在我国构建多层次医疗保障体系的背景下，商业健康保险创新药品目录（以下简称“商保创新药目录”）的落地，标志着商业健康险已深度参与高价值医疗资源配置。本文聚焦国际通行的管理准入协议（MEAs），系统梳理其基于财务（FBAs）与基于绩效（PBAs）的运行逻辑，并结合国际支付实践进行分析。针对当前我国商保面临的困境，本文旨在探索一套符合我国国情的商保管理准入路径，在维护医保基金安全与激励医药创新之间求取最大公约数，实现医疗保障的高质量发展。
Abstract
Against the backdrop of constructing a multi-layer healthcare security system in China, the implementation of the commercial health insurance innovative drug catalog signifies that commercial health insurance has become deeply involved in the allocation of high-value medical resources. This paper focuses on the internationally recognized Managed Entry Agreements (MEAs), systematically reviewing the operational logic of Finance-Based Agreements (FBAs) and Performance-Based Agreements (PBAs), and analyzing them in conjunction with international payment practices. Addressing the current dilemmas faced by China's commercial insurance, this study aims to explore a managed entry pathway tailored to the Chinese context. The goal is to find the greatest common divisor between maintaining fund security and incentivizing pharmaceutical innovation, thereby achieving high-quality development of healthcare security.
关键词
商业健康险 /
创新药目录 /
管理准入协议
Key words
commercial health insurance /
innovative drug catalog /
managed entry agreements
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参考文献
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