特药纳入我国医疗保障体系的价值判断与方法

A Study on the Value Judgment and Methods of Special Drugs Incorporated into Health Care System of China

特药纳入我国医疗保障体系如一把双刃剑。特药既能够对重大疾病的治愈有所帮助,避免因大病致贫、返贫的情况发生;但医保又不能应保尽保,造成医保资源无法可持续。建立特药纳入医疗保障体系的价值取向应为:坚持本着医保要承担化解参保人疾病风险的政策目的,又要与经济发展水平相适应、保证资金的可持续性。因此,建立科学化的药品遴选机制尤为重要。本文通过国外的实际经验和具体办法以及靶向药尼洛替尼的案例来说明我国建立的药品遴选所应遵循的标准。

Incorporating special drugs into health care system is like a double-edged sword,which not only can help the patients to cure critical illnesses and to avoid being lead or returning to poverty because of the medical costs,but also may induce the demand of the medical service and waste health care resources.The value orientation of the health care system incorporating special drugs should relieve the disease risks of the insured as well as match the level of economic development to ensure the sustainability.So it is essential to build specific measures of drug selection.This study introduces the standard of drug selection we should build through using the specific methods abroad and the case of Nilotinib.