四川省城乡居民大病保险合规医疗费用界定研究(三)——2011年药品挂网采购使用情况与“新农合”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( Ⅲ)—— Comparative Analysis of the Purchase and Application of Provincial Online Medicine with New Rural Cooperative Medi

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"新农合"药品目录进行对比分析,重点分析"新农合"目录外药品的采购使用情况。结果:2011年,该省医疗卫生机构采购"新农合"目录外药品数量占全部挂网药品数量的19.58%,采购金额占31.07%。医疗卫生机构采购、使用频次最高的前50位"新农合"目录外药品中,有39种属于该省城镇居民"医保"报销范围;采购金额前50位的"新农合"目录外药品品种中,有49种属于该省城镇居民"医保"报销范围,金额占"新农合"目录外药品采购总金额的36.60%。结论:"新农合"用药目录有待进一步扩充完善;建议可将部分"新农合"目录外药品纳入报销,适当扩大药品报销范围。

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＂New Rural Cooperative Medical Shceme＂（NRCMS） medicine list,especially the purchase and application of self-paid medicines.RESULTS：The number of the medicines out of NRCMS list in Sichuan medical institutions accounted for 19.58% of online medicines in 2011,and the amount of the medicines accounted for 31.07%.Among top 50 medicines in the list of frequency,39 types belonged to＂Medical Insurance＂（MI）list.Among top 50 medicines in the list of purchasing amount,49 types met reimbursement requirements of MI,accounting for 36.60%.CONCLUSIONS：NRCMS medicine list need further enlargement and improvement.The range of medicine reimbursement can be enlarged properly,and part of the medicines out of NRCMS list should be included into reimbursement range.