医保真实世界数据研究面临的挑战

Challenges of Real-World Data Research on Medical Insurance

袁妮 ¹吕子萱 ²黄祖彤 ¹周娜 ³王雅群⁴

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作者信息

1. 大连医科大学公共卫生学院大连 116044;大连医科大学创新药物政策与医疗保障研究中心大连 116044
2. 大连医科大学公共卫生学院大连 116044;武汉大学董辅礽经济社会发展研究院武汉 430072
3. 北京大学卫生政策与管理学系北京 100091
4. 大连医科大学公共卫生学院大连 116044
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摘要

目的:本研究基于英国国家卫生与服务优化研究院(NICE)的真实世界数据(RWD)应用案例,分析药品医保准入中RWD的角色与挑战,为我国政策制定提供借鉴.方法:采用案例研究法,分析NICE体系下药品准入与管理准入计划(MAA)的实施细节.结果:英国医保体系通过NICE实施的MAA,利用RWD评估药品疗效与成本效益,促进了创新药品快速进入国家医疗服务体系(NHS).结论:我国可借鉴英国经验,完善RWD相关政策与标准,加强国际合作,推动RWD在医保体系的广泛应用与深入发展,为医疗资源的优化配置与患者的医疗保障提供更加坚实的支撑.

Abstract

Objective:Based on the real-world data(RWD)application case study of the National Institute for Health and Care Excellence(NICE)in the UK,this study analyzes the roles and challenges of RWD in medical insurance access of drugs,which can provide a reference for the policy making in China.Methods:A case study method was used to analyze the implementation details of the Managed Access Agreement(MAA)under the NICE system.Results:The UK healthcare system has facilitated the rapid entry of innovative medicines into the National Health Service(NHS)by utilizing RWD to assess the efficacy and cost-effectiveness of medicines through the MAA implemented by NICE.Conclusion:China can learn from the UK,improve RWD-related policies and standards,strengthen international cooperation,and promote the wide application and in-depth development of RWD in the medical insurance system,so as to provide a more solid support for the optimal allocation of healthcare resources and patients'healthcare security.

关键词

真实世界数据(RWD)/英国国家卫生与服务优化研究院(NICE)/医保准入

Key words

real-world data(RWD)/National Institute for Health and Care Excellence(NICE)/medical insurance access

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出版年

2024

中国医疗保险

中国医疗保险研究会

中国医疗保险

影响因子：0.492

ISSN：1674-3830

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