健康发展与政策研究2025，Vol.28Issue(1)：31-35,5.DOI:10.12458/HDPR.202407012
普惠型商业医疗保险特定高额药品保障的趋势分析
Trends in coverage of high-cost drugs under inclusive voluntary health insurance in China
摘要
Abstract
Objective To analyze the current status and trends of high-priced drugs covered by inclusive voluntary health insurance(IVHI)in China,and provide evidence for its high-quality development.Methods The benefit designs of IVHI in China and its high-priced drug lists from 2021 to 2023 were systematically collected.A comparative study was conducted to examine the provisions of coverage,the scope and level of coverage,and reimbursement trends for these drugs.Results Between 2021 and 2023,112(83.58%),165(86.84%),and 184(85.58%)IVHI plans provided coverage for high-priced drugs.The average number of drugs listed in the high-priced drug catalog rose from 22.1 to 38.7,with oncology drugs being the most common.During this period,the median deductible and cap for high-priced drug coverage remained at 0 RMB and 1 million RMB,respectively,while the median reimbursement ratio declined slightly from 80%to 75%.The reimbursement ratio for individuals with pre-existing conditions was,on average,over 30%lower than that for the general population(P＜0.001).As the number of high-priced drugs increased,so did the proportion of high-priced drug reimbursement relative to total reimbursement.Conclusions From 2021 to 2023,the number of drugs listed in the high-priced drug catalog increased annually,with oncology drugs being the primary focus of coverage.The scope and level of coverage for high-priced drug remained stable,but for individuals with pre-existing conditions,it was lower than for the general population.It is essential to maintain high-priced drug coverage as a core responsibility of IVHI and to further optimize the selection and payment mechanisms for these drugs to enhance coverage effectiveness.关键词
普惠型商业医疗保险/特定高额药品/保障/趋势分析Key words
inclusive voluntary health insurance/high-cost drug/security/development分类
预防医学引用本文复制引用
童禧辰,张璐莹,李静,李凯渊,陈文..普惠型商业医疗保险特定高额药品保障的趋势分析[J].健康发展与政策研究,2025,28(1):31-35,5.基金项目
国家自然科学基金(72374049) （72374049）
