江苏省国家谈判药品“双通道”管理政策比较研究

Comparison study of “dual channel” management policies of nationally negotiated drugs in Jiangsu Province

目的:通过系统梳理国家谈判药品“双通道”管理政策的实施背景、发展历程,以及江苏省与各地级市药品的遴选管理、定点医药机构遴选、医保支付方式,为国家完善“双通道”管理政策提供参考。方法:检索江苏省及13个地级市医疗保障局网站,比较有关“双通道”管理的政策文件和要求,应用ROSTCM6软件对江苏省各地级市“双通道”政策进行文本分析,并访谈关键知情人做进一步分析。结果:词频分析结果表明6个关键词出现频数超过100次,2个关键词出现频数低于10次;语义网络图表明,“双通道”政策核心要义为“医保”;各地区药品遴选数目、定点医药机构遴选标准和程序、支付待遇等管理存在差异。结论:“双通道”管理政策实施过程中存在地区间定点医药机构数量相差过大、定点医药机构监管措施尚未形成、各地级市医保支付待遇差异明显、管理差异影响部分患者异地结算等问题,建议合理设定定点医药机构,制定完善“双通道”定点零售药店动态管理机制,发挥普惠性商业保险的作用,完善异地结算管理政策。

Objective: Through systematically sorting out the implementation background and development history of “dual channel” management policy of national negotiated drugs, and the selection and management of drugs, selection of designated medical institutions and payment methods of medical insurance in Jiangsu Province and other cities, to provide references for the country to improve “dual channel” management policy.Methods: We searched the websites of Jiangsu Province and 13 municipal medical security bureaus to compare the policy documents and requirements of “dual channel” management, applied ROSTCM6 software to analyze the text of “dual channel” policies in Jiangsu Province and interviewed key interviewers for further analysis.Results: The results of the word frequency analysis showed that 6 keywords occurred more than 100 times while 2 keywords less than 10 times.The semantic network diagram shows that the core meaning of the “dual channel” policy is “medical insurance”;there are differences in the number of drug selection, selection criteria and procedures of designated medical institutions, payment treatment and other management in each region.Conclusions: There are problems in the implementation of the “dual-channel” management policy, such as large differences in the number of designated medical institutions between regions, the lack of post-selection supervision requirements and measures for designated medical institutions, obvious differences in medical insurance payment treatment between municipals, and differences in management between regions affecting the settlement of some patients in different places etc., and it is suggested the designated medical institutions should be set reasonably, the dynamic management mechanism of designated retail pharmacy with “dual channel” should be formulated and improved, the role of universal commercial insurance should be brought into full play, and the management policy of off-site settlement should be improved.