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目的:评估福建省医保药品支付标准改革对定点医疗机构临床用药的影响。方法:分析福建省省本级、福州市医疗保险管理中心331万参保人员2016年4—9月及上年同期门诊和住院药品消费数据,按年度统计药品费用、用药情况以及医保药品支付标准政策执行情况。结果:改革前后医保药品支付标准目录内费用占比从22.50%上升为64.95%;公立医院及非公立医院改革前后门诊药品前10位一致仅序号略有变化,改革后两者门诊支付标准内费用占门诊费用比例分别为73.21%、39.30%;公立医院住院前10位药品品种及其金额变化较大,其中联合采购价差较大的药品费用增幅较高,而非公立医院相对稳定。结论:医保药品支付标准改革显著影响了临床用药品牌选择和用药结构;以药品集中采购结合联合带量采购形成的医保药品支付标准有利于降低药品价格;医保药品支付标准改革结合医药卫生体制综合改革措施更有利于发挥引导作用。
Objective: To assess the impact of the reform of Medicare drug payment standards in Fujian Province on the clinical use of designated medical institutions. Methods: The data of outpatient and inpatient consumption from April to September in 2016 and the same period of last year in the province-level Fuzhou Medical Insurance Management Center and the 331 million insured persons were statistically analyzed. The annual cost of drug and medication, as well as the payment standard of Medicare drug Policy implementation. Results: Before and after the reform, the proportion of the expenses in the standard payment directory of Medicare increased from 22.50% to 64.95%; the numbers of the top 10 outpatients in public and non-public hospitals before and after the reform were only slightly changed; Accounting for 73.21% and 39.30% of outpatient expenses, respectively; the variety and amount of the top 10 drug products in public hospitals changed a lot, of which the cost of drugs with larger joint purchase price increased more than that of non-public hospitals. Conclusion: The reform of Medicare drug payment standard significantly affects the choice of clinical drug brands and the structure of drug administration. The payment standard of Medicare drug products formed by centralized purchase of drugs combined with purchase of united drugs helps to reduce drug prices. The reform of Medicare drug payment standards combined with the comprehensive reform of medical and health system Measures are more conducive to play a guiding role.