中国药房2024，Vol.35Issue(13)：1552-1557,6.DOI:10.6039/j.issn.1001-0408.2024.13.02
日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示
Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South Korea on the simple renewal mechanism for negotiated drugs in China
摘要
Abstract
OBJECTIVE To learn the practical experience of medical insurance payment standards adjustment in Japan and South Korea,which will serve as a reference for the improvement of simple renewal mechanism in China.METHODS Retrieving relevant literature from CNKI and related policy documents from official websites of Japan and South Korea,the medical insurance payment standards adjustment practice in Japan and South Korea would be elucidated from 2 perspectives of adjustment criteria and formulas,and then were compared with the current simple renewal mechanism in China to clarify the areas where simple renewal mechanism in China can be optimized and propose several suggestions.RESULTS&CONCLUSIONS In terms of adjustment methods,Japan and South Korea were similar to China.For excessive drugs,the reduction rate of drugs was calculated based on the situation of excess and adjustments were implemented;however,there were differences in the specific adjustment criteria and formulas.Japan and South Korea adopted a linear price reduction approach for drugs with significant oversupply,while China adopted a gradient price reduction approach for drugs with both current and expected oversupply.The results of the comparative analysis show that China has initially established simple renewal mechanisms that are in line with the national conditions and the actual medical insurance situation,and has taken some innovative measures,including considering the current and expected oversupply of drugs and introducing a halving mechanism in the adjustment formula.However,there are also certain shortcomings,such as a relatively single set of indicators for adjusting conditions and a too broad range of gradient price reduction in adjustment formulas,which fail to fully reflect the market-oriented mechanism of"volume for price".It is recommended that China's medical insurance department increase consideration of drug fund expenditures,refine the gradient price reduction range of adjustment formulas,increase policy preferences for special category drugs when adding new indications,and further improve the mechanism for simple renewal.关键词
医保谈判/简易续约/医保支付标准调整/医保基金支出Key words
medical insurance negotiations/simple renewal mechanism/medical insurance payment standards adjustment/medical insurance fund expenditures分类
医药卫生引用本文复制引用
唐璋淳,卢钰琼,代展菁,许佳艺,虞杰,路云,常峰..日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示[J].中国药房,2024,35(13):1552-1557,6.基金项目
中国博士后科学基金第74批面上资助项目(No.2023M743897) （No.2023M743897）
