中外创新药物医保支付的比较研究  

Comparative Study on the Payment of Medical Insurance for Innovative Drugs Between China and Foreign Countries

作　　者：于飞[1] 卢静[2] 高辰旭 李敬伟[1] YU Fei;LU Jing;GAO Chenxu;LI Jingwei(Department of Medical Insurance,Peking University First Hospital,Beijing 100034,China;Department of Medical Insurance,West China Hospital of Sichuan University,Chengdu 610041,China;School of Public Health,Peking University,Beijing 100038,China)

机构地区：[1]北京大学第一医院医保处,北京100034 [2]四川大学华西医院医保办公室,成都610041 [3]北京大学公共卫生学院,北京100038

出　　处：《医药导报》2024年第3期470-476,共7页Herald of Medicine

基　　金：四川省科技厅四川省重点研发项目(2023YFS0249)。

摘　　要：按疾病诊断相关分组(DRG)付费是当前我国医保支付改革的重要研究方向,但在一定程度上限制了创新药物的临床推广使用。许多国家已对创新药物的额外支付进行了深入研究。该文以美国、法国、德国为例,分析总结DRG付费体系下创新药物额外支付的国际经验,并结合我国创新药物医保支付现状及DRG付费对创新药物发展的影响,提出了明确的纳入标准、选择合适支付模式、建立动态调整机制、完善支付方式等政策建议,以期在全面推进DRG付费改革中,为进一步建立和完善我国创新药物医保支付机制提供参考。Payment by diagnosis related groups(DRG)is an important research direction in China's current medical insurance payment reform.However,it limits the clinical development and utilization of innovative medicines to a certain extent.Additional payments for innovative medicines have been thoroughly studied in many countries.This paper conducted an analysis and summary of the global experience regarding additional payment for innovative medicines under the DRG payment system.Using the United States,France,and Germany as case studies,this paper also examined the current state of medical insurance payment for innovative medicines in China and the influence of DRG payment on the development of such medicine.In addition,it has put forward explicit policy recommendations,including the establishment of inclusion criteria,the selection of appropriate payment modes,the implementation of dynamic adjustment mechanisms,the enhancement of payment methods,etc.This paper aims to provide references to comprehensively promote DRG payment reform while further establishing and enhancing medical insurance payment mechanisms related to innovative medicines in the context of China's national conditions.

关 键 词：创新药物 医保支付 按疾病诊断相关分组 政策建议 

分 类 号：R95[医药卫生—药学]