医保药品目录调整:基本医保定位与经济性考量之比例原则

The Adjustment of Medical Insurance Drug List:The Principle of Proportionality between Basic Medical Insurance Positioning and Economic Considerations

在当前医保基金压力过大的背景下,理性的医保控费成为我国基本医疗保险亟需解决的问题。发挥医保药品目录的控费功能,核心问题是如何处理好基本医保定位与经济性考量之间的平衡。立足我国医保药品目录调整制度的法律和实践困境,分析比例原则的合法性与合理性限度,在其框架下实现目录准入和退出制度的良性互动,做好医保药品目录与药品管理法的衔接。在不超过必要限度的范围内,应赋予参保人以个案方式获得司法救济以保障基本医保需求的权利,以公正的司法判决来维持基本医保定位与经济性考量之间的平衡。

Under the background of the current pressure on the medical insurance fund,rational medical insurance fees control has become an urgent problem to be solved in China’s basic medical insurance system.The core issue is how to handle the balance between basic medical insurance positioning and economic considerations.Based on the legal and practical dilemma of China’s basic medical insurance drug list adjustment system,this paper analyzes the legality and rationality limit of the principle of proportionality.Under the principle,we try to realize the benign interaction of the directory access and exit system under the principle framework,and do a good job of connecting the medical insurance drug list with the drug management law.Within the scope of not exceeding the necessary limits,the insured person can be given the right to obtain judicial remedies in a case-by-case manner to protect their basic medical insurance needs,so that it can maintain a balance between basic medical insurance positioning and economic considerations with fair judicial decisions.