通讯作者: 蒋蓉, 13770643566@163.com

DOI：10.12201/bmr.202209.00002

Comparison study of dual channel management policies of nationally negotiated drugs in Jiangsu province

• 摘要：目的：通过系统梳理国家谈判药品“双通道”管理政策的实施背景、发展历程，及江苏省与各地级市药品的遴选管理、定点医药机构遴选、医保支付方式，为国家完善“双通道”管理政策提供参考。方法：检索江苏省及13个地级市医疗保障局网站，比较有关“双通道”管理的政策文件和要求，应用ROSTCM6软件对江苏省各地级市“双通道”政策进行文本分析，并访谈关键知情人做进一步分析。结果：词频分析结果表明6个关键词出现频数超过100次，2个关键词出现频数低于10次；语义网络图表明，“双通道”政策核心要义为“医保”；各地区药品遴选数目、定点医药机构遴选标准和程序、支付待遇等管理存在差异。结论：基于江苏省各地级市实践，“双通道”管理政策实施过程中存在地区间定点医药机构数量相差过大、尚未形成定点医药机构遴选后监管要求和措施、地级市之间医保支付待遇差异明显、各地区管理差异影响部分患者异地结算等问题，建议合理设定定点医药机构，制定完善“双通道”定点零售药店动态管理机制，充分发挥普惠性商业保险的作用，完善异地结算管理政策。

  关键词： 国家谈判药品；“双通道”管理；“双通道”药品遴选；定点医药机构；医保支付; ; ; ; 

   

  Abstract: Objective: Through systematically sorting out the implementation background and development history of dual channel management policy of national negotiated drugs, and the selection and management of drugs, selection of designated medical institutions and payment methods of medical insurance in Jiangsu Province and other cities, to provide references for the country to improve dual channel management policy. Methods: We searched the websites of Jiangsu Province and 13 municipal medical security bureaus to compare the policy documents and requirements of dual channel management, applied ROSTCM6 software to analyze the text of dual channel policies in Jiangsu Province and interviewed key interviewers for further analysis. Results: The results of the word frequency analysis showed that 6 keywords occurred more than 100 times while 2 keywords less than 10 times. The semantic network diagram shows that the core meaning of the dual channel policy is medical insurance; there are differences in the number of drug selection, selection criteria and procedures of designated medical institutions, payment treatment and other management in each region. Conclusions: Based on the practice of cities in Jiangsu Province, there are problems in the implementation of the dual-channel management policy, such as large differences in the number of designated medical institutions between regions, the lack of post-selection supervision requirements and measures for designated medical institutions, obvious differences in medical insurance payment treatment between municipals, and differences in management between regions affecting the settlement of some patients in different places etc., and it is suggested the designated medical institutions should be set reasonably, the dynamic management mechanism of designated retail pharmacy with “dual channel” should be formulated and improved, the role of universal commercial insurance should be brought into full play, and the management policy of off-site settlement should be improved.

  Key words: National negotiated drugs; Dual channel management; Dual channel drug selection; Designated medical institutions; Medical insurance payment

  提交时间：2022-09-01

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 刘孟嘉, 张金穗, 陈文, 胡敏. 定点医疗机构信用管理在医保基金监管中的重要性与实现策略. 2020. doi: 10.12201/bmr.202009.00017

  吕兰婷. 我国药品谈判政策演变与创新扩散机制探究*. 2022. doi: 10.12201/bmr.202210.00019

  杨昊韵, 张晓, 丁晨钰. 基于SWOT分析的江苏省职工医保门诊共济优化路径设计. 2022. doi: 10.12201/bmr.202204.00009

  李钊, 赵珂, 周绿林, 陈盛. 国家集采常态化视域下药品集团采购模式对比及发展对策研究. 2021. doi: 10.12201/bmr.202109.00037

  刘同心, 周良荣, 陈莉, 周鹏翔. 基于监管需求的医保定点医院信用评价指标体系构建 ——以张家界实验研究为例. 2022. doi: 10.12201/bmr.202110.00003

  孙言, 朱正, 杨莉. 国家组织药品集中带量采购价格降幅影响因素分析. 2022. doi: 10.12201/bmr.202203.00008

  许光建, 乔羽堃. 我国医疗服务价格调整与医保支付方式改革的联动机制研究. 2021. doi: 10.12201/bmr.202104.00018

  陈童, 蒋蓉, 邵蓉. 加拿大药品返利协议研究及其对我国的启示. 2021. doi: 10.12201/bmr.202101.00019

  李洪宇, 孙强. “两票制”政策对山东省药品供应状况影响分析. 2021. doi: 10.12201/bmr.202011.00015

  宋佳, 范成鑫, 王婉晨, 艾旭峰, 刘馨璐, 李翠玉, 张玉杰, 李秋莎, 王安琪, 丰志强, 尹文强, 马东平. 利益相关者视角下我国药品集中带量采购政策研究——基于政策工具的文本分析. 2022. doi: 10.12201/bmr.202203.00006

• 序号	提交日期	编号	操作
  1	2022-07-11	bmr.202209.00002V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论