Management of New Medical Service Pricing Items Based on Real-World Comprehensive Value Evaluation

China Health Insurance ›› 2026, Vol. 0 ›› Issue (5) : 73-79.

China Health Insurance ›› 2026, Vol. 0 ›› Issue (5) : 73-79. DOI: 10.19546/j.issn.1674-3830.2026.5.009
Topics in Focus

Management of New Medical Service Pricing Items Based on Real-World Comprehensive Value Evaluation

Author information +
History +

Abstract

To evaluate the comprehensive value of innovative medical service technologies, real-world data can be used to provide evidence-based support for the new project approval, outcome-based pricing, and medical insurance access of these innovations. On the basis of explaining the logic of real-world evidence (RWE) in supporting medical insurance decisions and reviewing the national-level requirements for real-world value assessment in new pricing project management, this study examines the practices of typical regions concerning real world study-based new project approval, outcome-based pricing, and medical insurance access. It then puts forward three recommendations for accelerating the clinical translation of innovative medical technologies through real-world comprehensive value assessment and promoting a shift from experience-based to evidence-driven pricing and access decisions. First, issuing systematic guidance documents for managing new medical service pricing projects to unify and standardize local practices; second, establishing operational comprehensive value assessment indicators to support approval and medical insurance access for innovative technologies; third, strengthening the application of assessment results by making RWE the basis for project outcome adjustments and medical insurance access.

Key words

innovative medical technology / real world / comprehensive value evaluation / conditional new item initiation / outcome

Cite this article

Download Citations
Management of New Medical Service Pricing Items Based on Real-World Comprehensive Value Evaluation[J]. China Health Insurance. 2026, 0(5): 73-79 https://doi.org/10.19546/j.issn.1674-3830.2026.5.009

References

[1] 路蒙. 医院医疗服务收费管理常见问题浅析[J].中国价格监管与反垄断,2025(02):91-93.
[2] 吕兰婷,傅金澜.卫生技术评估在医疗服务价格项目管理中的应用[J].中国医院管理,2022,42(07):39-42.
[3] 袁加,陈刚,冯骊琛.新增医疗服务价格项目管理探讨[J].中国卫生经济,2020,39(08):51-53.
[4] 张晨曦,王海银,刘昕,等.基于HTA的医疗服务项目医保准入机制国际实践与启示[J].中国卫生经济,2024,43(09):92-96.
[5] 吴胤歆,刘文彬.新增医疗服务项目纳入医保目录管理机制探索[J].中国卫生经济,2019,38(03):35-37.
[6] 戴运,张圣和,王滢鹏,等.全国医疗服务价格项目立项指南实施对公立医院的影响研究[J].中国医疗保险,2025(11):63-68.
[7] 黄祖彤,周娜,于滨玮,等.医保准入中真实世界数据库构建及其证据等级探讨[J].中国医疗保险,2025(12):19-31.
[8] 袁妮,吕子萱,黄祖彤,等.医保真实世界数据研究面临的挑战[J].中国医疗保险,2024(10):15-23.
[9] 廖珊妹,张小娟,张晓薇,等.真实世界研究的方法学进展[J].中国食品药品监管,2021(04):32-43.
[10] 丁一磊. 以真实世界医保综合价值评价助推医疗、医药高质量创新发展[J].中国卫生经济,2026,45(01):1-4.
[11] 国家医疗保障局.关于开展真实世界医保综合价值评价试点工作的通知[EB/OL].(2025-09-23)[2026-04-17].https://www.nhsa.gov.cn/art/2025/9/23/art_109_17984.html.
[12] 国家医疗保障局.关于发布真实世界医保综合价值评价国家可信评价点网络公约和成员名单的公告[EB/OL].(2026-01-16)[2026-04-17].https://www.nhsa.gov.cn/art/2026/1/16/art_109_19379.html.
[13] 国家医疗保障局.关于 《医疗服务真实世界医保综合价值评价管理指南 (试行)》公开征求意见的公告[EB/OL].(2026-01-05)[2026-01-10].https://www.nhsa.gov.cn/art/2026/1/5/art_109_19241.html.
[14] 李福明,刘世蒙,杨毅,等.卫生技术评估赋能医疗卫生服务体系高质量发展的内在逻辑与治理路径[J].中华医院管理杂志,2025,41(12):891-896.
[15] 林燕羡,刘宝.我国新增医疗服务价格项目管理现状与对策研究[J].中华医院管理杂志,2021,37(11):878-882.
[16] 彭倩,殷悦,梁乐怡,等.医疗卫生服务定价:基于价值定价转型方法学初探[J].中国卫生经济,2024,43(06):14-17.
[17] 蒋帅.医疗服务技术劳务价值的内涵特征与核心维度探析[J].中国卫生经济,2026,45(03): 57-60+86.
[18] 余兴源,朱培嘉,段颖,等.价值医保视角下我国基本医疗保险效果评价研究[J].中国医院,2025,29(06):2-6.
[19] 肖丹妮,胡琳琳,贾溜溜.患者报告结局在医保支付中的应用:价值医疗视角下的国际实践与启示[J].中国医疗保险,2026(01):115-121.
[20] 胡宏伟,刘堂森.我国医疗保障体系相关目录比较与协同优化研究[J].中国卫生政策研究,2026,19(2):1-8.
[21] 丛鹂萱,王海银,金春林.基于多源流理论的我国创新医疗技术支付政策研究[J].中国卫生资源,2020,23(01):63-67+83.

Accesses

Citation

Detail

Sections
Recommended

/