In order to further promote the reform of medical service price and strengthen the macro management of medical service price, the author constructed a calculation method for price adjustment space of medical service. This study was centered on two parameters of the historical base and the growth coefficient, to calculate the total amountof price adjustment. The historical base used the total revenue of medical services in the region from the previous year, and the growth coefficient was measured by two methods, the comprehensive indicator method and the consumer price index (CPI) reference method.Taking Suzhou, a national pilot city, as an example, the historical base in 2022 was 18 754 million yuan. By using the comprehensive indicator method, the annual growth coefficient was calculated to be 2.38%, and adjustment space of medical service price was 446.35 million yuan; According to the CPI reference method, the growth coefficient of Suzhou was 2.10%, and adjustment space of medical service price was 393.83 million yuan.The two methods for calculating the total amount each have their own advantages and disadvantages, and need to be further optimized and improved by drawing on the practical experience of reform in each pilot city.

医疗器械作为生命科学领域内的关键产业,该领域发展政策的制定也是我国医改进程中无法回避的重要课题.近年来,英国的生命科学领域发展迅速,了解和分析英国生命科学领域医疗器械产业的发展趋势、组织机构及其变革措施,发现英国更加强调整体发展环境的建设,以创新研发为着力点,围绕全行业的发展,最终落地于相关医疗器械在卫生行业的应用,可为我国更好地将医疗器械融入新形势下医改政策提供借鉴.

美国作为商业医疗保险体系发展较为成熟的典型国家,其医保管理费用能够较好地反映商业保险公司经办效率情况.本文基于对美国各类医保项目管理费用相关数据的整合统计,分析总结商业保险公司管理费用水平特点和原因,以期为我国合理设计医保经办管理费用投入、完善医疗保险经办管理服务体系建设提供一些实践信息参考.

共同富裕是社会主义的本质要求,推动医疗保障高质量发展是实现共同富裕的重要方面,当前我国健康服务供给总体不足和人民医疗服务需求不断增长之间的矛盾依然突出.尤其是对于发病率低的小群体来说,比较突出的问题是可选择的治疗药品很少并且费用高昂,如何保障这类群体的用药需求和减轻其疾病负担是我国改善健康公平、实现共同富裕的一个重要研究课题.目前不少国家开始探索专项基金保障模式,用以平衡保障疾病负担和经济负担极重小群体的高值药品用药需求和广大参保人基本用药需求之间可能存在的矛盾,其中以英国从癌症药物基金开始探索的高值创新药品用药保障专项基金模式最为典型.基于此,本文从支付端视角出发,从药品准入和退出机制、资金筹集和风险控制机制、数据收集和管理机制等多维度对英国高值创新药品支付保障机制进行深度分析,并提炼总结其独立筹资、过渡性、附条件性、可控性、多维度管理等特点.

The reform of medical service prices in China has been launched, and the reasonable pricing and management of medical technology services are of great significance for improving patient well-being and advancing the reform of our medical system. The author provided a detailed review of the policy evolution, current management status, and main issues of medical service price management in China since 2000. The medical service price management policies in China since 2000 were divided into four evolutionary stages: initial exploration of decentralization, substantial development, continuous advancement, and deep promotion. The author also described the formation mechanism and pricing methods of international medical service prices, and compared the similarities and differences in medical service price management at home and abroad. Some suggestions were put forward for improving the macro reform of medical service price management in China.

通过梳理全国各省(区、市)出台的城乡居民高血压、糖尿病门诊用药保障政策,了解各地开展城乡居民"两病"门诊保障的模式和特点.目的在于掌握不同地区"两病"保障的辐射对象、认定标准、待遇水平以及提供服务的机构类型;理解"两病"专项保障在"两病"保障体系中发挥的作用;为扩大"两病"保障范围、提升保障效果提供未来政策优化的依据.

OBJECTIVE To learn from 340B drug pricing program（short for 340B program） in the United States, and provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States, and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel” policy in China. RESULTS ＆ CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions, which easily led to duplicate discounts and drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions, coupled with the economic incentives brought by the sale of drugs, the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard, when China is carrying out the construction of designated retail pharmacies under the “dual channel” policy, it is necessary to clarify the selection criteria for designated retail pharmacies, enhance the financial transparency of medical institutions and designated retail pharmacies, establish a scientific prescription circulation mechanism, strengthen the review and certification of insured patients and prescriptions, and improve the supervision and management mechanism. Meanwhile, the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions, so as to achieve the availability of drugs without abuse, and effectively control costs.

Objective:To design a set of evaluation index system for the medical service price reform mechanism, so as to provide reference for the evaluation of deepening the medical service price reform mechanism.Methods:On the basis of searching literature of medical service prices reformfrom August 2021 to March 2023, policy logic analysis and expert consultation were used to construct evaluation indexes for the medical service price reform mechanism, set evaluation index thresholds, and assign scores to index thresholds in different grades.Results:The evaluationindex system of medical service price reform mechanism included 5 level-1 indexes, 12 level-2 indexes and 35 level-3 indexes. After scoring, the scores of 5 level-1 indexes were 12, 24, 35, 21, and 8, respectively.Based on the percentile scoring method, the evaluation criteria were categorized into five grades: premium, excellent, good, average and failure.Conclusions:This study constructed a set of evaluation index system for the mechanism of medical service price reform, which had strong scientific and operability. However, due to the fact that medical service price reform in the new era is still in its initial stage, the index system need to be further optimized drawing on the practical experience of reforms in pilot cities.

