| 引用本文：雷清强, 陈天池, 廖博玮, 晏紫乐, 许宏, 陈文, 胡敏.定点零售药店纳入医保门诊统筹管理实践比较分析[J].中国卫生政策研究,2023,16(12):26-32 |
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| 定点零售药店纳入医保门诊统筹管理实践比较分析 |
| 投稿时间：2023-10-05 修订日期：2023-12-05 PDF全文浏览 HTML全文浏览 |
| 雷清强1, 陈天池2, 廖博玮1, 晏紫乐1, 许宏2, 陈文1,3, 胡敏1,3 |
1. 复旦大学公共卫生学院 上海 200032;
2. 上海市医疗保障局 上海 200125;
3. 复旦大学长三角医疗保障研究中心 上海 200032 |
| 摘要:目的：梳理和分析我国各地将定点零售药店纳入医保门诊统筹管理的实践，为完善相关政策提供参考。方法：检索各省、市、自治区及统筹区的医保政策文件，应用ROST CM6软件对政策文本进行高频词与语义网络分析，结合访谈和实地调研结果，明确各地药店门诊统筹政策实践的关键维度并进行归纳总结，分析地区差异、现存问题及其原因，提出政策建议。结果：门诊统筹药店遴选、药品目录制定、购药待遇设计、药品价格与支付管理以及医院外流处方监管是政策实践的5个关键维度，各地实践存在较大差异，目前主要存在门诊统筹药店布局、外配处方顺畅流转、药店药品价格形成机制以及与其他政策措施协同等方面的问题。结论：应充分利用零售药店优势，满足本地区门诊用药需求，推动药店药品价格透明化，还需协调相关医保医药政策，加强医保与卫健、药监等相关部门协同管理，分析评价政策措施潜在后续影响，因地制宜及时完善调整政策措施。 |
| 关键词:门诊统筹 定点零售药店 处方外流 |
| 基金项目:国家社会科学基金重大项目（20ZDA072） |
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| Comparative analysis of the management practice of including designated retail pharmacies in the outpatient pooling of basic medical insurance |
| LEI Qing-qiang1, CHEN Tian-chi2, LIAO Bo-wei1, YAN Zi-le1, XU Hong2, CHEN Wen1,3, HU Min1,3 |
1. School of Public Health, Fudan University, Shanghai 200032, China;
2. Shanghai Healthcare Security Administration, Shanghai 200125, China;
3. Yangtze River Delta Medical Security Research Center, Fudan University, Shanghai 200032, China |
| Abstract:Objective: To summarize and analyze the practice of the local practice on covering drugstore bills by pooled funds of basic medical insurance, and provide a reference for improving relevant policies. Methods: The medical insurance policies from various provinces, municipalities, autonomous regions, and coordination areas were systematically retrieved. ROST CM6 software was applied to analyze the high-frequency words and semantic network of the policy text, and combined with the interview and field investigation resultss, the key dimensions of the policy practice were identified and summarized. Then the regional differences, existing problems, and their causes were analyzed to put forward policy recommendations. Result: The selection of pharmacies covered in the payment system with outpatient expenses reimbursed by the pooled fund, the formulation of drug reimbursement list, the design of benefit plans, the management of drug prices and payments, and the supervision of hospital outflow prescriptions were five key dimensions of policy practice. There were significant differences in practice among different regions, and the problems mainly included the overall arrangement of covering pharmacies in the payment system, the mechanism of drug prices in pharmacies, and the coordination with other medical insurance policies. Conclusion: To improve the convenience of buying drugs for the insured, it is necessary to make full use of the advantages of pharmacies to meet the demand for outpatient medicine, promote the transparency of drug prices in pharmacies, coordinate the relevant medical insurance policies, strengthen the collaborative management between the healthcare security administration and relevant departments such as the health commission and the medical products administration, analyze and evaluate the potential effects of policy measures, and adjust policy measures promptly according to local conditions. |
| Key words:Outpatient pooling Designated retail pharmacy Prescription outflow |
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