真实世界医保综合价值评价（以下简称“医保价评”）是我国医保迈向“价值导向的战略性购买”的关键制度创新。本文系统阐述医保价评的现实背景与战略意义,分析我国医保在覆盖规模、基金运行和创新药保障方面取得的历史性成就,以及人口老龄化加速、医药技术快速迭代和药品临床价值不确定性增加等新挑战。在此基础上,从相对价值、长期价值和体系价值三个维度界定医保价评的核心评价框架,并从数据底座建设、标准规范制定、组织机制搭建和成果应用转化四个方面系统介绍其实施路径。医保价评在尊重国际通行规范的基础上,构建了基于我国真实世界数据的评价体系,丰富了全球医药价值评价的方法学工具箱,为发展中国家开展医保战略性购买提供了可借鉴的实践方案。
Abstract
The Real-World Value Assessment for Lifelong Universal Healthcare Security (hereinafter referred to as “R-VALUES”) is a key institutional innovation that enables China’s healthcare security system to move toward “value-oriented strategic purchasing”. This paper systematically elaborates on the practical background and strategic significance of R-VALUES, analyzing the historic achievements China’s healthcare security has made in terms of coverage scale, fund operation, and innovative drug coverage, as well as the emerging challenges posed by accelerated population aging, rapid iteration of medical technologies, and growing uncertainties in the clinical value of pharmaceutical products. On this basis, the paper defines the core evaluation framework of R-VALUES from three dimensions—relative value, long-term value, and systemic value—and systematically introduces its implementation pathways from four aspects: data infrastructure development, standard and specification formulation, organizational mechanism building, and application translation of assessment outcomes. On the basis of respecting internationally accepted norms, R-VALUES has established an evaluation system based on China's real-world data, and enriched the methodological toolbox for global pharmaceutical value assessment, offering a replicable practical approach for developing countries to implement strategic purchasing in healthcare security.
关键词
医保综合价值评价 /
战略性购买 /
真实世界数据 /
价值维度 /
医保治理
Key words
real-world value assessment for lifelong universal healthcare security /
strategic purchasing /
real-world data /
value dimensions /
healthcare governance
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