山东省国家医保谈判药品 “双通道” 管理政策比较研究  

Comparative study on dual channel management policy of medicines covered under national medical insurance system s price negotiation program in Shandong Province

作　　者：孙雅群 宋燕[1,2] SUN Yaqun;SONG Yan(College of Medical Security,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan Shandong 250117,China;Shandong Institute of Medicine and Health Information,Jinan Shandong 250062,China)

机构地区：[1]山东第一医科大学医疗保障学院/山东省医学科学院,山东济南250117 [2]山东省医药卫生科技信息研究所,山东济南250062

出　　处：《卫生软科学》2023年第10期13-16,共4页Soft Science of Health

基　　金：山东省药物政策研究重点课题(YZY202202);山东省医药卫生科技发展计划项目(2015WS0174);山东第一医科大学学术提升计划项目(2019QL002)。

摘　　要：国家医保谈判政策已经进入常态化趋势,为保障谈判药品的使用,国家出台了多项措施,其中“双通道”管理政策极具特色,实践表明该政策有效提高了谈判药品的可及性,降低了患者的负担。本文比较山东省和省内各地市国家医保谈判药品“双通道”管理政策方案,从“双通道”定点医疗机构、定点零售药店、纳入药品种类、药品自付比例和支付方式等方面对比分析各个地市的政策差异和创新性管理办法。山东省及其16个地市的“双通道”管理政策制定实施总体情况较好,充分落实了国家级指导意见,接下来可在单行支付、平衡各地区保障水平等工作上继续推进。National medical insurance system s price negotiation program has entered a trend of normalization.In order to ensure the use of medicines covered under price negotiation program,China has introduced a number of measures,among which the dual channel management policy is very distinctive.Practice has shown that this policy effectively improves the accessibility of medicines covered under price negotiation program and reduces the burden of patients.By comparing the dual channel management policy of medicines covered under national medical insurance system s price negotiation program in Shandong Province and other cities in Shandong,this paper compares and analyzes the policy differences and innovative management methods of each city from the aspects of dual channel which is designated medical institutions and designated retail pharmacies,types of included medicines,out-of-pocket payment ratio of medicines and payment methods.The overall situation of the formulation and implementation of the dual channel management policy in 16 cities of Shandong Province is generally good,and the national guidance has been fully implemented.Next,we can continue to promote the work of one-way payment and balancing the security of each region.

关 键 词：国家医保谈判药品 “双通道”管理政策 定点医疗机构 定点药店 

分 类 号：R197.1[医药卫生—卫生事业管理]