基于多维尺度分析的国家谈判药品可及性问题研究

Study on the Accessibility of National Negotiated Drugs Based on Multi-dimensional Scaling Analysis

目的 分析从国家层面开展药品谈判政策以来国内对国家谈判药品可及性的相关研究热点,探索提高患者药品可及性。方法 通过文献计量统计CNKI数据库中2017年1月1日—2022年5月1日关于国家谈判药品可及性的关键问题。组织12名专家开展专题小组剖析多维度原因并总结政策建议。结果 国家谈判药品可及性问题主要反映在医疗机构、医保报销和“双通道”管理中,包括3个维度:(1)可获得性不理想。医疗机构中配备率和种类较低且临床使用意愿不高。(2)可负担性存在问题。医保基金运行压力持续增大,且部分患者用药负担改善不明显。(3)可持续性面临障碍。“双通道”管理中患者购药后的输注渠道不通畅以及药品使用存在安全风险。结论 以国家谈判药品的可获得性和可负担性为抓手,实现服务方与支付方的有效联动,完善医院及医师绩效考核,建设多层次医保体系,同时理清“双通道”实施路径关键环节跟进配套服务,保障患者持续使用。

Objective Based on the hot spot of An analysis of the hotspots ofresearch related to the accessibility of national drugs since the launch of the national drug negotiation policy,exploring ways to improve access to medicines for patients.Methods Using bibliometric analysis to count key issues in the CNKI database on the accessibility of national drugs from January 1,2017 to May 1,2022,a focus group with a panel of 12 experts are organized to analyze the multidimensional causes of the problems and summarize policy recommendations.Results The problem of accessibility of national negotiated drugs exists mainly in hospital institutions,medical insurance reimbursement and “dual-channel” management,including the following three dimensions:(1)The availability of national negotiated drugs is unsatisfactory;The availability and variety of national negotiated drugs in medical institutions are limited,and the willingness to use them in clinical practice is not high.(2)The affordability of national negotiated drugs is problematic.The pressure on medical insurance funds continues to increase,while some patients' medication burdens do not improve significantly.(3)The sustainability of national negotiated drugs faces obstacles.In the “dual channel” management,the infusion channels for patients after purchasing drugs are not smooth,and there are safety risks in the use of drugs.Conclusion It is needed to take the availability and affordability of state-talked drugs as a grip to achieve effective linkage between service providers and payers,improve the performance assessment of hospitals and physicians,and build a multi-level medical security system,while clarifying the key aspects of the“dual-channel” implementation pathway and following up with supporting services to ensure sustainable use of national negotiated drugs by patients.