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目的:了解山东省青岛市、江苏省和浙江省医疗保险特殊用药谈判制度的基本情况。方法:查阅山东省青岛市、江苏省和浙江省与医疗保险特殊用药谈判制度相关的政策法规,从谈判机制、保障对象、支付范围、筹资机制及补偿水平五个方面进行比较。结果:青岛市筹资来源于财政拨款,谈判涉及药品和医用材料,覆盖重大疾病、罕见病及慢性病;江苏省无进行额外筹资,有针对性地救助乳腺癌和慢性髓性白血病患者,并将仿制药纳入了谈判范围;浙江省建立了财政补贴与个人缴费的分担机制,没有限定医疗保险特殊用药的临床指征,实行按费用分段补偿。结论:为进一步完善制度,可鼓励医疗保险特殊用药赠送谈判;增加罕见病用药,逐步纳入医用材料;建立医疗保险特殊用药保障目录的动态调整机制。
Objective: To understand the basic situation of medical insurance special medication negotiation system in Qingdao, Jiangsu and Zhejiang Provinces. Methods: Check out the policies and regulations related to medical insurance special medication negotiation system in Qingdao, Jiangsu and Zhejiang Provinces from five aspects: the negotiation mechanism, the object of protection, the scope of payment, the financing mechanism and the level of compensation. Results: The financing of Qingdao came from the financial appropriation, the negotiation involved the medicine and the medical material, covered the major disease, the rare disease and the chronic disease. In Jiangsu Province, without additional funding, targeted rescue of breast cancer and chronic myeloid leukemia patients, and imitation Pharmaceutical included in the scope of negotiations; Zhejiang Province established a mechanism for sharing financial subsidies and individual contributions, there is no limit on the clinical indications for special medical insurance, the implementation of the cost of sub-compensation. Conclusion: In order to further improve the system, we can encourage medical insurance special drug donation negotiation; increase rare disease drug and gradually incorporate medical materials; and establish a dynamic adjustment mechanism for medical insurance special drug protection directory.