首页|基于医保支付标准的抗肿瘤药合理使用管理流程优化及患者负担评价研究

基于医保支付标准的抗肿瘤药合理使用管理流程优化及患者负担评价研究

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随着国家谈判抗肿瘤靶向药纳入医保支付,恶性肿瘤患者就医负担不断降低。文章基于医保支付标准和天津市肿瘤医院空港医院抗肿瘤药合理使用的管理实践,构建并优化抗肿瘤靶向药合理使用的医院管理流程,为医保支付政策的优化及药品的合理使用提供参考依据。文章梳理了国家组织药品医保谈判的主要政策内容,并以医院抗肿瘤靶向药的合理使用管理流程优化为研究对象,结合抗肿瘤靶向药合理使用的管理实践,构建抗肿瘤靶向药合理使用的监管体系。通过对比纳入医保支付前后患者个人负担变化情况分析药品谈判纳入医保支付后给患者就医负担带来的主要影响。并提出了从政策上进一步推进谈判药的落地与支付标准的扩大,从医疗机构管理层面需不断优化管理流程,加强医保资金使用监管,保证患者用药需求,促进药品和医保资金的合理使用。在政策层面建议依据药品说明书变化及时调整医保支付标准,进一步提高肿瘤患者用药可及性。为医保管理部门持续开展贵重药品的国家谈判和有效降低恶性肿瘤大病患者个人负担提供政策建议。
Research on Optimization of Management Process for Rational Use of Anti Tumor Drugs and Patient Burden Evaluation Based on Medical Insurance Payment Standards
With the national negotiation of anti-tumor targeted drugs into the medical insurance payment,the medical burden of patients with malignant tumor continues to reduce.This study is based on the medical insurance payment standards and the management practices of Tianjin Cancer Hospital Airport Hospital,to construct and optimize the hospital management process for the rational use of anti-tumor targeted drugs,providing reference for the optimization of medical insurance payment policies and the rational use of drugs.This study outlines the main policy contents of medical insurance product negotiations.The rational use of anti-tumor targeted drugs in hospital was taken as the research content,combined with the management practice of the rational use of anti-tumor targeted drugs,the supervision system of the rational use of anti-tumor targeted drugs was constructed.By comparing the changes of patients'personal burden before and after the inclusion of medical insurance payment.The research results propose to further promote the implementation of negotiation drugs and the expansion of payment standards from a policy perspective.From the perspective of medical institution management,it is necessary to continuously optimize management processes,strengthen supervision of the use of medical insurance funds,ensure patient medication needs,and promote the rational use of drugs and medical insurance funds.At the policy level,it is recommended to adjust the medical insurance payment standards in a timely manner based on changes in drug instructions,further improving the accessibility of medication for cancer patients.The research conclusion provides policy recommendations for the medical insurance management department to continue national negotiations on valuable drugs and effectively reduce the personal burden of malignant tumor patients.

medical insurance paymenttargeted drugsmanagement processpersonal burdencost evaluationrational administration of drug

陈璐、马雷

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天津市肿瘤医院空港医院院长办公室,天津 300308

天津市肿瘤医院空港医院医疗保险部,天津 300308

医保支付 靶向药 管理流程 个人负担 费用评价 合理用药

2024

中国卫生标准管理
《中国卫生标准管理》杂志社

中国卫生标准管理

影响因子:1.374
ISSN:1674-9316
年,卷(期):2024.15(23)