摘要
以DRG为代表的医保支付改革,关注支付单元同质化、价格与价值关联、预付制等,导致医院成为价格接受者,会引起医院降低患者治疗成本、改变编码、增加患者数量等的行为转变。药品使用受其影响,包括不必要用药减少、低价药替代高价药、药品费用向门诊和药店转移等。医保准入谈判和药品集中采购政策均可降低药品价格,但前者将为医生治疗医保患者时提供更多的用药选择,后者则限制医生治疗医保患者时的用药选择。医保支付及相关政策间存在联动,将协同影响药品使用,即医保准入谈判通过影响支付单元界定及药品价格而影响DRG分组及权重,药品集中采购通过改变价格而影响DRG权重,DRG通过引导成本最小化而可能促进医院对集采药品的使用。
As one of the reforms of medical insurance payment,DRG focuses on the homogenization of payment unit,correlation between price and value,and prospective payment,thus leading to the transformation of hospitals into recipients of predetermined price,which brings about the behavioral change of reducing average treatment cost of specific patients,changing codes and admission of more hospitalized patients.It also poses potential impacts on drug use,such as reducing unnecessary drugs,replacing expensive drugs with low-priced substitutes,and transferring drug costs to outpatients and pharmacies.Medical insurance access negotiation policy and centralized drug procurement policy both led to lower drug price,while the former provides doctors with more drug choices and the latter limits their choices when treating medical insurance patients.There is linkage between medical insurance payment and related policies,thus affecting drug use synergistically:medical insurance access negotiation policy affects DRG grouping and weight by influencing the definition and price of payment unit,centralized drug procurement policy affects DRG weight by influencing the price of payment unit,and DRG might promote the use of centrally procured drugs in hospitals by encouraging minimization of cost.
作者
王瑞欣
张馨予
严佳琦
钱梦岑
应晓华
WANG Ruixin;ZHANG Xinyu;YAN Jiaqi;QIAN Mengcen;YING Xiaohua(School of Public Health,Fudan University,Shanghai 200032,China)
出处
《世界临床药物》
2021年第7期536-541,共6页
World Clinical Drug
基金
国家自然科学基金项目“按疾病诊断相关分组支付与大数据病种组合分值付费的比较研究”(72074051)
国家医保研究院项目“DIP实施效果评价”(YB2020B01)。
关键词
医保支付
按病种付费
医保准入谈判
药品集中采购
药品使用
medical insurance payment
DRG
medical insurance access negotiation
centralized drug procurement
drug use
作者简介
王瑞欣,硕士研究生,研究方向:卫生经济学与医疗保险;通信作者:应晓华,教授,研究方向:医保支付、卫生经济学评价、信息监管等。
