医疗服务价格混乱的成因及对策

作者分析了当前医疗服务价格混乱的原因主要是：①医疗服务价格形成机制的不合理;②医疗服务价格管理的滞后性;③医院分配制度的不合理及局限性;④传统公费医疗保健制度提供了可能性。提出了治理医疗服务价格混乱的对策是;①建立合理的价格形成机制;②加强医疗服务价格的监督和管理;③进一步加快医疗相关体制改革。     

Price variation for total shoulder arthroplasty in the United States: transparency,variability, and compliance with federal reporting regulations

BackgroundCurrent federal regulation requires hospitals to report publicly negotiated prices for surgical procedures to improve transparency and reduce costs. The purpose of this study was to assess pricing variability for total shoulder arthroplasty (TSA) as well as compliance with the federal mandate on reporting.MethodsThe Centers for Medicare & Medicaid Services Provider of Services data (July 2021) and the standard charge files (current as of September 29, 2021) were analyzed to assess prices for TSA. The median and interquartile price ranges were tabulated for commercial payer rates as well as cash pay rates. Multivariable regression was performed to identify hospital factors associated with higher price variation with the outcome variable of median commercial TSA price at reporting hospitals. All regressions are weighted by the inverse probability of being a reporting hospital.ResultsThere was a wide variation in pricing for TSA, with median price ranging from $3139 to $41,577 for commercial pricing (interquartile price range from $1930 to $42,128.24). The median price for cash pay ranged from $3437 to $36,378 (interquartile price range from $2256 to $43,469). For-profit hospitals, those in an urban setting, and those in the Pacific region of the United States were associated with the highest commercial price for TSA.ConclusionThere is wide variability in pricing for TSA in the United States for both commercial and cash payers. For-profit hospitals, urban hospital setting, and the Pacific region were associated with higher pricing. Comparison of price variability at different institutions may contribute to costs savings for patients and payers.     

医疗机构关于新版医疗服务价格项目的思考

通过对《全国医疗服务价格项目规范(2012年版)》(简称新版项目规范)的研究,探索非营利性医疗机构(简称医疗机构)关于新版项目规范工作的思路。通过研究得出,新版项目规范主要呈现出4个方面的政策性变化及特点,同时认为新版项目规范在项目打包定价原则及辅助操作类项目的落实上值得进一步探讨。     

Do cigarette prices near secondary schools vary by area-level socioeconomic status? Findings from a field study in Ontario and Québec,Canada

ObjectivesTo examine, in the context of youth smoking, whether cigarette prices near secondary schools varied by area-level socioeconomic status in Southwestern and Central Ontario, and the greater Montréal region.MethodsWe collected cigarette prices four times between 2016 and 2019 from stores near secondary schools and used mixed-effects and ordinary least squares regressions.ResultsWe found consistent evidence that cigarette prices near secondary schools were lower in neighbourhoods with lower area-level household income, and that differences were large enough to be meaningful. In Ontario and Québec, our results indicate a Can$0.26 [0.04, 0.47] to Can$0.51 [0.33, 0.69] and Can$0.10 [-0.04, 0.24] to Can$0.37 [0.22, 0.52] difference in prices for a pack of 25 cigarettes between neighbourhoods with a median household income standard deviation below/above the provincial median, respectively.ConclusionPolicy changes that limit area-level cigarette price differences without lowering cigarette prices may reduce inequities in youth smoking.     

对国家医保药品目录调整工作的回顾与思考

2018年以来，国家医保局先后进行了4次医保药品目录调整谈判。目前，目录调整工作流程已逐步固定，主要包括准备、申报、专家评审、谈判和公布结果5个阶段，在企业信息收集、专家评审指标、专家测算、信息系统应用、申报信息公开等方面进行了不断完善。未来，可以在统筹兼顾科学性和实操性的基础上，强化不同环节工作逻辑一致性，应用真实世界证据，持续优化相关技术规则，建立常态化工作机制，不断优化医保药品目录调整工作。