我国药品目录调整特点及对医院医保管理的影响研究

Research on the characteristics of drug catalogue adjustment and its impact on hospital medical insurance management in China

目的:梳理近10年医保药品目录变化过程、内容及特点,探析历次变化对医院医保管理产生的影响。方法:主要采用文献研究梳理相关重大政策文件和文献,采用描述统计方法进一步证实影响。结果:药品目录调整多部门联动机制逐步建立;"有进有出"的调整机制正逐步建立;对医院的影响主要存在于落实政策的操作层面。结论:应高度重视药品目录调整;建立院内工作机制,有效组织宣传培训;发挥信息系统支撑和高效保障作用。

Objective:This paper reviews the process,content and characteristics of the changes in the medical insurance drug catalog in China in the past 10 years,and clarifies the impact of previous changes on the medical insurance management of hospitals.Methods:Literature study was mainly used to sort out relevant major policy documents and literature,and statistical methods were described to further confirm the impact.Results:the adjustment of drug catalogue in China tends to be normal gradually;the multi department linkage mechanism of drug catalogue adjustment is gradually established;the adjustment mechanism of"in and out"is gradually established;there is basically no impact on the index of hospital medical insurance fund and drug proportion,mainly in the operational level of implementing policies.Conclusions:We should attach great importance to the adjustment of the drug catalogue,establish the working mechanism in the hospital,effectively organize the publicity and training,and give full play to the supporting and high-efficiency guarantee functions of the information system.