我国医疗保险国谈药品单独支付政策省际比较研究

An inter-provincial comparative study on the separate payment policy for national medical insurance negotiated drugs in China

目的:对国家医疗保险谈判药品单独支付省级政策文本进行分析,总结关键措施及特点,为各省制定和优化单独支付政策提供借鉴。方法:检索各省、自治区、直辖市医疗保障局网站,收集有关单独支付的政策文件,对检索到的政策文本进行总结与分析。结果:各省份单独支付政策在目录发布、目录遴选方式、药品管理方式、政策待遇水平和政策衔接等方面存在差异。结论:单独支付政策是“三医”协同发展的重要推手。各省要平衡好单独支付目录各种政策要素,处理好医保基金控制和患者获得感以及理清单独支付政策与支持创新药发展的关系,减少“三医”协同障碍。

Objective:This study aims to analyze the provincial policy text of separate payment for National medical insurance negotiated drugs,summarize the key measures and characteristics,and provide reference for the formulation and improvement of separate payment policies in various provinces.Methods:The retrieved policy texts were analyzed by searching the websites of the medical security bureaus of various provinces,municipalities,and autonomous regions.Results:There are differences in the separate payment policies of different provinces in terms of catalogue publishing,catalogue selection,drug management,policy treatment level and policy cohesion.Conclusion:The separate payment policy is the key driver of Joint Reformation for Public Health Services,Medical Insurance,and Medical Production-Circulation.And all provinces should balance the various policy elements of the separate payment catalogue,deal with the control of medical insurance funds and patients'sense of gain,and clarify the relationship between the separate payment policy and support the development of innovative drugs,so as to reduce the obstacles of Joint Reformation for Public Health Services,Medical Insurance,and Medical Production-Circulation.