中成药医保支付标准的研究及探讨

发布时间：2018-03-27 19:29

本文选题：国际经验　切入点：调整机制　出处：《北京中医药大学》2017年硕士论文

【摘要】：我国现行的政府定价、集中招标采购、医院药品加成管制这三项管制政策下,出现了"药价虚高""看病难,看病贵""廉价药中标死"的难题。鉴于此,2015年5月,国家发改委等7部委联合发布了《关于印发推进药品价格改革意见的通知》,决定"从6月1日起取消绝大部分药品政府定价……药品实际交易价格主要由市场竞争形成"。同时该文件指出"医保基金支付的药品,由医保部门会同有关部门拟定医保药品支付标准……探索建立引导药品价格合理形成的机制"。"药品支付标准"这一概念主要来自实施社会医保制度的德、日、中国台湾等国家和地区。他们将"医保支付标准"作为药价管理核心,合乎其医疗体制的内在逻辑,既然公共医保体系导致药品需方性质和行为发生变化,药价管理就应以医保支付标准为核心,通过报销政策,以约束药价的形成,使之既保障公共医保体系的有效运行,又不过于抑制产业的活力。我国药品支付标准使用范围包括医保目录内的所有中西药,但中西药存在使用原则、临床适应症、成分组方、原料来源等各方面差异,如何充分针对中成药的特殊性制定合理的支付准及后期配套政策值得深入探索。尽管国外先进理论和经验表明药物价格参考体系是目前公认的最合理,应用最广泛,较成熟的支付政策,但其中部分理论并不能完全适用于中医理论指导下,组分复杂、化学成分不完全明确的中成药。如何借鉴国外和台湾地区相对成熟的医保支付制度其理论机制和实践经验对我国占据医药市场19%左右份额的中成药进行支付,是否适合我国中药市场情况,能否从他国和先进地区政策理论和经验中找到满意答案,都是值得关注和思考的。本文通过对中成药相对化药主要差异性进行研究,借鉴国外和先进地区药品支付标准对中成药支付标准和配套政策探索,同时继承中成药特色,研究具有中医药特色的中成药医保支付标准。制定科学的中成药支付标准一方面有利于引导中成药价格回归于市场,促进企业增强对提升药品质量的动力从而占领更多的市场份额,有效提升药品质量,另一方面对促进中成药质量标准化具有重要的意义,进而推进我国医保药品价格政策改革更加符合中国实际医药市场情况,有效地缓解医保基金压力,保障参保患者的权益。
[Abstract]:China's current government pricing, centralized bidding and procurement, hospital drug addition control, these three regulatory policies, there are "false high drug prices", "difficult to see a doctor," "expensive" "cheap drugs to die." in view of this, in May 2015, Seven ministries and commissions, including the National Development and Reform Commission, jointly issued the Circular on issuing opinions on promoting Drug Price Reform, and decided that "the vast majority of drug government pricing shall be abolished from June 1. The actual transaction prices of drugs are mainly competitive in the market." And the document says, "Medicines paid by the health care fund, The medical insurance department, together with the relevant departments, shall formulate the standards for the payment of medical care drugs and explore the establishment of a mechanism to guide the rational formation of drug prices. "the concept of" drug payment standards "mainly comes from the implementation of the social medical insurance system in Germany and Japan. Countries and regions such as Taiwan, China, and other countries and regions. They regard the "standard of medical insurance payment" as the core of drug price management, which conforms to the inherent logic of their medical system. Since the public health care system has caused changes in the nature and behavior of the drug demand side, The drug price management should take the standard of medical insurance payment as the core and restrict the formation of the drug price through the reimbursement policy to ensure the effective operation of the public medical insurance system. The scope of payment standards in China includes all Chinese and western medicines in the medical insurance catalogue, but there are differences in the use principles, clinical indications, ingredients, sources of raw materials, and so on. It is worth exploring how to make reasonable payment standard and supporting policy in the later period according to the particularity of Chinese patent medicine. Although foreign advanced theories and experience show that the drug price reference system is the most reasonable and widely used at present, A more mature payment policy, but some of which can not be fully applicable to the guidance of traditional Chinese medicine theory, the components are complex, How to draw lessons from the relatively mature medical insurance payment system abroad and Taiwan and its theoretical mechanism and practical experience to pay for the Chinese patent medicine which occupies about 19% of the medical market in our country. It is worth paying attention to and pondering whether it is suitable for the situation of Chinese traditional medicine market and whether we can find a satisfactory answer from the policy theory and experience of other countries and advanced regions. Drawing lessons from foreign and advanced regional drug payment standards to explore the payment standards and supporting policies of proprietary Chinese medicines, and at the same time inheriting the characteristics of proprietary Chinese medicines, To study the standard of medical insurance payment for Chinese patent medicine with the characteristics of traditional Chinese medicine. On the one hand, it is helpful to guide the price of Chinese patent medicine to return to the market. Promoting enterprises to enhance the power to improve the quality of medicines, thus occupying more market share, effectively improving the quality of medicines, on the other hand, promoting the standardization of the quality of proprietary Chinese medicine is of great significance. Furthermore, the reform of medical insurance drug price policy in China is more in line with the actual medical market situation, which can effectively relieve the pressure of medical insurance fund and protect the rights and interests of insured patients.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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