基于德尔菲法和共识会议法的肾脏病相关医保药品限定支付范围细则研究  

Research on the Detailed Rules for the Limited Payment Scope of Medical Insurance Drugs Related to Kidney Diseases Based on Delphi method and Consensus Conference Method

作　　者：高锦娟[1] 林含 李晶晶 康洽福 洪富源[5] 陈秀云 林昕 

机构地区：[1]福建中医药大学附属第二人民医院,福州350003 [2]福州市第一总医院,福州350004 [3]福建医科大学附属协和医院,福州350001 [4]福建省医疗保障研究院,福州350001 [5]福建省立医院,福州350001 [6]福建省医疗保障基金中心,福州350001

出　　处：《中国医疗保险》2023年第8期122-126,共5页China Health Insurance

基　　金：福建省医疗保障研究院2023年调研项目“医保药品限定支付政策专家共识调研”(2023D01);福建省卫生健康委员会2022年省卫生健康软科学研究课题“医保限定支付药品合规使用情况研究”(2022RKB009)。

摘　　要：2022版国家医保药品目录部分限定支付范围表述不够清晰,临床准确执行存在困难。本文从肾脏病方向梳理相关医保药品限定支付范围疑义条目,经30位专家三轮次德尔菲法、16名专家共识会议法投票表决后提出7条细则与4条修订建议,为医保药品限定支付范围细则研究提供参考,为医保部门精细化管理、临床精准化执行提供依据。The limited payment scope of some medical insurance drug catalogs is not clearly stated,and there are difficulties in accurate clinical implementation.From the perspective of kidney disease,this paper combs the doubtful items of the limited payment scope of related medical insurance drugs.After three rounds of Delphi method method voting by 30 experts and consensus meeting method voting by 16 experts,seven detailed rules and four revision suggestions are proposed,providing reference for the study of the detailed rules of the limited payment scope of medical insurance drugs,and providing basis for the refined management and clinical precision implementation of the medical insurance department.

关 键 词：医保药品 限定支付 肾脏病 德尔菲法 共识会议法 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]