医保制度改革对医院慢性病药物可及性影响的探索性研究--基于一线临床与药学工作实践

Exploratory Study on the Impact of Medical Insurance System Reform on the Accessibility of Chronic Disease Drugs in Hospitals--Based on Front-line Clinical and Pharmacy Work Practices

目的 探讨近年来医疗保障制度改革相关政策对慢性病药物可及性的影响。方法 于2022年8月抽取15名临床和药学一线工作者作为研究对象,采用半结构式提纲开展1对1深度访谈,基于主题框架法进行资料分析。结果 医保支付方式改革提高了低价药物的可获得性和可接近性,对于高价药物作用相反。药品集中采购对慢性病患者药物的可负担性存在双向影响:用药习惯的改变降低了部分患者的可接受性,医师和患者对于药物选择的受限降低了患者原研药物的可获得性和可接近性。国家谈判药物提高了慢性病患者用药的可负担性与高价药物的可获得性。“互联网+医保服务”的发展提升了药物可接近性,但覆盖面较小,应用尚不广泛。结论 医保制度改革对慢性病药物可及性具有多重影响,相关决策者要充分考虑医保政策对药物可及性的影响,保障广大慢性病患者权益。

OBJECTIVE To explore the influence of policies of health security system reform on the accessibility of drugs for chronic diseases in recent years. METHODS Fifteen clinical and pharmacy front-line workers were selected as the research objects in August 2022. The semi-structured outline was used to conduct one-to-one in-depth interviews, and the data were analyzed based on the thematic framework method. RESULTS The reform of health insurance payment method improved the availability and accessibility of low-priced drugs, but had the opposite effect on high-priced drugs. Centralized drug procurement had a bidirectional impact on the affordability of drugs for patients with chronic diseases: the change of medication habits reduced the acceptability of some patients, and the limited choice of drugs by doctors and patients reduced the availability and accessibility of original drugs for patients. National drug negotiations had improved the affordability of drugs for patients with chronic diseases and the availability of expensive drugs. The development of “internet plus medical insurance service” had improved the accessibility of drugs, but the coverage was still small and the application was not widely. CONCLUSION The reform of medical insurance system has multiple effects on the accessibility of drugs for chronic diseases. Relevant policy makers should consider the impact of medical insurance policy on the accessibility of drugs to protect the rights and interests of patients with chronic diseases.