| 引用本文: |
江欣禅,王艳,徐伟,等.三省（市）医疗保险特殊用药谈判制度比较[J].中国卫生经济,2017,(3):40-42.[点击复制] |
.Comparison of negotiation mechanisms of medical insurance special drugs in China[J].CHINESE HEALTH ECONOMICS,2017,(3):40-42.[点击复制] |
|
| 摘要: |
| 摘要 目的：了解山东省青岛市、江苏省、浙江省三地医疗保险特殊用药谈判制度的基本情况。方法：查阅三地与医疗保险特殊用药谈判制度相关的政策法规，从谈判机制、保障对象、支付范围、筹资机制、补偿水平五个方面进行比较。结果：青岛市筹资来源于财政拨款，谈判涉及药品和医用材料，覆盖重大疾病、罕见病、慢性病；江苏省无进行额外筹资，有针对性地救助乳腺癌和白血病患者，并将仿制药纳入了谈判范围；浙江省建立了财政补贴与个人缴费的分担机制，没有限定适用特药的临床指征，实行按费用分段补偿。结论：为进一步完善制度，可鼓励药品赠送谈判，提高药品谈判效率；增加罕见病用药，逐步纳入医用材料；建立特药保障目录的动态调整机制。 |
| 关键词: |
| DOI： |
|
| 基金项目: |
|
| Comparison of negotiation mechanisms of medical insurance special drugs in China |
|
| () |
| Abstract: |
| Abstract Objective: To learn about the different negotiation mechanisms of medical insurance special drugs in Qingdao city (Shandong province), Jiangsu province, and Zhejiang province. Method: To compare the differences between these three provinces from five aspects of negotiations mechanism, medical care object, medical coverage, financing mechanism, and reimbursement level by consulting the relative policies of medical insurance special drugs in these three provinces. Result: The financial source of Qingdao city is financial allocation. And Qingdao city has the broadest drug negotiation range, which includes drugs and medical materials of critical diseases, rare diseases, and chronic diseases. There is no additional financing mechanism in Jiangsu province, and the drug negotiation mechanism is specific to breast carcinoma and leukemia. In addition, generic drug is included in the negotiation range. In Zhejiang province, the risk sharing mechanism of fiscal subsidies and individual contribution was set. The clinical medication indication is unlimited, and reimbursements are given by sectional expenses compensation. Conclusion: Encouraging the medical company to donate drugs during negotiation would increase the efficiency of drug negotiation. Also, broadening rare diseases coverage and adding more medical materials into negotiation range would perfect the contribution of negotiation mechanisms for medical insurance special drugs. Moreover, the dynamic adjustment mechanism of medical insurance special drugs formulary should be built. |
| Key words: |
