医保支付标准与集中采购联动的螺旋式降价效应及其缓冲阈值设计

The Spiral Price Reduction Effect of The Linkage between Health Insurance Payment Standard and Centralized Purchasing and Design on Buffer Threshold

医保药品支付标准与集中采购制度联动实施,可充分发挥控价控费作用,但其螺旋式降价效应可能影响参保人福利、医疗机构谈判动力。文章通过借鉴澳大利亚和中国台湾的研究经验,在全面评价医保支付标准与集中采购联动效应基础上,设计支付标准缓冲阈值,以最大限度控制联动负效应,助力医保支付改革的平稳推进。

Drug health insurance payment standard system can play a full role of price and expenditure control under its linkage with centralized purchasing. But at the same time its spiral decline may influence the welfare of the insured and negotiating motivation of medical institutions. The article aims to design buffer threshold of payment standard to maximally control negative effects and finally promote the smooth progress of health insurance payment reform, based on the study of the experiences of Australian and Taiwan, China, and the comprehensive evaluation of the linkage effect.