国家医保谈判药品政策在L省落地实施效果评估研究  

Research on the Implementation Effect Evaluation of National Medical Insurance Negotiated Drug Policy in L Province

作　　者：牛俊 李杰 刘中华 王海燕 

机构地区：[1]辽宁省医疗保障事务服务中心,沈阳110003 [2]中国科学院大学经济与管理学院,北京100190

出　　处：《中国医疗保险》2024年第4期64-70,共7页China Health Insurance

摘　　要：目的:分析L省国家医保谈判药品使用现状,评估国家医保谈判药品政策在L省的落地实施效果,以期为政策优化与完善提供实证参考与经验借鉴。方法:从谈判成效、可及性和可负担性三个层面评估分析2023年国家医保谈判药品政策在L省的落地实施成效,并从不同时间、不同地区、不同病种和典型药品四个维度探究国家医保谈判药品政策在L省的落地实施特征。结果:2023年,国家医保谈判药品谈判成功率达82.31%,价格平均降幅达60.10%,国家医保谈判药品在L省的配备率达96.53%,患者自付比例、次均费用和次均自付费用分别为36.25%、442.11元和160.27元。讨论:建议各级医保和卫健部门协同做好医疗机构配备使用国家医保谈判药品的指导工作,提升药品可获得性与购药便捷性;持续开展国家医保谈判药品政策落地实施效果跟踪评价,降低患者用药负担;各统筹区因地制宜开展国家医保谈判药品相关政策解读与宣传,提升政策知晓度。Objective:This paper analyzes the current status of national negotiated drug in L Province,and evaluates the implementation effect of national negotiated drug policy in L Province,in order to provide valuable empirical reference and experience for the optimization and improvement of national negotiated drug policy.Methods:The implementation effect of L Province’s national negotiated drug policy in 2023 is evaluated from three aspects:negotiation effectiveness,accessibility and affordability,and the analysis is conducted from the four dimensions of different times,different regions,different diseases and typical drugs to explore the implementation characteristics of national negotiated drug policy in L Province.Results:In 2023,the negotiation success rate of national negotiated drug reaches 82.31%,the average price reduction reaches 60.10%,and the equipment rate of national negotiated drug in L Province reaches 96.53%.For patients,the out-of-pocket ratio,the average cost per time and the average out-of-pocket cost per time are 36.25%,442.11 yuan and 160.27 yuan respectively.Discussion:It is recommended that medical insurance and health departments at all levels collaborate to provide guidance for medical institutions to equip and use national medical insurance negotiated drugs,and improve the accessibility and convenience of drug procurement.Meanwhile,we should continuously carry out tracking and evaluating the implementation effect of national medical insurance negotiated drug policy,and reduce the burden of medication on patients.According to local conditions,each pooling area shall carry out interpretation and publicity of national medical insurance negotiated drug policy to enhance policy awareness.

关 键 词：国家医保谈判药品 可及性 可获得性 可负担性 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]