| 引用本文：施文凯, 吕兰婷.基本医疗保险循证决策体系构建：卫生技术评估的作用[J].中国卫生政策研究,2019,12(11):73-79 |
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| 基本医疗保险循证决策体系构建：卫生技术评估的作用 |
| 投稿时间：2019-08-16 修订日期：2019-11-09 PDF全文浏览 HTML全文浏览 |
| 施文凯1, 吕兰婷1,2 |
1. 中国人民大学公共管理学院 北京 100872;
2. 中国人民大学卫生技术评估与医药政策研究中心 北京 100872 |
| 摘要:卫生技术评估是一种基于当前最优证据支持卫生技术决策的评估方法，国际上已广泛应用于医疗保险政策制定过程，如医保支付范围和目录确定、支付价格形成等，并在优化卫生资源配置、控制医疗费用合理增长等方面发挥了重要作用。本文从价值追求、决策转化、证据提供等方面探讨卫生技术评估在促进我国基本医疗保险高质量发展中的作用，认为医保决策中建立卫生技术评估决策转化机制面临着医保改革深化的现实需求和医疗大数据快速发展等机遇，同时也面临着缺乏有效的HTA组织管理路径和决策转化机制，以及价值取舍等挑战。最后，从认知准备、决策转化和实施传播等方面提出卫生技术评估应用于我国基本医疗保险决策转化体系的构建策略。 |
| 关键词:基本医疗保险 卫生技术评估 循证决策 价值 |
| 基金项目:中国人民大学科学研究基金（中央高校基本科研业务费专项资金资助）（19XNA005） |
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| The construction of evidence-based decision-making system for basic medical insurance: Based on the role of health technology assessment |
| SHI Wen-kai1, LV Lan-ting1,2 |
1. School of Public Administration and Policy, Renmin University of China, Beijing 100872, China;
2. Health Technology Assessment and Policy Evaluation Group, Renmin University of China, Beijing 100872, China |
| Abstract:Health Technology Assessment (HTA) is an evidence-based assessment method to support health technology decision-making. It has been widely used in the process of health insurance policy-making in the world, especially in the determination of payment scope and directory, the formation of payment prices, etc. International practice has proved that HTA plays an important role in optimizing the health resources allocation and in controlling the reasonable growth of medical expenses. This paper discusses the role of HTA in promoting high-quality development of basic medical insurance in China, from the aspects of value pursuit, decision transformation and evidence provision. It is considered that the establishment of decision-making transformation mechanism of HTA in health insurance decision-making faces the real needs of deepening the medical insurance system reform and the rapid development of big data in medical systems. At the same time, it also faces challenges of lack of effective HTA organization management path and decision-making transformation mechanism, as well as value trade-offs. Finally, from the perspectives of cognitive preparation, decision-making transformation and implementation spreading, this paper puts forward the construction strategy of HTA's decision-making transformation system applied to basic medical insurance in China. |
| Key words:Basic medical insurance Health Technology Assessment(HTA) Evidence-based decision-making Value |
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