经济学评估在医保准入决策中的意义及其应用机制探讨

Application of Economic Evaluation in Reimbursement Decision Making Mechanism of Chinese Health Insurance System

本文基于经济学相关原理,对我国医保准入决策中应用经济学评估结果的意义和方法进行了阐述,认为:经济学评估的两大主要内容"性价比研究"和"预算影响研究"对医保准入决策均意义重大,前者提供了准入的优先次序,后者提供了准入的可承受范围。医保准入应该基于预算约束,优先纳入性价比优秀的新技术,并根据累计预算影响水平决定医保准入的范围。如此能最大化有限资源的使用效率,为参保人群带来预算约束下最充分的健康产出。

In this study, we discussed the potential mechanism of applying economic evaluation in reimbursement decision making of health insurance in China. We propose that the cost-effectiveness analysis could be used to support decision-maker to prioritize the intervention choices and budget impact analysis could be used to help decide the scope of access based available insurance fund budget. It is recommended that the Chinese health insurance system should apply the results of economic evaluation to support suitable decision making for access and reimbursement.