药品集中带量采购与医保谈判政策的协同作用  

Synergy of Centralized Drug Volume-based Purchasing and Medical Insurance Negotiation Policy

作　　者：谭清立 郭润镒 孙慧琳[3] 于大川[4] TAN Qingli;GUO Runyi;SUN Huilin;YU Dachuan(School of Medical Business,Guangdong Pharmaceutical University,Guangdong Zhongshan 528400,China;Guangdong Research Base for Drug Regulatory Science,Guangzhou 510006,China;Dept.of Endocrinology,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Institute of Social Security,Guangdong University of Finance,Guangzhou 510521,China)

机构地区：[1]广东药科大学医药商学院,广东中山528400 [2]广东省药品监管科学研究基地,广州510006 [3]广东药科大学附属第一医院内分泌科,广州510080 [4]广东金融学院社会保障研究所,广州510521

出　　处：《中国药房》2021年第15期1793-1799,共7页China Pharmacy

基　　金：国家社会科学基金一般项目(No.20BSH029);广州市哲学社会科学发展“十四五”规划2021年度课题(No.2021GZGJ313)。

摘　　要：目的:探讨药品集中带量采购(简称“带量采购”)与医保谈判政策的协同作用。方法:运用文献分析法、政策解读法、访谈法,从经济效益和社会效益两方面对带量采购和医保谈判的协同作用进行分析,针对药品供给与使用中出现的问题提出相应建议。结果与结论:带量采购与医保谈判在经济效益方面的协同作用包括优化医保基金管理,提升资金使用效率;优化医保基金支付环节,降低交易成本;推进医疗保障信息平台联网,降低信息交流成本。带量采购与医保谈判在社会效益方面的协同作用包括考核药品质量评价相关指标,完善药品质量评价体系;提高医疗服务水平,形成总额预算管理下的复合式医保支付方式;以市场撬动企业监管,减少政府监管压力。相关部门应继续加强对医疗机构的综合治理,减少不合理用药现象;加强政策衔接,避免医保药品调整政策执行不畅,使带量采购和医保谈判的政策红利更多地通过制度改革和资金优化配置等方式惠及人民群众。OBJECTIVE:To investigate the synergy between centralized drug volume-based purchasing(called“volume-based purchasing”for short)and medical insurance negotiation policy.METHODS:From the aspects of economic and social benefits,the synergy of volume-based purchasing and medical insurance negotiation was analyzed by using the methods of literature analysis,policy interpretation and interview.The corresponding suggestions were put forward for the problems of the supply and use of drugs.RESULTS&CONCLUSIONS:The synergy of volume-based purchasing and medical insurance negotiation in terms of economic benefits include medical insurance fund management optimization to improve fund utilization efficiency improvement;medical insurance fund payment optimization to reduce transaction cost;network promotion of medical security information platform to reduce the cost of information exchange.The synergy of volume-based purchasing and medical insurance negotiation in terms of social benefits includes relevant index assessment of drug quality evaluation to improve drug quality evaluation system;medical service level improvement to form compound medical insurance payment mode under total budget management;enterprise supervision driven by market to reduce the pressure of government supervision.The relevant departments should continue to strengthen the comprehensive management of medical institutions to reduce the phenomenon of irrational drug use;strengthen policy convergence,avoid the poor implementation of medical insurance drug adjustment policy,so that the policy dividend of volume-based purchasing and medical insurance negotiation can benefit the people more through system reform,optimal allocation of funds,etc.

关 键 词：药品集中带量采购 医保谈判 协同作用 医疗改革 

分 类 号：R951[医药卫生—药学]