中美两国医保目录调整工作程序和决策支持体系  

Work Procedures and Decision-making Support Systems for the Adjustment of Health Insurance Catalogs in China and the United States

作　　者：聂珏荃 李皛 NIE Jue-Quan;LI Xiao(University of Kentucky College of Pharmacy,KY 40536,USA;Beijing Peking University Weixin Biotechnology Co.,Ltd.,Beijing 100094,China)

机构地区：[1]肯塔基大学药学院,美国肯塔基州40536 [2]北京北大维信生物科技有限公司,北京100094

出　　处：《中国药物经济学》2020年第12期32-38,46,共8页China Journal of Pharmaceutical Economics

摘　　要：医保目录调整是一项关系到民生的多学科、多部门合作的工作。完善的评价指标体系,可确保药品目录调整过程中完善的信息收集和全面的决策考量,大幅提高国家医保局和药企之间的沟通效率。统一的准入流程,可以帮助国家医保局和药企提早确定工作计划,保证提交资料的真实性、准确性和完整性。使药品从获批到被纳入医保目录的时间缩短,有效药物的可及性提高。本研究对美国的政府医疗保险工作流程和决策体系进行了总结描述,并对其借鉴价值进行了详细分析。美国医保目录制度和调整工作起步较早,在不断提高保方与药企合作效率的过程中完善了双方合作的流程;详细的证据提交标准也为收集高质量的决策数据提供了便利。与此同时,中国与美国的国情也有许多不同之处,不可将美国方法全盘复制运用在中国。本研究也结合中国国情,提出了结合中国特有的制度优势,建设更科学、更先进决策体系的设想。The adjustment of the medical insurance catalog is a multi-disciplinary and multi-sectoral work related to people’s livelihood.A complete evaluation index system can ensure complete information collection and comprehensive decision-making considerations during the adjustment of the drug catalog,and greatly improve the communication efficiency between the National Medical Insurance Administration and pharmaceutical companies.A unified access process can help the National Medical Insurance Bureau and pharmaceutical companies determine work plans early to ensure the authenticity,accuracy and completeness of the submitted materials.It shortens the time from approval of drugs to being included in the health insurance list,and improves the availability of effective drugs.This research makes a summary description of the US government medical insurance work process and decision-making system,and analyzes its referential value in detail.The US health insurance catalog system and adjustment work startes early,and the process of cooperation between the two parties has been improved in the process of continuously improving the efficiency of cooperation between the insurance party and the pharmaceutical company;detailed evidence submission standards also provide convenience for the collection of high-quality decision data.At the same time,there are many differences between our country and the United States in terms of national conditions,and it is not possible to fully replicate the American method in China.This research also put forward the idea of building a more scientific and advanced decision-making system with China’s unique system advantages according to China’s national conditions.

关 键 词：美国政府医保 医保目录调整程序 决策支持体系 中国特色 

分 类 号：R956[医药卫生—药学]