医保药目使用效果影响因素初探

摘要

临床治疗指标、医疗卫生支出、药物经济学性价比、生命质量指数是国内外制定和调整医保药品目录的主要依据。医保药品目录效果的影响因素包括药品与临床使用符合度、患者医疗费用负担减轻程度、医疗行为控制程度、医保基金运行风险等。经济水平、医保制度、诊疗水平是影响医保药品目录使用的客观因素，医保管理水平、医患双方合理用药意识则是可控因素。%The formulation of medical insurance drug catalogue at home and abroad is based primarily on clinical indicators, budget impact, pharmacoeconomics and quality of life. Influence factors of medical insurance drug catalogue include coincidence degree of drugs and clinical use, the level of reducing the medical cost burden on patients, the extent of controlling medical behavior and operation risk of medical insurance fund. Economic level, health care and the clinic level are objective factors which affect the implementation of medical insurance drug catalogue. The management level of medical insurance and rational use of drugs is controllable factors.