国家谈判药品先行自付比例的制定策略研究

A Study of Strategies for Setting Prior Self-Financed Ratio for National Negotiated Drugs

目的:探索科学、合理的医保谈判药品先行自付比例制定策略。方法:梳理国内典型地区谈判药品先行自付比例的实践经验,基于委托代理和利益相关者理论,探索可行的谈判药品先行自付比例制定策略。结果:基于典型地区实践,本研究总结出五类常见的先行自付比例制定方式,认为第五类差异化形成谈判药品先行自付比例区间的方式更符合新时代医保管理需求。同时,本文从医保、患者、医疗机构、医药企业四方视角分别提出了影响谈判药品先行自付比例的因素,并设计了基于“基准比例和调整幅”的谈判药品先行自付比例的制定策略,能够在保证医保基金安全的前提下,平衡患者用药负担,促进临床用药合理化。结论:建议各地建立科学、合理、透明的谈判药品先行自付比例制定机制,探索谈判药品先行自付比例动态调整机制,在此基础上可逐步完善常规乙类药品的先行自付比例管理。

Objective:The paper attempts to explore scientific and reasonable strategies for the formulation of national negotiated drug prior self-financed ratio.Methods:The study summarizes the practical experience of national negotiated drug prior self-financed ratio in typical areas in China,and explores feasible strategies for the formulation of national negotiated drug prior self-financed ratio based on principal-agent and stakeholder theories.Results:The study summarizes five common methods of formulating the prior self-financed ratio based on the practice in typical regions,and concludes that the fifth way of forming a differentiated range for multiple negotiated drug prior self-financed ratio is more in line with the needs of medical insurance management in the new era.At the same time,the factors affecting the prior self-financed ratio of national negotiated drugs are proposed from the perspectives of medical insurance,patients,medical institutions and pharmaceutical enterprises,and a strategy based on the"benchmark ratio and adjustment range"is devised for the formulation of prior self-financed ratio of negotiated drugs,which can relieve the burden of patients'medicines while ensuring the safety of the health insurance fund and promote the rational drug use.Conclusion:Each region should establish a scientific,reasonable and transparent mechanism for the formulation of national negotiated drug prior self-financed ratio,explore the dynamic adjustment mechanism,and gradually improve the management of self payment ratio of regular Category B drugs on this basis.