健康发展与政策研究2025，Vol.28Issue(5)：540-545,6.DOI:10.12458/HDPR.202410105
惠民保特定高额药品保障现状与趋势分析
Analysis on the current status and development trend of specific high-priced drug coverage of Huimin insurances
摘要
Abstract
Objective To analyze the current status and development trend of specific high-priced drug coverage of an inclusive commercial medical insurances(hereinafter referred to as''Huimin insurances'')in China.Method This study systematically collected Huiminbao policy documents and their high-priced drug lists implemented across various provinces in 2022-2023,employing policy document analysis to extract and examine the categories of specific high-priced drugs and their coverage levels.Results From 2022 to 2023,the number of Huimin insurances schemes with specific high-priced drug in China increased from 148 to 193.A total of 29 provinces implemented the policy,up from 27.The scope of specific drug coverage expanded,with the average number of drugs included per scheme rising from 29 to 39,and a growing trend toward including drugs not on the national reimbursement drug list.In terms of coverage levels,the average deductible for these drugs decreased from 7,000 yuan to 6,700 yuan,and the average coverage amount increased from 968,500 yuan to 994,200 yuan,while the reimbursement ratio slightly declined.Additionally,restrictions on pre-existing conditions were relaxed,with the proportion of schemes excluding coverage for these conditions decreasing from 45.27%to 31.61%.Conclusions The specific high-priced drug covered by the Huimin insurances have exhibited a positive trend in terms of scope,drug quantity,and coverage level.However,challenges remain,including the accumulation of homogeneous drugs within the list and limited availability of some high-priced drugs.To promote the sustainable development of Huimin insurances,it is recommended to establish a basic list of specific drugs tailored to local conditions,optimizing the scheme design,and exploring the establishment of a multi-party co-payment mechanism for rare diseases.关键词
普惠型商业医疗保险/特定高额药品/保障Key words
inclusive commercial medical insurances/high-priced drug/security分类
经济学引用本文复制引用
严睿,王恩楠,徐怀伏..惠民保特定高额药品保障现状与趋势分析[J].健康发展与政策研究,2025,28(5):540-545,6.基金项目
江苏高校哲学社会科学一般项目(2023SJYB0297) （2023SJYB0297）
