目的: 通过对广东省医保谈判药品“双通道”管理政策文本进行分析,归纳政策的核心要点及待完善之处,并提出“双通道”管理政策的优化建议。方法: 搜集广东省21个地市人民政府、医疗保障局发布的“双通道”管理相关政策文件,使用ROST CM6软件进行词频和语义网络分析,并对各市的政策内容进行对比分析,总结不同地区的政策差异。结果: 词频分析结果显示,共识别出26个高频关键词（出现频次≥200次）,其中4个关键词出现频数高达1000次;语义网络图表明,“双通道”政策核心为“医保”“药品”;进一步对不同地区的政策内容进行比较分析得出,各地在药品管理、定点零售药店遴选和管理、处方流转和购药管理、支付管理等方面均存在差异。结论: 各地“双通道”药店数量差异较大,“双通道”药店遴选后的监管要求和标准尚未完善,各地医保支付政策差异明显。建议各地市合理设置“双通道”药店准入标准,建立并完善“双通道”药店监管要求和措施,健全医保单独支付政策,同时发挥其他保险的补充作用。
Abstract
Objective: By analyzing the policy texts of the "dual-channel" management of negotiated medical insurance drugs in Guangdong Province, this study aims to summarize key components and areas for refinement in policy, and to propose optimization suggestions for the "dual-channel" management policy. Methods: Relevant policy documents on "dual-channel" management issued by the people's governments and healthcare security administrations of 21 prefecture-level cities in Guangdong Province were collected. ROST CM6 software was used for word frequency and semantic network analysis, and the policy contents of each city were compared and analyzed to summarize the policy differences among different regions. Results: The word frequency analysis identified 26 high-frequency key words (with a frequency of ≥ 200 times), among which 4 key words appeared more than 1000 times. The semantic network diagram indicated that the core of the "dual-channel" policy was "medical insurance" and "drugs". Further comparative analysis of the policy contents of different regions revealed that there were differences in drug management, selection and management of designated retail pharmacies, prescription transfer and drug purchase management, and payment management. Conclusion: The number of "dual-channel" pharmacies varies significantly among different regions. The regulatory requirements and standards for "dual-channel" pharmacies after selection are not yet complete, and there are obvious differences in medical insurance payment policies among different regions. It is suggested that each prefecture-level city should reasonably set the access standards for "dual-channel" pharmacies, establish and improve the regulatory requirements and measures for "dual-channel" pharmacies, improve the separate payment policy for medical insurance, and give full play to the supplementary role of other insurances.
关键词
“双通道”管理; /
“双通道”药品 /
国家谈判药品 /
政策文本分析
Key words
"dual-channel" management /
"dual-channel" drugs /
national negotiated drugs /
policy text analysis
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基金
2023年度教育部人文社会科学研究规划基金项目“我国基本医保制度成熟定型的路径探索与法治保障研究”（23YJA820005）
