基于HTA的医疗服务项目医保准入机制国际实践与启示  

International Practice and Insights on the Medical Insurance Access Mechanism of Medical Service Item Based on HTA

作　　者：张晨曦 王海银[2] 刘昕 金春林[2] Zhang Chenxi;Wang Haiyin;Liu Xin;Jin Chunlin(School of Public Health,Shandong Second Medical University,Weifang,Shandong,261053,China;不详)

机构地区：[1]山东第二医科大学公共卫生学院,山东潍坊261053 [2]上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所),上海200040

出　　处：《中国卫生经济》2024年第9期92-96,共5页Chinese Health Economics

基　　金：上海市科技计划项目(21ZR1458800、23692108900)。

摘　　要：目的:探讨如何构建适用于我国的基于卫生技术评估(HTA)的医疗服务项目医保准入机制。方法:梳理目前各省份医保准入流程,通过专家访谈了解其不足之处;运用文献分析的方法,总结英国和新加坡医保准入的经验和HTA报告包含的指标信息。结果:我国大部分地区医疗服务价格管理虽然由“排除法”逐渐向“准入法”过渡,但缺乏准入评估的工具。英国和新加坡医保准入机制主要包括主题遴选、评估范围界定、实施HTA、医保准入决策等;HTA报告包含临床证据、成本证据、评估项目对卫生体系的预算影响等数据资料。结论:可以通过多准则决策分析构建循证卫生政策决策框架;通过制定国家层面指导性文件、多情境下HTA评估体系、加强对HTA的监督等途径构建基于HTA医保准入机制。Objective:To discuss how to construct the medical insurance access for medical service items based on Health Tech-nology Assessment(HTA)applicable to China.Methods:This study consolidated the current medical insurance access in some prov-inces and cities from China and identified deficiencies through the expert interview.We summarized the experience and indicators contained in the HTA report in UK and Singapore by using literature analysis.Results:In most regions of China,the management of medical services price is gradually moving from exclusion items based on certain conditions to access approach,lacking of tools for assessment.In UK and Singapore,the medical insurance access mechanism mainly consists of subject selection,scoping,HTA imple-mentation and decision-making,in the HTA report,with the data including clinical evidence,cost evidence and budget impact on health system,etc.Conclusion:Building an evidence-based health policy decision-making framework through multi-criteria deci-sion analysis and the construction of medical insurance access mechanism based on HTA can be achieved by developing national guidelines,multi-scenario HTA systems,and enhancing the supervision on the process of HTA.

关 键 词：医疗服务项目 卫生技术评估 医保准入 启示 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F014.31[经济管理—政治经济学]