基于全民医保目标的基本药物遴选模型探讨

摘要

中国距2020年实现全民医保目标仍有差距,但差距正不断缩小.国家基本药物制度也在逐步实施并不断提高覆盖率.该制度要求将基本药物全部纳入医保报销体系,但是医保体系的筹资能力又是有限的.因此,基本药物遴选应该充分考虑全民医保的理想目标和筹资水平局限的现实差距,同时确保在药物政策的公平与效率间达到平衡.基本药物遴选"背包模型"把医保人口覆盖率设为目标函数,将医保药品筹资能力作为约束条件引入模型,结合我国国情和发展规划,为基本药物的遴选提出了一种新的方法.%There was an evanescent gap towards the target of universal coverage by social medical insurance system in China by 2020.The coverage ofNational Essential Medicines System was also widening from the grass TootS to the whole countries, which required all the essential medicines to be reimbursed by the social medical insurance system within the limit of drugs financing. Hence. the selection of essential medicines should pay enough attention on the gap between the ideal aim of universal coverage and the reality of drugs financing. in the meantime to balance the equity and efficiency. This research originally designed a Knapsack model of essential medicines selection, by the objective function of the proportion of population with access to social medical insurance system, subject to the constrain of drugs financing ability of the insurance system, providing a new method of essential medicines selection suitable for the national situation and the development plan of China.