Under the DRG/DIP prospective payment, innovative technology is probably subject to predicament in clinical promotion due to short marketing time and high cost. Exclusion payment has been introduced to DRG payment in many foreign countries to foster the rational promotion of innovative technology in medical institutions. Based on global vision and China’s reality, this paper studies the establishment and application of exclusion payment in China from four aspects of theoretical basis, mode, conditions and scope, by which innovative technology is expected to be sustainably extended in clinical use when DRG payment reform is extensively promoted.
Key words
DRG /
innovative technology /
exclusion payment
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References
[1] 国家医保局.2022年医疗保障事业发展统计快报[EB/OL].(2023-03-10)[2023-03-28]. http://www.gov.cn/xinwen/2023-03/10/content_5745859.htm.
[2] 商惠,温焘源.国产冠状动脉支架历史发展和技术进展[J].中国医疗器械信息,2020,26(01):10-13+155.
[3] LINDSAY A B. The Effect of Medicare’s New Technology Add-on Payment[EB/OL].(2010-06-05)[2023-04-02].https://conservancy.umn.edu/bitstream/handle/11299/93750/Bockstedt_umn_0130E_11164.pdf?sequ.
[4] 胡宏伟,郭宏旺,眭旭东.多元视角下DRG除外支付机制探析[J].中国医疗保险,2022(10):54-57.
[5] MAUDE S L,FREY N,SHAW P A, et al.Chimeric antigen receptor T cells for sustained remissions in leukemia.[J]. The New England journal of medicine,2014,371(16).
[6] 蔺淼,李佳明,丁锦希,等.CAR-T细胞治疗产品医保支付政策研究——基于美国Medicare的实证分析[J].中国新药杂志,2022,31(15):1456-1461.
[7] LOI n°2003-1199 du 18 décembre 2003 de financement de la sécurité sociale pour 2004 (1)[EB/OL] (2003-12-19)[2023-04-14].https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000000249276/.
[8] OMEDIT. Darzalex Daratumumab[EB/OL].(2023-03-07)[2023-04-15].https://www.omedit-idf.fr/medicaments-princeps/darzalex/.
[9] Atih. Tarifs MCO et HAD(2020)[EB/OL].(2020-03-01)[2023-04-15]. https://www.atih.sante.fr/tarifs-mco-et-had.
[10] CEPS. Rapport d’activité2020[EB/OL].(2021-12-06)[2023-04-02].https://solidarites-sante.gouv.fr/IMG/pdf/ceps_rapport_d_activite_2020_211206.pdf.
[11] 刘心怡,张璐莹,尚春晓,等.DRG付费下创新药品支付的国际经验与启示[J].世界临床药物,2021,42(07):547-550.
[12] 吴晶,董心月,赵博雅.美国DRG下高值创新医疗技术的支付政策及启示[J].中国医疗保险,2022(06):118-124.
[13] Optum. National Average Payment Table Update[EB/OL].[2023-04-12].https://www.optumcoding.com/upload/docs/2021%20DRG_National%20Average%20Payment%20Table_Update.pdf.
[14] 陈薇,方赛男,刘建平,等.国际循证医学证据分级体系的发展与现状[J].中国中西医结合杂志,2017,37(12):1413-1419.
[15] AVALERE. How a New Technology Add-On Payment (NTAP) Works[EB/OL]. (2022-05-05)[2023-04-09]. https://avalere.com/insights/how-a-new-technology-add-on-payment-works.
[16] Légifrance. Code de la sécurité sociale Rechercher dans le texte[EB/OL].(2021-12-12)[2023-04-01].https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000034396445.
[17] 徐嘉婕,王美凤,王海银,等.中国台湾地区创新医疗技术支付进展及经验[J].中国卫生资源,2020,23(01):59-62.
[18] HAS. Notice d’information[EB/OL].(2021-12-17)[2023-04-07].https://solidarites-sante.gouv.fr/soins-et-maladies/medicaments/professionnels-de-sante/autorisation-de-mise-sur-le-marche/la-liste-en-sus/article/notice-d-information.
[19] 北京市医保局.关于印发《CHS-DRG付费新药新技术除外支付管理办法的通知(试行)》[EB/OL].(2022-07-23)[2023-04-07].http://ybj.beijing.gov.cn/tzgg2022/202207/t20220713_2798069.html.
[20] 唐紫君,郭佳瑜,汤金燕,等.2017—2020年中国上市创新药物现况分析[J].世界临床药物,2022,43(03):294-299.
[21] 唐紫君,陈雅静,应晓华.国家医保目录内外抗肿瘤类创新药物临床效果比较[J].复旦学报(医学版),2023,50(01):122-128.