摘要
目的为我国医保谈判药品“双通道”管理政策的顺利实施落地提供参考。方法基于史密斯政策执行过程模型,从实施细则与监管体系、药品遴选、药品配备和质量控制、医保基金运行状况和信息化能力4个方面对医保谈判药品“双通道”政策的执行困境进行分析,并提出相应推进策略。结果与结论我国医保谈判药品“双通道”政策可能存在政策实施细则和全流程监管体系不够明确,部分医保谈判药品纳入“双通道”管理的适宜性和可操作性有待斟酌,药品配备和质量控制方面存在难点,各地医保基金管理和运行状况存在差异以及信息化能力不足等执行困境。对此,本研究认为可通过完善“双通道”政策实施细则、提高“双通道”药品目录合理性、建立“双通道”药店动态退出机制、推行专业化配送服务、完善电子处方流转平台等措施来推动“双通道”政策的实施落地。
OBJECTIVE To provide reference for the smooth implementation of the“dual channel”management policy for China’s medical insurance negotiated drugs.METHODS Based on Smith policy implementation process model,the dilemmas for the implementation of“dual channel”policy for medical insurance negotiated drugs were analyzed from four aspects:implementation details and regulatory system,drug selection,drug provision and quality control,the situation of medical insurance funds and information technology capabilities.The corresponding promotion strategies were put forward.RESULTS&CONCLUSIONS The“dual channel”policy for medical insurance negotiated drugs in China might face implementation difficulties such as a lack of clear implementation rules and a full process supervision system,the suitability and operability of some medical insurance negotiated drugs need to be considered in the“dual channel”management,difficulties in drug allocation and quality control,differences in the management and operation of medical insurance funds in different regions,and insufficient informatization capability.In this regard,this study suggests that measures,such as improving the implementation rules of the“dual channel”policy,enhancing the rationality of the“dual channel”drug catalog,establishing a dynamic exit mechanism for“dual channel”pharmacies,promoting professional delivery services,and improving the electronic prescription circulation platform,which can be taken to enhance the implementation effect of the“dual channel”policy.
作者
李欣雨
徐娟
LI Xinyu;XU Juan(School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Double First-class Major Discipline Platform(Hospital High-quality Development Research Center),Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中国药房》
CAS
北大核心
2024年第8期906-911,共6页
China Pharmacy
基金
湖北省医疗保险研究会委托项目(No.H20210183)
县级医院科学管理能力提升方案研究项目(No.H20240025)。
关键词
医保谈判药品
双通道
史密斯政策执行过程模型
电子处方流转
冷链运输
medical insurance negotiated drugs
dual channel
Smith policy implementation process model
electronic prescription circulation
cold-chain delivery
