本文系统梳理了我国台湾地区全民健康保险制度在医保支付与药品价格管理协同方面的实践与成效。台湾地区依据《全民健康保险法》构建了以“目录准入—支付标准—动态调价”为核心的闭环管理体系,依托药品费用支出目标制（DET）实现“控成本—换可及”的平衡,有效控制医疗费用增速的同时保障创新药可及性。研究表明,其总额预算支付、分类药价调整及风险共担机制为大陆地区正在推进的按病种付费（DRG/DIP）改革提供了重要借鉴,尤其在支付标准与药价联动、创新药准入评估及基层医疗协同等方面具有较大的参考价值。

This study systematically examines the practice and outcomes of the coordinated mechanism between medical insurance payment and pharmaceutical price management within the health insurance system in China’s Taiwan Region. Under the framework of the Health Insurance Act, Taiwan Region has established a closed-loop management system centered on “formulary inclusion-payment standards-dynamic price adjustments”. Relying on the drug expenditure target (DET) mechanism, it achieves a balance between cost containment and accessibility, effectively controlling the growth of healthcare expenditures while ensuring the availability of innovative drugs. The research indicates that its global budget payment system, categorized drug price adjustments, and risk-sharing mechanisms offer valuable insights for the ongoing Diagnosis-Related Group (DRG)/Diagnosis-Intervention Packet (DIP) reforms in Mainland. These insights are particularly relevant in areas such as the linkage between payment standards and drug price, the evaluation of innovative drug access, and the coordination within primary care.