因。结果：推进基本药物在二级以上医院的使用，需要从推进药品价格改革、加强绩效考核、提高医务人员认知度等多方面着手解决。结论：改变基本药物在二级以上公立医院的使用比例和金额较低的现状，须持续深化改革、深入调查研究、构建预警机制、加大药品可及性等考核激励力度，不断强化对公众合理用药的宣传引导。

Objective: To put forward countermeasures to deepen the reform of the essential medicine system through analyzing the problems and causes of the procurement and use of essential medicines in second-class and above public hospitals in a prefecture-level city. Methods: The data of medicine (consumables) purchase on the centralized control system of second-class and above public hospitals were utilized. Combined with pharmacy practice of the hospital, relevant discussions were carried out to find out the causes of the problems. Results: Promoting the use of essential medicines in second-class and above public hospitals could be accomplished from the following aspects, such as pushing forward the reform of medicine price, strengthening performance appraisal and improving the awareness of the staff in the hospital, etc. Conclusion: In order to change the current low proportion and low amount of money of essential medicines in second-class and above public hospitals in prefecture-level cities, the reform needs to be deepened, investigation and study need to be done thoroughly, early warning mechanism needs to be established, and drug accessibility needs to be increased, as well as publicity and guidance of rational drug use of the public needs to be strengthened continuously.