高值医用耗材治疗费用高、患者负担重,我国尚未建立全国统一的医保耗材目录,医用耗材医保支付管理属于区域性政策,存在管理碎片化、保障效果不足、公平性差异大等问题。本文从我国医用耗材目录管理现状出发,围绕诊疗引导、价格杠杆、支付管理三方面对目录功能进行深入剖析,并基于域内外成熟管理经验,优化目录结构,为完善我国省级高值医用耗材医保目录提供参考。
Abstract
High-value medical consumables mean high treatment costs and heavy burdens on patients. China has not developed a unified medical insurance catalogue of medical consumables at the national level. The management of medical insurance payment for medical consumables is a regional policy. There are problems such as fragmented management, insufficient reimbursement, and significant difference in fairness. This paper starts from the current status of medical consumables catalogue management in China, conducts an in-depth analysis of the catalogue's functions around diagnosis and treatment guidance, price leverage, and payment management, and optimizes the structure based on the domestic and foreign management experience to provide a reference for improving the provincial high-value medical consumable medical insurance catalogue in China.
关键词
高值医用耗材 /
医保目录 /
结构优化
Key words
high-value medical consumable /
medical insurance catalogue /
structure optimization
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基金
国家医疗保障局课题项目“高值医用耗材技术评价方法研究”,本文为“高值医用耗材医保评估与准入”系列论文第1篇,共4篇
