中日医保药品目录管理差异与思考:日本医保目录动态调整机制之启示

目的:分析和研究日本医保目录动态管理机制,与中国医保准入等政策相比对,为中国医保目录动态调整机制建立提供借鉴与参考。方法:通过文献比较研究和描述性分析,具体阐述日本医保目录动态管理机制,并与中国医保目录准入机制、创新药谈判机制与流程进行对比,提出针对性意见建议。结果:日本建立医保目录动态调整机制,特点是建立公开、透明、多方参与的公共决策机制,并与药品注册和价格相衔接,加速了创新药的准入进程。日本在鼓励创新和医保基金可持续中寻找平衡点,很大程度上得益于日本完善的医保目录和医保支付标准管理制度,诸方面有较为科学的流程与依据。结论:完善的制度设计与建设非常重要,条目清晰的医保目录价格动态调整规则十分必要。同时,公开透明的决策机制和官方认可的评价机构不可或缺。

The Differences and Thought of National Reimbursement Drug List Management between Japan and China: The Implications from Japen Medical Insurance List Dynamic Adjustment Mechanism

Objective:To analyze the dynamic update management mechanism of Japan National Reimbursement Drug List(NRDL), and compare it with the current China NRDL policy providing a reference for the establishment of NRDL dynamic management policy in China.Methods:The related literatures are reviewed and descriptive analysis is used to demonstrate the details in the Japan NRDL dynamic update management mechanism to make a comparative analysis with China in the field of NRDL update.Results:Japan has set up a dynamic NRDL adjustment policy, which is characterized by a public decision-making mechanism that is accessible to all parties, the association between drug registration and pricing, and an accelerated access process for innovative drugs. The balance between innovation and sustainable health insurance funds in Japan is attributable largely to the developed national basic medical care insurance medicine catalog, healthcare reimbursement standards, as well as the scientific evidence-based process from different parties. Tailored suggestions are provided for NRDL management in China.Conclusion:It is important and necessary to design and develop a complete and clear policy for the dynamic update management of NRDL. A public decision-making mechanism, which is accessible to all parties and evaluation agencies certified by government, is an integral part,the policy.