摘要
目的:探索中国医保预算影响分析研究范式,为规范研究框架和研究过程、提高研究结论的可靠性,提供理论和经验依据。方法:通过文献研究,了解医保预算影响分析研究的模型设计、关键要素、数据需求等理论方法及最新发展动态,结合中国国情,总结归纳适合中国的医保预算影响分析研究范式。结果:医保预算影响分析应包括模型设计、研究角度、市场情景、目标人群、研究时限、治疗成本、不确定性分析7大关键要素;此外,医保预算影响分析报告还应包括计算所用数据集、数据来源,并附计算软件与运算过程,以便于医保主管部门审查验证。结论:医保预算影响分析能够评价短期、特定情景内药物进入医保目录对医保基金的影响,与药物经济学配合使用服务于医保决策。
Objective To explore the research paradigm of impact analysis on health insurance budget in China,provide theoretical and empirical basis for standardizing the research framework and research process,and improving the reliability of research conclusions.Methods The literature review method was used to understand the model design,key elements,data requirements and other theoretical methods and the latest development trends of health insurance budget impact analysis,and summarize the research paradigm of health insurance budget impact analysis suitable combined with Chinese situation.Results The impact analysis of health insurance budget should include seven key elements:model design,research perspective,market situation,target population,research duration,treatment cost and uncertainty analysis.In addition,the health insurance budget impact analysis report should include the data set and data sources used for calculation,together with calculation software and calculation process,so as to facilitate the examination and verification of the medical insurance department.Conclusion The impact analysis of health insurance budget can evaluate the influence of drugs entering health insurance catalogue in short-term and specific scenarios on health insurance fund,and can be used with pharmaco economics to serve health insurance decision-making.
作者
柳鹏程
李灿
杜怿
方刚
王敏娇
姚文兵
LIU Peng-cheng;LI Can;DU Yi;FANG Gang;WANG Min-jiao;YAO Wen-bing(China Pharmaceutical University,Nanjing Jiangsu 211198,China;不详)
基金
国家社会科学基金重大项目(15ZDB167)
江苏高校哲学社会科学研究基金项目(2017SJB0060)
中国药科大学“双一流”学科创新团队建设项目(CPU2018GY39)。
关键词
医疗保险
预算影响分析
研究范式
medical insurance
budget impact analysis
research paradigm
作者简介
通讯作者:姚文兵,E-mail:wbyao@cpu.edu.cn。
