Page 7 - 《中国药房》2023年12期

·药事管理·

DRG付费下法国创新医药产品医保支付政策研究 Δ

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李佳明 ，丁锦希 1， 2 # ，黄晟馨 ，任雨青 ，林钊名（1.中国药科大学国际医药商学院，南京 211198；2.中国药科
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大学医药市场准入政策研究中心，南京 211198）
中图分类号 R95 文献标志码 A 文章编号 1001-0408（2023）12-1409-06
DOI 10.6039/j.issn.1001-0408.2023.12.01

摘 要 目的 分析法国创新医药产品附加清单制度的实施经验，为我国支持医疗机构使用创新医药产品提供借鉴。方法 以法
国为研究案例，运用政策分析法，系统性研究疾病诊断相关分组（DRG）付费下法国建立附加清单制度对创新医药产品进行补偿支
付的做法，包括建立背景、遴选程序与实施效果，对我国创新医药产品的医保支付方法给出建议。结果与结论 法国附加清单制度
对临床疗效显著但治疗费用高昂的创新医药产品建立了一套涵盖申报、审评、支付、调整4个阶段的补偿支付体系，有效减轻了医
疗机构用药负担，促进了医疗机构使用创新医药产品，激励了医药行业的创新动力，但同时也给医保基金带来了支付压力。随着
我国DRG/按病种分值付费改革的迅速铺展，部分地区也在积极探索对创新医药产品建立补偿支付机制，但仍存在不完善之处。
对此，可参照法国附加清单制度的实施经验，从设立遴选标准、选择补偿模式、做好动态调整三方面出发，针对创新医药产品建立
一套行之有效的补偿支付体系。
关键词 疾病诊断相关分组；附加清单制度；创新医药产品；医保支付政策；法国

Study on French medical insurance payment policy for innovative medical products paid under DRG
LI Jiaming ，DING Jinxi ，HUANG Shengxin ，REN Yuqing ，LIN Zhaoming （1. School of International
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Pharmaceutical Business， China Pharmaceutical University， Nanjing 211198， China；2. Research Center of
Medical Market Access Policy， China Pharmaceutical University， Nanjing 211198， China）
ABSTRACT OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical
products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking
France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list
system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the
establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance
payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a
compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost，
covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical
institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of
the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of
our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a
compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the
implementation experience of the French additional list system and establish an effective compensation and payment system for
innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the
implementation of dynamic adjustment.
KEYWORDS diagnosis-related group； additional list system； innovative pharmaceutical products； medical insurance payment
policy； France

Δ 基金项目 中国药科大学“双一流”学科创新团队建设项目（No. 为规范医疗服务行为、提高医保基金使用效率，国
CPU2018GY41）
家医保局于2019年发布了《国家医疗保障疾病诊断相关
＊第一作者 博士研究生。研究方向：医药市场准入与医疗保障政
策。E-mail：2448015398@qq.com 分组（CHS-DRG）分组与付费技术规范》，开始推进疾病
诊断相关分组（diagnosis-related group，DRG）付费改革
# 通信作者 教授，博士生导师，博士。研究方向：医保管理与医药
市场准入、药物经济学评价。E-mail：13605152326@163.com 试点工作；2021年底，国家医保局总结试点地区经验，印

中国药房 2023年第34卷第12期 China Pharmacy 2023 Vol. 34 No. 12 · 1409 ·