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目的:设计我国基本药物独立筹资结构,完善基本药物筹资机制。方法:分别以社会、个人和政府为出发点,以1 836.5亿元作为我国基本药物的筹资标准,通过当前医保基金报销水平以及结余情况,推算出医保对于基本药物的筹资范围;并采用世界卫生组织/国际健康行动机构的方法定量测算出个人对基本药物的筹资上限;基于此,根据国民生产总值与财政收入的变动关系,结合国家财政收支状况评估财政补助对于基本药物筹资的可负担性。结果与结论:我国基本药物独立筹资结构,个人应以343.43亿元为上限,医保和财政的筹资范围分别为673.67~1 028.82亿元和464.25~819.4亿元。照此结构,医保基金、个人以及政府财政均有较好的可负担性。且出于公平性的考虑,本研究建议个人按照人次均缴费的方式来为基本药物筹资。
Objective: To design an independent fund-raising structure for essential medicines in China and improve the funding mechanism for essential medicines. Methods: Taking social, individual and government as the starting point respectively, with the amount of 183.65 billion yuan as the financing standard of basic drugs in our country, the coverage of medical insurance for basic drugs was calculated through the current reimbursement level of medical insurance fund and the balance; and the World Health Organization / International Health Action Agency approach to quantify the individual funding cap for essential drugs; based on this, in accordance with the changing relationship between GNP and fiscal revenue, combined with the state fiscal revenue and expenditure assessment of financial subsidies for the funding of essential medicines affordability . RESULTS AND CONCLUSION: The independent fund-raising structure of essential drugs in our country should be 34.343 billion yuan for individuals and the coverage for health insurance and finance should be 673.67-1102.882 billion yuan and 464.25-81.94 billion yuan respectively. According to this structure, medical insurance funds, individuals and government finances have better affordability. For the sake of fairness, this study suggests that individuals should raise funds for essential medicines according to the payment method.