Objective: The establishment of medical insurance admission rules for innovative high-value medical consumables and supporting medical service pricing projects is the key to promoting the clinical application of innovative technologies and realizing value purchases. This study proposes suggestions for improving the medical insurance admission management of innovative high-value medical consumables and supporting medical service price projects in China from the aspects of classification management, admission process, and evaluation indicators, providing a reference for relevant projects to be included in medical insurance reimbursement. Method: This study reviewed the management experience of medical insurance admission for innovative high-value medical consumables and supporting medical service price projects at home and abroad, formed preliminary suggestions, and further verified their applicability and operability through expert interviews. Results: The study found that Australia, Taiwan Province of China and other places effectively improved the evaluation efficiency of medical service price items and promoted the application of latest innovative medical technology through classified access, standardized window period and evaluation cycle, and set up differentiated evaluation processes and indicators. In terms of medical consumables medical insurance access, Australia, Japan, the Republic of Korea and other countries have formed mature experience and adopted classified management. The difference in evaluation content mainly lies in whether economic evaluation or complete health technology evaluation is needed. The interviewed experts further proposed applicable and feasible suggestions based on classification, admission process, and evaluation criteria. Conclusion: This study proposes management methods and path suggestions for optimizing the medical insurance admission of innovative high-value medical consumables and supporting medical services in China, providing policy references for regulating the medical insurance admission of related projects and promoting the timely and rational use of innovative technologies.
Key words
innovative high-value medical consumables /
medical service price items /
medical insurance admission
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