德国医用耗材医保准入管理的启示

Enlightenment from Germany's management of health insurance access of medical consumables

随着我国医药卫生体制改革的持续推进,高值医用耗材价格虚高、过度使用等问题日益凸显,逐步成为增加人民群众就医负担的主要因素之一。本文围绕医用耗材的定义与分类、支付类型、准入流程等方面,系统介绍德国在医用耗材医保准入管理方面的有关经验和做法,为我国制订医用耗材医保准入和支付管理的框架方案提供有益借鉴:一是前置统一的产品安全、质量标准,加快医用耗材上市准入效率;二是优化医保支付标准,促进医用耗材合理价格形成;三是分类设置新医用耗材医保准入途径,支持医用耗材产业创新动力。

As China's healthcare system reform has been continuously developing,some problems such as inflated prices and excessive use of high-value medical consumables have emerged as one of the main factors that increase the patients'financial burden.By focusing on the definition and classification,types of payment and health insurance access procedures of medical consumables,this article systemically introduced the experience and practices of Germany's management of health insurance access of medical consumables,so as to provide a reference for China to design a framework plan concerning the management of health insurance access and payment of medical consumables.A total of three enlightenments were summarized from the study.Firstly,it is necessary to set up unified product safety and quality standard in the prerequisite process to increase the market access efficiency of medical consumables.Secondly,it is essential to optimize the payment standard of health insurance,so as to allow the price of medical consumables to reach a reasonable level.Thirdly,it is also important to set up multiple pathways of health insurance access for innovative medical consumables based on classification,so as to encourage innovation in the field of medical consumable production.