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DRG付费下法国创新医药产品医保支付政策研究
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| 篇名： | DRG付费下法国创新医药产品医保支付政策研究 |
| TITLE： | Study on French medical insurance payment policy for innovative medical products paid under DRG |
| 摘要： | 目的 分析法国创新医药产品附加清单制度的实施经验，为我国支持医疗机构使用创新医药产品提供借鉴。方法以法国为研究案例，运用政策分析法，系统性研究疾病诊断相关分组（DRG）付费下法国建立附加清单制度对创新医药产品进行补偿支付的做法，包括建立背景、遴选程序与实施效果，对我国创新医药产品的医保支付方法给出建议。结果与结论法国附加清单制度对临床疗效显著但治疗费用高昂的创新医药产品建立了一套涵盖申报、审评、支付、调整4个阶段的补偿支付体系，有效减轻了医疗机构用药负担，促进了医疗机构使用创新医药产品，激励了医药行业的创新动力，但同时也给医保基金带来了支付压力。随着我国DRG/按病种分值付费改革的迅速铺展，部分地区也在积极探索对创新医药产品建立补偿支付机制，但仍存在不完善之处。对此，可参照法国附加清单制度的实施经验，从设立遴选标准、选择补偿模式、做好动态调整三方面出发，针对创新医药产品建立一套行之有效的补偿支付体系。 |
| ABSTRACT： | OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost， covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the implementation experience of the French additional list system and establish an effective compensation and payment system for innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the implementation of dynamic adjustment. |
| 期刊： | 2023年第34卷第12期 |
| 作者： | 李佳明；丁锦希；黄晟馨；任雨青；林钊名 |
| AUTHORS： | LI Jiaming，DING Jinxi，HUANG Shengxin，REN Yuqing，LIN Zhaoming |
| 关键字： | 疾病诊断相关分组；附加清单制度；创新医药产品；医保支付政策；法国 |
| KEYWORDS： | diagnosis-related group； additional list system； innovative pharmaceutical products； medical insurance payment |
| 阅读数： | 186 次 |
| 本月下载数： | 14 次 |
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