多层次医疗保障体系下高值医疗器械保障机制的探索

Exploration of High-Value Medical Equipment Compensation in the Context of Multi-Level Medical System

以胰岛素泵为例,梳理各地高值医疗器械的保障模式:青岛市通过地方救助模式将胰岛素泵及其耗材纳入保障,随后过渡到商保中;广州市将胰岛素泵及其耗材纳入当地惠民保;上海市通过地方医保的形式对胰岛素泵及其耗材提供保障。针对高值医疗器材的保障机制提出思考建议:明确界定,规范编码;完善评估标准,建立动态调整机制;逐步推动创新型医疗器械纳入商保体系,满足更高层次的医疗保障需求。

Taking insulin pumps as an example,this study sorted out the guarantee models of high-value medical devices in various cities.Qingdao City has included insulin pumps and their consumables in the guarantee through the local rescue model,and then transitioned this to commercial insurance.Guangzhou City has included insulin pumps and their consumables in local universal health Insurance.Shanghai provides insurance for insulin pumps and their consumables in the form of local medical insurance.This study suggested to clearly define and standardize coding,improve evaluation standards and establish a dynamic adjustment mechanism,gradually promote the inclusion of innovative medical equipment in the commercial insurance system to meet higher-level medical security needs,so as to improve the security mechanism of high-value medical equipment.