我国现行药品医保谈判机制运行情况调查研究
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篇名: 我国现行药品医保谈判机制运行情况调查研究
TITLE:
摘要: 目的:为我国药品医保谈判机制的进一步完善提供参考。方法:对参与江苏省、江西省、青岛市、成都市四地药品医保谈判的部分医保经办机构和医药企业工作人员进行问卷调查,了解其业务熟悉情况和对谈判机制的认可程度,并采用描述性分析、独立样本t检验分析等方法对数据进行统计和分析。结果:共发放问卷70份,回收有效问卷68份,有效回收率为97.14%;包括医保经办机构受访者21人,医药企业受访者47人。对于业务熟悉情况,受访者各方面评分平均值均>3(4分制),以“药品谈判项目执行过程中的管理方式”评分最低;两类受访者在“药品谈判过程应遵循的基本原则”“实质性谈判过程中的谈判目标”“业务熟悉情况总评分”方面的评分比较差异均有统计学意义(P<0.05),医药企业受访者均高于医保经办机构受访者。在对谈判机制的认可程度上,对谈判机制整体效果的认可程度除“有利于维持药企的价格体系”外其余各方面评分平均值均≥4(5分制),对谈判准备工作、实质性谈判工作、谈判协议执行情况、谈判项目监管评估情况的认可程度除“患者取药用药方便快捷”外其他各环节各方面评分平均值均>4。两类受访者对谈判机制整体效果、谈判准备工作、谈判项目监管评估情况的认可程度各方面评分比较差异均无统计学意义(P>0.05);而对实质性谈判工作的认可程度在“谈判过程中双方在平等、合作、融洽的氛围下进行谈判”方面的评分比较差异有统计学意义(P<0.05),医保经办机构受访者高于医药企业受访者;同时,对谈判协议执行情况的认可程度在“在协议生效后,医保经办机构严格按照协议执行”“基金向药企方支付及时、方式合理”两方面的评分比较差异均有统计学意义(P≤0.05),医保经办机构受访者均高于医药企业受访者。结论:现行药品医保谈判机制整体效果较好,运行较为顺畅,但仍存在准备阶段收集的依据材料不够充分、患者取药用药流程繁复、谈判双方地位不平等、基金向药企方支付不及时、评估工作不完善等不足。
ABSTRACT: OBJECTIVE: To provide reference for further improving negotiation mechanism of drug medical insurance in China. METHODS: Questionnaire investigation was conducted among the medical insurance agency and pharmaceutical company staff who participated in drug medical insurance negotiation in Jiangsu province, Jiangxi province, Qingdao, Chengdu. Their business familiarity and recognition of the negotiating mechanism were also investigated. The descriptive analysis, independent sample t test and other methods were adopted to analyze the data statistically. RESULTS: A total of 70 questionnaires were distributed and 68 valid questionnaires were collected with effective recovery rate of 97.14%. Respondents included 21 staff members of medical insurance agencies and 47 of pharmaceutical companies. In terms of business familiarity, the average score of respondents in all aspects was greater than 3 (4 points system), the lowest score was “management of the implementation of drug negotiation projects”. There were statistical significances in scores of 3 items between 2 parties in the negotiation (P<0.05): “basic principles of the drug negotiation process should be followed” “negotiation objectives in the substantive negotiation process” “ total score of business familiarity”. The scores of respondents in pharmaceutical companies were higher than those of health insurance agencies. In the recognition of the negotiating mechanism, average score of each survey item was ≥4 (5 points system) in the recognition of the overall effect of the negotiation mechanism except for “which is conducive to maintaining the price system of pharmaceutical companies”. The average score of all aspects of preparation of the negotiations, substantive negotiation, implementation of the negotiation agreement and negotiation project’s supervision and evaluation was >4 except for “patients taking drugs is quick and easy”. There was no statistical significance between 2 types of respondents in all aspects of overall effect of the negotiation mechanism, preparation of the negotiations and negotiation project’s supervision and evaluation (P>0.05). But in the recognition of the substantive negotiation, there was statistically significance between 2 types of respondents in “negotiations between the two sides in an equal, cooperative, harmonious atmosphere” (P<0.05). Healthcare agencies’ respondents had higher scores than pharmaceutical companies’ ones. And in the recognition of the implementation of the negotiation agreement, there was statistical significance between 2 types of respondents in the “after the agreement entered into force, the medical insurance agency will be strictly in accordance with the agreement” and “fund pay to pharmaceutical companies timely and reasonable” (P≤0.05). Healthcare agencies’ respondents have higher scores for than pharmaceutical companies’ ones. CONCLUSIONS: The current drug medical insurance negotiation mechanism shows good overall effect and runs smoothly. But there are still some shortages, such as collected information the preparation stage is not sufficient; the procedures of patients taking the drug is complicated; negotiating parties do not have equal status; the fund is not paid to the pharmaceutical enterprise timely; evaluation is not perfect.
期刊: 2017年第28卷第15期
作者: 张湛,杨建卫,梁永晴,陈唯,夏苏建
AUTHORS: ZHANG Zhan,YANG Jianwei,LIANG Yongqing,CHEN Wei,XIA Sujian
关键字: 药品医保谈判;机制;运行情况;认可程度;调查
KEYWORDS: Drug medical insurance negotiation; Mechanism; Operation situation; Degree of recognition; Survey
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