| ObjectiveTo carry out the spirit of "Notice about print and distribute promote the reform of drug prices" republiced by National Development and Reform Commission,The national health and family planning commission,Ministry of Labor and Social Security;explore to set up new guiding drug reasonable price formation mechanism,establish a corresponding health care procedures,methods,and the reference for drug payment standard,promote the healthy development of the medical and health undertakings,meet people’s growing demand for medical and health services.Methods Through consulting relevant literature,learn about drug price formation mechanism of other countries and regions,as well as parts of our country medical insurance payment standards set up practical experience and relevant policies.Application the way of focus interview,group interview method,and access to data,such as the historical data collection,collect the relevant data such as drug trading volume and price,received 36 kinds of common names,75 kinds of brand names,article 7111 of drug information,application Excle software,set up the database,descriptive statistics analysis.Result1.Medicare drug payment standards should include two aspects of content:one is the price paid for health care medicine,the second is the way how to pay the health care medicine.2.The health care price should include many parts:the price of the using drugs,new drugs,innovation drugs,and the method for adjustment of medicine medical insurance to pay the price.(1)For the medicare drug payment standards of using drugs,we can select the drugs according to its effective components,pharmacological action,effect factors,such as from a therapeutic or on pharmacology of the drug has a similar role,several production competition,clinical dosage is bigger,the influence of drugs,medical insurance fund in accordance with the common name and specifications are classified,calculating a weighted average of prices of similar medicines as medicare drug payment standard.(2)For the medicare drug payment standards of new drugs,we can refer to the drug price by the method called "similar efficacy comparison method" and "cost calculation".(3)The price of innovation drugs can be formulated by medical insurance department and pharmaceutical company.(4)The adjustment methods of medicare drug payment standards can study the methods of Japan and Taiwan.The medicare drug payment price of Japan is adjusted every two years,according to the market situation,the price is based on health care and medical organizations purchase prices of medicines,and use the R-zone method.The adjustment methods of Taiwan give full play to the initiative to negotiate with drug medical institutions.The underwriter gather market price data gathered in a fixed time,according to the regulation of "national health insurance measures for drug price adjustment homework provisions"to calculate the weighted average price.3.Drug classification is the key to develop medicare drug payment standards.(1)Classified by trade name.The advantage of this method is its detailed classification,it is a clear reference in the implementation.But the workload of classification is heavy,and the classification is too exquisite,which may make every type only including a few kinds of drugs.(2)Classified by common name.The advantage is it is convenient to obtain data and calculate the weighted average price.But the disadvantage is that the same general name drugs might be different in specifications,dosage forms,packaging,quality level,etc.Therefore the calculated medicare drug payment standards will not be able to accurately reflect the drug prices generally.(3)Classified by common name and levels of audit quality is a good way,but it will be a difficulty of how to define the quality of the drug and who will bear the problem such as quality appraisal.3.The way to pay the drug price can be devided by two parts:one is the share way of medical insurance department and patients;the second is the share way of medical insurance department and hospital.With the patients fees can be paid in proportion to share the way and pay the combination of benchmark;With the hospital can use a variety of combined system of payment in advance.4.The precondition of pay medicare drug standards including medicine zero bonus policy,urban and rural medical insurance plan as a whole,open and transparent pharmaceutical trading platform,and mobilize the initiative of hospitals and doctors,and so on.5.With reference to foreign or regional health care system is conditional.The first is the medical and medicine separation,Australia and Germany is the separation of the practice of traditional medicine,and Japan and Taiwan region also appear in medicine for the medical system shortcomings after implemented the reform of the pharmaceutical separation.Followed by the perfect drug economics evaluation system,Germany,Australia,Japan and Taiwan will be pharmacoeconomics evaluation as an important reference of drug pricing.When making drug prices,not only consider the cost and safety,also should consider its economy.The third is fully considered the patient burden,Germany in shall practise a system of medical expenses to share at the same time in order to control the medical burden of patients,and to assume the cost of patients,the lowest not less than 5 euros,not more than 10 euros.In order to avoid personal sharing is overweight,Taiwan set the share cap standards,regulations,individual responsibility cap of 200 Yuan.The fourth is to have a clear division of responsibilities,clear responsibilities of drug pricing,drug pricing,Australia organization management and technology support department including drug insurance pricing mechanism,drugs advisory committee and the state administration of therapeutic drugs;Australia Japan has the health ministry in charge of the country’s health care and social security matters,it consists of class political economics,is Japan’s drug price administration department,responsible for pharmaceuticals price and specific insurance medical material price survey,etc;The Taiwan region shall be the responsibility of the national health insurance bureau of national health insurance the formulation and adjustment of drug prices,etc.The fifth is the control of the doctors behavior and the incentive to the corresponding mechanism for medical institutions.Conclusion:Ormulating the medicare drug payment standards reasonablely is very important to speed up the perfect modern market system and the transformation government fimction,regulate the behavior of drug market prices promote the healthy development of the medical and health undertakings and medicine industry,promoting the healthy development of medical and health undertakings and the pharmaceutical industry to meet people’s growing demand for medical and health,relieve patients’ unreasonable medical expenses burden,and to improve the modern market system and the transformation government function. |
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