英国高值创新药支付保障机制研究与启示

Research on the Guarantee Mechanism for Payment of High-Value Innovative Drugs in the UK and Its Enlightenments

共同富裕是社会主义的本质要求,推动医疗保障高质量发展是实现共同富裕的重要方面,当前我国健康服务供给总体不足和人民医疗服务需求不断增长之间的矛盾依然突出。尤其是对于发病率低的小群体来说,比较突出的问题是可选择的治疗药品很少并且费用高昂,如何保障这类群体的用药需求和减轻其疾病负担是我国改善健康公平、实现共同富裕的一个重要研究课题。目前不少国家开始探索专项基金保障模式,用以平衡保障疾病负担和经济负担极重小群体的高值药品用药需求和广大参保人基本用药需求之间可能存在的矛盾,其中以英国从癌症药物基金开始探索的高值创新药品用药保障专项基金模式最为典型。基于此,本文从支付端视角出发,从药品准入和退出机制、资金筹集和风险控制机制、数据收集和管理机制等多维度对英国高值创新药品支付保障机制进行深度分析,并提炼总结其独立筹资、过渡性、附条件性、可控性、多维度管理等特点。

Common prosperity is an essential requirement of socialism,and promoting the high-quality development of healthcare security is an important task of common prosperity.Currently,the contradiction between the overall insufficient supply of health services in China and the continuous growth of people's demand for medical services is still prominent.Especially for small groups with low incidence rate,the prominent problem is that there are only a few alternative drugs with high price.How to ensure the drug demand of the small groups and reduce their disease burden is an important topic of improving health equity and achieving common prosperity in China.At present,many countries are exploring a special fund guarantee model to handle the potential contradiction between the high-value drug needs of small groups with extremely heavy disease burden and economic burden,and the basic drug needs of the majority of the insured.Among them,the high-value innovative drug guarantee special fund model explored by the UK from the Cancer Drug Fund is the most typical one.Therefore,the article analyzes the UK's high-value innovative drug payment guarantee mechanism from the perspective of the payment side,including drug access and exit mechanism,fund raising and risk control mechanism,data collection and management mechanism,and summarizes its characteristics of independent financing,transition,additional condition,controllability,and multi-dimensional management.