医疗资源平衡视角下的中美医保药品目录控费政策对比

Comparison of the policy of controlling fees of medicare drugs in China and the United States from the perspective of medical resource balance

从医疗资源平衡分配的视角,对中国最新版的医疗保险药品目录(2017)进行分析,并对比美国的医疗保险药品报销目录制度,分析我国国家医疗保障局成立后对医疗保险管理的影响。结果发现两国在面临相同的问题,相较于中国,美国的医保药品目录在调整方面具有市场化带来的灵活性;不足之处在于药品目录由保险公司主要负责推动制定,话语权不足。建议我国学习美国药品目录调整的灵活性,以此来更好地匹配患者需求的医疗资源;同时发挥国家统一制定的优势,在谈判使患者更多获益。

Based on the perspective of balanced distribution of medical resources,this paper analyzed the latest version of China＇s medical insurance ＂ Drug Directory ＂（ 2017）, and compared the US medical insurance drug reimbursement catalog system,and analyzed the influence on medical insurance management after the establishment of China＇s National Medical Insurance Bureau. These results showed that two countries faced the same problems. Compared with China,the US medical insurance drug catalog displayed the flexibility brought by marketization in the adjustment, and the shortcoming was that the insurance company is mainly responsible for promoting the formulation. These findings suggest that China may learn the flexibility of the US drug catalog adjustment to better match the medical resources needed by patients.At the same time,it should take advantage of the country＇s unified formulation and seek more benefits for patients in the drug price negotiations.