摘要
高值创新药物疗效好,能显著改善症状和患者生活质量。但因价格高、治疗人群基数大,导致医保基金支出风险高,其医保准入难度不断增加。从国际经验来看,量价协议是控制高值创新药物准入基金风险的主要手段。本文结合我国国情,分析中国量价协议的实施障碍,建议建立多层次医疗保障体系,设计新型商业健康保险产品,由商业保险与基本医保分担准入风险,提升高值创新药物医保准入成功率,在保障基金可持续的前提下,满足患者不断增长的临床新需求。
High-value innovative drugs can notably alleviate symptoms and promote quality of life with their remarkable effi cacy.However,their diffi culty of medical insurance access is increasing because of huge risk to medical insurance fund expenditure caused by their high cost and patient population.Based on foreign experiences,the main method to control fund risk is price-volume agreement.This article analyzes the implementation obstacles of price-volume agreement in the condition of China’s institution and suggests to construct a multi-level healthcare security system,design a novel commercial medical insurance to share risk with basic medical insurance.This new mechanism can facilitate medical insurance access of high-value innovative drugs and satisfy the rising clinical need while secure fund sustainability.
作者
丁锦希
李佳明
任雨青
Ding Jinxi;Li Jiaming;Ren Yuqing(China Pharmaceutical University,Nanjing,211198)
出处
《中国医疗保险》
2021年第2期26-30,共5页
China Health Insurance
基金
中国药科大学“双一流”学科创新团队建设项目(CPU2018GY4)。
关键词
高值创新药物
量价协议
多层次医疗保障
high-value innovative drug
price-volume agreement
multi-level healthcare security
