四川省城乡居民大病保险合规医疗费用界定研究(二)——2011年药品挂网采购使用情况与“医保”目录对比分析

Research on the Definition of Compliance Medical Costs in Serious Illness Insurance of Ubran and Rural Residents in Sichuan Province( Ⅱ)—— Comparative Analysis of the Purchase and Application of Provincial Online Medicine with Medical Insurance Medicine

目的:为进一步扩大大病保险报销药品范围提供参考。方法:于四川省药械集中采购与监管网站检索2011年该省挂网药品采购、使用情况,并与该省"医保"药品目录进行对比分析,重点分析自费药品的采购、使用情况。结果:2011年,该省医疗卫生机构采购、使用的自费药品的数量占全部挂网药品数的7.90%,采购金额占12.40%。使用频次前50位的自费药品品种中,有28种属于"新农合"目录内药品;采购金额前50位的自费药品品种中,有20种属于"新农合"目录内药品,其采购金额占自费药品采购总金额的24.40%。结论:该省各类医疗卫生机构"医保"自费药品使用管理总体较为严格;可适当扩大药品报销范围,合并"医保"目录和"新农合"目录品种,并将自费品种中的部分品种经科学论证后纳入报销范围;同时,可选择将部分"医保"目录内药品的新剂型纳入报销范围。

OBJECTIVE：To provide reference for further expansion of reimbursement range of serious illness insurance medicines in our province.METHODS：The purchase and application of online medicines in Sichuan province in 2011 were retrieved from official website of Sichuan medicine and instruments centralized purchase and monitoring,compared with Sichuan＂Medical Insurance＂medicine list,especially the purchase and application of self-paid medicines.RESULTS：The number of self-paid medicines purchased by Sichuan medical institutions accounted for 7.90% of online medicines in 2011,and the amount of purchased medicines accounted for 12.40%.Among top 50 medicines in the list of occurrence frequency,28 types belonged to＂New Rural Cooperative Medical Scheme＂（NRCMS） list.Among top 50 medicines in the list of purchasing amount,20 types belonged to NRCMS list,accounting for 24.40%.CONCLUSIONS：The purchase and management of self-paid medicines included in＂Medical Insurance＂are strict in vaiours medical institutions.The range of medicine reimbursement can be enlarged properly,and＂Medical Insurance＂list should be combined with NRCMS list.Part of self-paid medicines should be included into reimbursement range after scientific verification.At the same time,part of new dosage form of medicines in＂Medical Insurance＂list can be included in reimbursement.