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日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 Δ

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唐璋淳 ，卢钰琼，代展菁，许佳艺，虞 杰，路 云，常 峰（中国药科大学国际医药商学院，南京 211198）
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中图分类号 R95 文献标志码 A 文章编号 1001-0408（2024）13-1552-06
DOI 10.6039/j.issn.1001-0408.2024.13.02

摘 要 目的 借鉴日本和韩国医保支付标准调整的实践经验，为我国简易续约规则的完善提供参考。方法 检索中国知网的相
关文献、日本和韩国政府官网的相关政策文件等，从调整条件和调整公式两个方面归纳总结目前日韩调整医保支付标准的做法，
并与我国现行简易续约规则进行对比，明晰我国简易续约规则可优化之处，提出政策建议。结果与结论 在调整方式上日韩与我
国相似，对于超量药品根据超量情况计算药品降幅并实施调整；但具体的调整条件和调整公式又有所不同，日韩针对目前超量较
大的药品采取线性降价的方式，而我国针对目前和预期均超量较大的药品采取梯度降价的方式。对比分析结果显示，我国已初步
建立了符合国情和医保实际的简易续约规则，并采取了一些创新举措，包括考量药品目前与预期的超量情况和在调整公式中引入
降幅减半机制；但同时也存在一定不足，如调整条件的指标设置较为单一、调整公式的梯度降价区间过于宽泛，未能充分体现“以
量换价”的市场化机制。建议我国医保部门在简易续约时增加对药品基金支出大小的考量、细化调整公式的梯度降价区间、加大
对特殊品类药品在新增适应证时的政策倾斜，进一步完善简易续约规则。
关键词 医保谈判；简易续约；医保支付标准调整；医保基金支出

Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South
Korea on the simple renewal mechanism for negotiated drugs in China
TANG Zhangchun，LU Yuqiong，DAI Zhanjing，XU Jiayi，YU Jie，LU Yun，CHANG Feng（School of International
Pharmaceutical Business， China Pharmaceutical University， Nanjing 211198， China）

ABSTRACT OBJECTIVE To learn the practical experience of medical insurance payment standards adjustment in Japan and
South Korea， which will serve as a reference for the improvement of simple renewal mechanism in China. METHODS Retrieving
relevant literature from CNKI and related policy documents from official websites of Japan and South Korea， the medical insurance
payment standards adjustment practice in Japan and South Korea would be elucidated from 2 perspectives of adjustment criteria and
formulas， and then were compared with the current simple renewal mechanism in China to clarify the areas where simple renewal
mechanism in China can be optimized and propose several suggestions. RESULTS & CONCLUSIONS In terms of adjustment
methods， Japan and South Korea were similar to China. For excessive drugs， the reduction rate of drugs was calculated based on
the situation of excess and adjustments were implemented； however， there were differences in the specific adjustment criteria and
formulas. Japan and South Korea adopted a linear price reduction approach for drugs with significant oversupply， while China
adopted a gradient price reduction approach for drugs with both current and expected oversupply. The results of the comparative
analysis show that China has initially established simple renewal mechanisms that are in line with the national conditions and the
actual medical insurance situation， and has taken some innovative measures， including considering the current and expected
oversupply of drugs and introducing a halving mechanism in the adjustment formula. However， there are also certain shortcomings，
such as a relatively single set of indicators for adjusting conditions and a too broad range of gradient price reduction in adjustment
formulas， which fail to fully reflect the market-oriented mechanism of “volume for price”. It is recommended that China’s medical
insurance department increase consideration of drug fund expenditures， refine the gradient price reduction range of adjustment
formulas， increase policy preferences for special category drugs when adding new indications， and further improve the mechanism
for simple renewal.
KEYWORDS medical insurance negotiations； simple renewal mechanism； medical insurance payment standards adjustment；
medical insurance fund expenditures

Δ 基金项目 中国博士后科学基金第 74 批面上资助项目（No. 自2018年国家医疗保障局成立以来，我国已组织开
2023M743897） 展了多轮创新药品医保目录准入工作，创新药品进入医
＊第一作者 硕士研究生。研究方向：医药卫生政策与药品采购。
保的速度不断加快，药品可及性和可负担性显著提高。
E-mail：18783896596@163.com
2020年国家医疗保障局发布的《基本医疗保险用药管理
# 通信作者 教授，博士生导师，博士。研究方向：药品价格与采购
政策、卫生技术评估。E-mail：cpucf@163.com 暂行办法》规定，谈判药品协议有效期为2年，协议期满

· 1552 · China Pharmacy 2024 Vol. 35 No. 13 中国药房 2024年第35卷第13期