医保基金监管中临床药物使用的常见违法违规问题
Common violations of laws and regulations of clinical drug use in the supervision of medical insurance fund
丁庆莉 1龚波1
作者信息
- 1. 上海市医疗保障局监督检查所,上海 200040
- 折叠
摘要
通过国谈创新药准入和药品目录更新,越来越多有效的治疗药物被纳入医保基金支付,在满足参保患者用药需求的同时减轻医疗费用负担,但在监管中发现药物临床使用中滋生一些医保违法违规行为.同时,随着药品集采、"双通道"药品、医保支付方式改革等新政策的落地,以及"互联网+医疗"等医疗新业态的发展,监管中也发现一些新问题.现结合医保监管典型案例,对临床药物使用的常见违法违规问题作一综述.
Abstract
Through national negotiations on innovative drugs and the update of drug catalogue,more and more effective therapeutic drugs have been included in the medical insurance fund,which reduces the burden of medical expense while meeting the drug needs of insured patients.However,some violations of laws and regulations of clinical drug use in the supervision of medical insurance fund have been found.At the same time,with the implementation of new policies such as centralized drug procurement policy,"dual channel drugs"and reform of medical insurance payment methods,as well as the development of new medical forms such as"internet+health care",some new problems and phenomena have also been found in the supervision.Based on the typical cases in the supervision of medical insurance,this paper summarized the common violations of clinical drug use.
关键词
医保监管/临床用药/违法违规/典型案例Key words
supervision of medical insurance/clinical drug/violation of laws and regulations/typical case引用本文复制引用
出版年
2024
NETL
NSTL
万方数据