职工医保门诊共济保障改革是完善基本医保制度的重大举措。本次改革将符合条件的定点零售药店纳入门诊统筹报销,为零售药店的高质量发展带来重大机遇。门诊共济保障改革以及零售药店实现高质量发展的关键环节是医院处方的流转。本文认为,处方流转的主要障碍一是处方管理及药品使用安全管理上的部门分割以及由此带来的风险责任冲突及利益冲突,二是零售药店本身的经营与管理模式还难以适应处方的风险管理要求。实现处方的畅通流转一是要坚持“三医”协同治理,建立处方管理及药品使用安全管理全链条监管机制,打破部门分割,充分尊重参与各方的管理要求及利益诉求;二是零售药店要转变运营模式,提升药事服务和商业服务能力,适应门诊共济保障改革后处方流转的要求。
Abstract
The reform of employee's medical insurance outpatient mutual aid guarantee is a major initiative to improve the basic medical insurance system. This reform will include eligible designated retail pharmacies in outpatient reimbursement, bringing significant opportunities for the high-quality development of retail pharmacies. The key link in the reform of outpatient mutual aid and the high-quality development of retail pharmacies is the circulation of hospital prescriptions. We believe that the first main obstacle to prescription circulation is the division of departments in prescription management and drug use safety management, as well as the resulting conflicts of risk, responsibility, and interest. The second main obstacle is that the operation and management model of retail pharmacies still cannot adapt to the risk management requirements of prescriptions. To facilitate the circulation of prescriptions, first, it is necessary to adhere to the collaborative governance of the "medical insurance-hospitals-drugs", establish a full chain supervision mechanism for prescription management and drug use safety management, break departmental divisions, and fully respect the management requirements and interests of all parties involved. Secondly, retail pharmacies need to transform operating models, enhance pharmaceutical and commercial service capabilities, and adapt to the requirements of prescription circulation after the reform of outpatient mutual aid.
关键词
门诊共济 /
零售药店 /
处方流转
Key words
outpatient mutual aid /
retail pharmacies /
prescription circulation
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基金
中国社会科学院创新工程课题“基层公共服务供给研究”（2024JJSB07）
