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目的:为了对重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rh TNFR:Fc)对医保预算的影响进行分析。方法:选取IMS Data 2015中的风湿类药品,把药品数量单位换算成限定日剂量(DDD),以IMS Data 2015 rh TNFR:Fc的用量为基线,假设其不同的新增用量比例,按照90%和80%的报销比例分别计算新增的医保支出及其对风湿类药品和全部药品的医保支出的影响。全国医保支出数据来源于政府部门的统计资料。结果:按照90%的报销比例,当rh TNFR:Fc的新增用量为2015年用量的0~100%时,医保支出增加约为5.22~10.43亿元,风湿类药品医保支出增加63.44%~126.87%,全部药品医保支出增加0.04%~0.08%。按照80%的报销比例,其医保支出的增量则相应减少。结论:rh TNFR:Fc进入目录对风湿类药品医保支出的影响较大,但对全部药品医保支出的影响则很小。
OBJECTIVE: To analyze the impact of recombinant human TNF-α (TNFR) on the medical insurance budget. Methods: The rheumatism drugs in IMS Data 2015 were selected and converted into DDD. The data of IMS Data 2015 rh TNFR: Fc was taken as the baseline. Assuming different dosage rates, the data of 90% And 80% reimbursement ratio, respectively, to calculate the new medical expenses and their impact on rheumatic drugs and all medicines and health care expenses. National health expenditure data from government statistics. Results: According to the 90% reimbursement ratio, when the added amount of rh TNFR: Fc was 0-100% of the dosage in 2015, the health insurance expenditure increased by about 5.22-10.43 billion yuan and that of rheumatism drugs increased by 63.44% ~ 126.87 %, All Medicare spending increased 0.04% ~ 0.08%. According to 80% of the reimbursement ratio, the increase of their medical insurance expenses will be reduced accordingly. Conclusion: The entry of rh TNFR: Fc into the catalog has a great influence on the health insurance expenditure of rheumatoid drugs, but it has a small effect on the total expenditure on health insurance.