基于药品再评价的医保目录动态调整风险控制机制研究——以澳大利亚为例  

Research on the Risk Control Mechanism of Health Insurance Directory Dynamic Adjustment Based on the Drug Reevaluation System——Take Australia as an Example

作　　者：董心月 张伶俐 颜建周[1] 邵蓉[1] DONG Xin-yue(National Drug Policy and Medical Industry Economy Research Center of China Pharmaceutical University,Nanjing,P.R.China)

机构地区：[1]中国药科大学国家药物政策与医药产业经济研究中心,江苏南京211198 [2]南京总医院药品科

出　　处：《中国卫生事业管理》2019年第8期603-608,共6页Chinese Health Service Management

基　　金：国家社会科学基金重大项目“我国创新药物政策环境研究”(15ZDB167)

摘　　要：我国于2017年2月颁布了时隔8年后新的医保目录,且不久前原人社部就建立医保目录动态调整机制向公众广泛征求意见,我国的医保改革仍在有条不紊地进行。本文通过研究澳大利亚基于药品再评价制度的医保准入风险控制机制,对澳大利亚的药品再评价作用于医保药品目录准入和支付价格动态调整的风险控制机制进行了系统性描述。建议我国建立起真实世界环境下基于药品再评价制度的医保目录与支付标准动态调整机制,借鉴国外经验探索动态医保准入的风险控制模式,以临床价值为导向,合理配置医保基金资源。China promulgated the new Health Insurance Directory after a lapse of 8 years in February 2017,and not long ago the former Ministry of Human Resources and Social Security of the People’s Republic of China sought advices from public on the establishment of Health Insurance Directory dynamic adjustment mechanism.Healthcare reform is still in full swing in China.In this paper,through the systematical study of risk control mechanisms for drug re-evaluation as a function of the medical insurance access in Australia,has made a systematic description of how the drug reevaluation acts on the risk control mechanism of reimbursement catalog access and drug price adjustment.It is recommended that China should establish the dynamic adjustment mechanism of health insurance directory and payment standard based on reevaluation of drug value in real world environment,draw lessons from foreign experiences to explore risk control methods for dynamic medical insurance access,which emphasize on the clinical value-oriented,in order to rationalize the distribution of health insurance fund resources.

关 键 词：澳大利亚 药品再评价制度 医保准入 支付标准 风险控制 

分 类 号：R951[医药卫生—药学]