国家治理变革视角下的“药品医保生命周期”管理——来自日本的启示

药品价格管理与医保药品目录管理一直以来都是我国医药卫生体制改革的重点与难点。虚高的药价不但加重了患者用药负担,也让医保资金不堪重负。做好药品从定价到医保准入、目录内价格调整及退出的全过程管理,有利于理顺政府与市场的关系,建立支撑国家治理体系和治理能力现代化建设的现代医保管理制度。国家医疗保障局的成立是国家治理变革的产物,更是医保制度在顶层设计上的重大变革,标志着我国药品管理改革已进入关键阶段。本文通过对日本药品价格管理制度与机制的深入研究,对其经验进行总结,并基于我国现阶段实践首次提出了“药品医保生命周期”与“药品医保生命周期管理”的概念,对医保在药品生命周期管理中的职责和功能进行了探讨。

Analysis of the life cycle management of medical insurance from the perspective of national governance reform: Taking Japan as a reference

Drug price and medical insurance drug catalog management have always been difficult and such difficulty attracted more attention from China''s medical and healthcare system reform. The inflated drug price not only aggravates the medication burden on patients, but also makes the medical insurance fund overburdened. To do a good job in the entire process management of drugs from pricing to medical insurance access, price adjustment and withdrawal in the catalog is conducive to straightening out the relationship between the government and the market. It also plays an essential role in establishing a modern medical insurance management system that supports the modernization of national governance system and enhanced governance capacity. The establishment of national medical security bureau is the product of the national governance reform, and also the major reform of the top-level design of the medical insurance system making that, which has made the reform of drug management in China enter a critical stage. Based on the in-depth study of Japan''s drug price management system and mechanism, and taking reference of its experience, this paper puts forward the concepts of "life cycle of medical insurance" and "life cycle management of medical insurance" for the first time in China''s current practice, and discusses the functions and responsibilities of medical insurance in life cycle management.