新增医疗服务项目纳入医保目录管理机制探索
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摘要
当前国家在审核新增医疗服务项目申请纳入医保目录时,目前只给出了一个宏观的指导性原则,即"临床诊疗必需、安全有效、费用适宜",除此之外并无其他具体的可操作性标准提供,这使得医疗保险管理机构在项目遴选的决策上缺乏科学性。通过对境内外经验的思考与总结,文章对新增医疗服务项目纳入医保目录的管理机制提出了建议,并对审核流程进行重新设计,以期为我国新增医疗服务项目纳入医保目录工作的开展提供参考。
At present, China only gave a macro guiding principle while reviewing the application of introducing new medical service projects into the medical insurance catalogue, which meant, "the service is necessary for clinical diagnosis and treatment, safe and effective in technology, and the cost is appropriate". There were no other available specific operable standard, which made the medical insurance management organizations lack of scientific decision-making in project selection. Through the summarization of foreign and domestic experience, it conducted the redesign for the auditing process so as to put forward suggestions for the inclusion of introducing new medical service projects into the medical insurance catalogue.
At present, China only gave a macro guiding principle while reviewing the application of introducing new medical service projects into the medical insurance catalogue, which meant, "the service is necessary for clinical diagnosis and treatment, safe and effective in technology, and the cost is appropriate". There were no other available specific operable standard, which made the medical insurance management organizations lack of scientific decision-making in project selection. Through the summarization of foreign and domestic experience, it conducted the redesign for the auditing process so as to put forward suggestions for the inclusion of introducing new medical service projects into the medical insurance catalogue.
引文
[1]陈洁.卫生技术评估[M].北京:人民卫生出版社,2008.
[2]李幼平,喻佳洁,孙鑫.快速评估方法与流程的探索[J].中国循证医学杂志,2014,14(5):6-9.
[3]赵琨,隋宾艳,郭武栋,等.卫生技术评估的国际经验及启示[J].中国卫生经济,2012,31(2):89-91.
[4]耿韬,叶露,姚红,等.医保给付管理中相关问题的理论探讨[J].中国卫生资源,2009,12(2):82-84.
[2]李幼平,喻佳洁,孙鑫.快速评估方法与流程的探索[J].中国循证医学杂志,2014,14(5):6-9.
[3]赵琨,隋宾艳,郭武栋,等.卫生技术评估的国际经验及启示[J].中国卫生经济,2012,31(2):89-91.
[4]耿韬,叶露,姚红,等.医保给付管理中相关问题的理论探讨[J].中国卫生资源,2009,12(2):82-84.