医疗保险战略性购买对药品供给侧改革的作用机制研究

Analysis of the Mechanism of the Strategic Purchasing of Health Insurance on the Reform of the Drug Supply Side

虽然医保战略性购买提供了医疗卫生筹资与供给之间的关键联系,但其政策设计和成功实施却是一个挑战。医保需要运用机制工具,与医药供给方进行博弈,才能促进供给端的创新、竞争和资源优化配置。国内外研究表明,发挥战略性购买功能涉及医保作为战略性购买方的建立,以及医保战略性购买机制的运用,包括医保选择性缔约,医保药品定价、偿付、采购、成本分担等直接与间接机制。实践中,我国医保战略性购买与医药供给侧衔接仍是模糊地带。建议从医保战略性购买能力,医保药品目录的动态调整、价格谈判机制、量价采购方面进行优化,以此推进我国医疗保障和药品供给侧高质量协同发展。

Although the strategic purchasing of health insurance provides a key link between health care financing and supply,its design and implementation remains a challenge.Health insurance needs mechanistic tools to interact with health service and drug suppliers in order to promote supply-side innovation,competition and optimal allocation of resources.Previous studies have shown that strategic purchasing involves the establishment of health insurance as a strategic purchaser,as well as the strategic purchase mechanism of health insurance,including the selective contracting of health insurance,pricing,payment,procurement and cost-sharing.In China's reality,the connection between the strategic purchasing of health insurance and the supply side of medicine is still blurred.It is suggested to improve the strategic purchasing power of health insurance,the dynamic adjustment of the list of drugs covered by health insurance,and price negotiation mechanism and volume-based drug procurement,so as to promote the high-quality and coordinated development of health insurance and supply side of drugs in China.