An analysis on formation mechanism and balance affiliation between health insurance payment standard and market price / 中国卫生政策研究

At present,because market price survey and health insurance payment standard adjustment mechanism in china is incomplete,health insurance payment standard can not be completely equivalent to the actual market price of drugs. This paper analyzed and summarized the main factors affecting the balance and formation mechanisms under differ-ent medical insurance payment standard policies. It is found that the balance formation mechanism depends not only on the reimbursement ratio of drugs,but also on the development pattern of the payment standard and on the source of the refer-ence price system selected. On the issue of the ownership of the balance,from the specific practices of pilot cities such as Chongqing and Shaoxing,it can be seen that the merits and demerits still exist to the medical institutions for internal de-velopment models or re-allocated by the government agencies'performance-based. Compared with the simple balance reten-tion model,the redistribution model can enhance the service of medical institutions by regulating their behavior. However, medical institutions may provide false data to get more balance in the redistribution model,and game theory was used to reduce the policy risk of misreporting the private balance of data from medical institutions,and the analysis of strategic choices of medical institutions and supervisory departments Finally,"three-step"policy proposal was proposed on the issue of balance attribution. In the short term,the balance should be given to the medical institutions to increase their bargaining motivation. At the same time,the performance appraisal and supervision methods should be explored to enhance the feasi-bility of redistribution model. In the long run,the balance should be eliminated gradually through the improvement of mar-ket price survey and medical insurance payment standard adjustment mechanism.

Discussion on Construction of Drugs Payment Standard System of Basic Medical Insurance / 中国卫生经济

By reviewing the pilot experiences of drugs payment standard under basic medical insurance in Sanming(Fujian),Chongqing and Fujian,it pointed out that the drug payment standard system should be designed following the principle of classification management.It was necessary to rationally divide payment standard group,select the appropriate method for payment standard,establish dynamic adjustment mechanism and solve problems of the belonging and burden of price difference so as to ensure the effective implementation of medical insurance cost control policy.

The theoretical and realistic analysis of medical insuranc e payment stan dard for pharmaceuti-cal in China / 中国卫生政策研究

It is an important countermeasure in the world to establish the medical insurance payment standard (reference price)to control the growth of pharmaceutical costs.Medical insurance payment standards for pharmaceu-ticals affect patients,behavior and pharmaceutical pricing through enhancing competition for pharmaceutical demand and patients,choice.After the liberalization of government pricing in China,it was also needed to establish the price formation mechanism to adapt to the development of pharmaceutical market.To establish the medical insurance pay-ment standards,one should know more about the development of China,s pharmaceutical policy and the current situa-tion and clarify the specific mechanism of controlling expenses.To achieve a sustainable availability of drugs, the control of costs and policy incentives,it is crucial to identify the problems in practice,pay close attention to the es-tablishment of pharmaco-economic evaluation system,drug classification management,the medical insurance payment and compensation levels,a reasonable allocation of compensation balance and so on.

The impact of medical insurance payment standard reform on clinical drug use in designated medical institutions:Based on Fujian provincial level,Fuzhou medical insurance insured per-sonnel empirical evidence / 中国卫生政策研究

Objective:To evaluate the influence of medical insurance payment standard reform on clinical drug use in designated medical institution.Methods:The medical expenses and drug consumption data of provincial level and Fuzhou medical insurance management center 3.31 million is included from April to September of 2016 and the same period of last year were statistically analyzed.The annual drug cost,drug use and the payment standard of med-ical insurance analysis were performed according to the annual statistics.Results: Before and after the reform, the proportion of the payment of standard drugs increased from 22.50%to 64.95%.The top 10 outpatient drugs in pub-lic hospitals and non-public hospitals were changed only in serial number,and after the reform,the cost of outpatient service fee was 73.21%and 39.30%respectively.Meanwhile,the variety and amount of drugs changed greatly of top 10 drugs public hospitals.The increase in drug cost of drugs with joint purchasing price difference was higher,and non-public hospitals were relatively stable.Conclusions: As per the findings of this study, Medicare insurance payment standard reform has significantly affected the choice of drug brands and drug use structure.To focus on the medical insurance payment standard of concentrated purchase of drugs combined with the amount of joint procurement of medicines is beneficial to reduce drug prices.The medical insurance payment standard reform combined with com-prehensive reform of medical and health system measures are much more conducive to play a guiding role.

Medicine reference price system in Germany and its implication for healthcare payment stand-ard in China / 中国卫生政策研究

It is significantly important but difficult to establish healthcare payment standard system in case our country has cancelled government and government guidance prices. In 1989, Germany was the first country to intro-duce the medicine reference price system in Statutory Health Insurance. It does not only aim to regulate the medicine prices, but also defines a reimbursement level for a cluster of products considered to be therapeutically equivalent, and has a good influence on lowering the price of medicine. This paper systematically reviews the medicine reference price system in Germany, including four aspects:the reference price system overview, the reference price groups’ de-termination procedure, the reference prices calculation and the co-payment mechanisms. Based on the Germany refer-ence price system, we can establish healthcare payment standard in over-the-counter or chronic market first, then sci-entifically divide the reference price groups, formulate and adjust payment standard based on the market price, and perfect the co-payment mechanism to avoid moral hazard.