高值药品保障政策的补偿机制研究  

A study on compensation mechanism of high value drug security policy

作　　者：蔡功杰 徐伟[1] 高楠[1] 杜雯雯[1] 杜珍珍[1] CAI Gong-jie;XU Wei;GAO Nan;DU Wen-wen;DU Zhen-zhen(School of International pharmaceutical business,China Pharmaceutical University,Nanjing Jiangsu 211198,China)

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198

出　　处：《卫生经济研究》2018年第4期42-45,共4页

基　　金：华海药业研究生创新基金(HHCX17S_023)

摘　　要：基于当前各典型地区特药补偿方案的实践,分析各补偿方案的异同和特点,以此为依据,设计了不同的补偿模式,并采用江苏省A市的数据,模拟各种补偿模式的运行效果。结果显示:起付线是影响特药保障效果的最重要因素,采用低费用段高补偿比的方案对减轻患者负担的作用更明显,封顶线的有无不会对各利益相关方产生重要影响。因此,对特药补偿方案的设计和评价,要综合考虑特药数量、用量、费用分布曲线以及当地经济发展水平、医保基金运行情况、居民支付能力等因素。Based on the practice of special drug compensation schemes in the typical regions,this paper analyzed the similarities and differences and characteristics of each compensation scheme,thereby designed different compensation models.The running effect of various compensation modes was simulated by adopting the data of A city in Jiangsu Province.The results showed that the deductible was the most important factor that affects the effect of special drug guarantee,and the effect of reducing the burden of patients was more obvious by adopting the scheme with low cost segment and high compensation ratio.The existence or absence of ceiling lines would not have a significant impact on all stakeholders.Therefore,the design and evaluation of special drug compensation schemes should take into account the quantity,dosage,cost distribution curve,level of local economic development,health insurance fund operation,residents'ability to pay and other factors.

关 键 词：高值药品 补偿机制 起付线 补偿比 封顶线 

分 类 号：F840.684[经济管理—保险]