惠民保与基本医保药品保障衔接水平分析方法及实证研究.docxVIP

《中国卫生经济》第42卷 第6期（总第484期）2023年6月 □ 医疗保障?MEDICALINSURANCE 惠民保与基本医保药品保障衔接水平分析方法 及实证研究 姜骁桐① , 郭珉江① , 刘 阳① , 李亚子① 摘 要 目的：为评估惠民型商业补充医疗保险与基本医保药品保障衔接水平提供分析框架，以期为惠民型商业补充医 疗保险产品药品待遇政策的评估与设计提供参考。方法：借鉴经济合作与发展组织对商业健康保险和医疗保障体系衔接方式 的定义，将其应用到药品保障领域的衔接水平分析，并以“沪惠保”为例进行实证分析。结果：基于惠民型商业补充医疗保 险和基本医保在药品保障范围、渠道和待遇方面的差异，将两者衔接方式分为3种类型，分别为补充型、增强型和重叠型。 结论：惠民型商业补充医疗保险药品待遇政策的设计与评估应兼顾考虑国家基本医保药品目录、城市间待遇水平差异、产品 筹资与管理水平。在具体药品的遴选上，可以借助国家医保谈判工作的经验。 关键词 惠民型商业补充医疗保险；基本医疗保险；药品保障；衔接水平 中图分类号 R1-9；F840.613 文献标志码 A 文章编号 1003-0743（2023）06-0030-05 Analysis Method and Empirical Study on the Cohesion Level of Inclusive Commercial Hea Analysis Method and Empirical Study on the Cohesion Level of Inclusive Commercial Health Insurance and Basic Medical Insurance Drug Security/JIANG Xiao-tong, GUOMin-jiang, LIUYang, et al.//Chinese Health Economics, 2023,42 (6):30-33,45 Abstract Objective:To provide an analytical framework for assessing the convergence level of drug reimbursement benefits beS tween inclusive commercial health insurance（ICHI）and basic medical insurance(BMI). Methods:Based on Organization for EcoS nomic Co-operation and Development’s definition of the linkage between commercial health insurance and medical security system, it is applied to the analysis of the level of linkage in the field of drug reimbursement, taking “Hu Huibao” as an example for empirical analysis. Results: The research divides the connection between the ICHIand BMIinto supplementary, complementary and overlapping types based on the differences of ICHIand BMIin coverage, path and salary. Conclusion:The design and appraisal of the drug security policy of ICHIshould consider the BMIdrug catalogue, the difference in treatment level between cities and the level of product financing and management. The drug selection could learn from the experiences of national medical insurance negotiation. Keywords inclusive commercial health insurance; basic med