Objective To analyze and evaluate the progress and effect of the salary system reform of public hospitals China,which is oriented to increase the value of knowledge. Methods Based on the thematic content and descriptive statistical analysis methods,the policy characteristics and effect of the public hospital salary system reform in different regions of China were summarized and evaluate. Results In the process of reform,various regions mainly focus on improving the post-performance salary system,gradually increasing the proportion of fixed salary,the salary expenditure still mainly comes from service income,and many regions implement the hospital presidents’ yearly salary system,the per capita wage level of public hospitals in various regions is generally controlled within 2～4 times of the per capita wage level of local（other） public institutions. On the whole,in recent years,the per capita wage of public hospitals across the country has reached 1.8～1.9 times of the average social wage. In 2021,the proportion of public hospital personnel expenditure in business expenditure reached 41.1%. Conclusion The reform of the remuneration system in public hospitals in China has achieved phased results. The incentive and restraint mechanism for the public hospital presidents’ remuneration has been basically completed. The per capita wage level and the proportion of personnel expenditure in business expenditure in public hospitals have been continuously increasing. However,the way of payment,the structure of remuneration and the source of funds for medical personnel still need to be further optimized and improved.

医疗保障宏观筹资负担能够反映医保制度对社会经济发展和家庭经济承受能力的适度性,是衡量医保制度运行效率的重要指标.本文厘清不同模式下典型国家的医疗费用统计口径,按照我国医保支出口径统计典型国家医保支出规模,结合宏观视角与微观视角、共时角度和历时角度,构建指标体系对各国的医保制度对经济发展适度性程度和医保制度运行效率进行比较,同时拓展研究内容至36 个OECD成员国,并对同等经济发展水平和人口老龄化程度下的医保制度运行效率进行分析.研究表明,在3种典型医疗保险模式的8个国家中,我国医保制度对宏观经济社会和微观家庭的经济负担最轻,制度运行效率最高,但宏观成本增速最快.因此,建议抓住医保改革机遇期,着力降低医保支出增速,确保群众医保待遇改善和经济社会发展同向而动.

Objective The purpose of the extension of the RIGHT Statement for INTroductions and INTerpretations of Clinical Practice Guidelines (RIGHT for INT) is to promote the development of comprehensive and clear articles that introduce and interpret clinical practice guidelines. Methods The RIGHT for INT checklist was developed following methods recommended by the EQUATOR Network. The development process included three stages. In the first stage, a multidisciplinary team of experts was recruited by email and WeChat and further divided into three groups (a steering group, a consensus group, and a secretariat group); in the second stage, the initial items were collected by literature review and brainstorming; and in the third stage, the final items were formed through a Delphi survey and expert consultation. Results A total of 40 initial items were collected through literature review and brainstorming. A final checklist of 27 items was formed after the Delphi survey and expert consultation. The RIGHT for INT checklist contains items on the following 10 topics: title, abstract, background of guideline interpretation, background of guideline development, guideline development methodology, recommendations, strengths, and limitations, implications for local guidelines and clinical research, dissemination and implementation, and reporting quality. Conclusion The RIGHT for INT checklist provides guidance for guideline interpreters on how to introduce and interpret clinical practice guidelines in a scientific and comprehensive manner.

Optimizing the drug price management mechanism and improving the availability and affordability of drugs are important in deepening the medical and health reform. The price of drugs in the United States has always been higher than the world average. The price of drugs, the total expenditure on drugs and the personal burden of patients have shown an increasing trend. By exploring the causes of high drug prices in the United States, the author found that there were four main reasons for the current situation of drug prices in the United States, including the interests of enterprises, the limited competition mechanism of the US drug market, relatively insufficient market bargaining power of the US payers, and opaque mechanism of price formation.Firstly, pharmaceutical companies try to achieve their interests by raising drug prices. Secondly, the price formation mechanism of the United States drug market is affected by the price strategy of pharmaceutical companies, and government policies also indirectly affect the role of the market. Thirdly, the payers in the United States are relatively scattered, so that the market bargaining power is relatively insufficient.Fourthly, due to the numerous drug circulation links and stakeholders, the drug price formation mechanism is opaque and lacks supervision. Therefore, when strengthening drug price management in China, we should build a coordination mechanism between the government and the market on the basis of the existing basic economic system and drug management mechanism, establish the strategic purchase and negotiation position of medical insurance for drugs, enhance the transparency of drug circulation and trading, and establish a scientific pricing system. It is also important to promote drug innovation and ensure drug quality.

HTA在我国医保决策领域的应用虽处于起步阶段,但由于学科特点与医保决策需求的高度契合性,未来将有很大的实践应用空间.我国医保管理体系与国外不同,不能盲目照搬国外模式,需要在不断的实践摸索中探索一条具有我国特色的医保HTA应用之路.医保HTA的长久持续发力离不开政府部门在机制化建设方面的久久为功,医保部门可以结合国家医保药品目录调整等改革任务,为HTA的体系建设进行积极探索,逐步形成中国医保HTA发展模式.本文介绍了卫生技术评估作用、概念和国际实践经验,并提出了对卫生技术评估在我国医保决策应用中的相关思考.

全球新冠肺炎疫情防控呈现不同效果,除与国家体制、防疫政策、公共卫生能力等方面有关外,医疗保障制度也是重要变量.本文从各国疫情防控绩效出发,深入分析社会医疗保险和国家卫生服务体系(NHS)两种医疗保障制度的特点和优劣,为我国完善医保制度和疫情防控提供借鉴.

目的 综述曲妥珠单抗治疗HER2阳性转移性胃癌的经济学评估情况,以期为曲妥珠单抗的利用提供参考.方法 通过对Medline、EMBASE、PubMed、Cochrane library等英文数据库与中国期刊全文数据库、万方数据知识服务平台等中文数据库的检索,对曲妥珠单抗治疗HER2阳性转移性胃癌的经济学评估情况进行总结归纳.结果 目前对于曲妥珠单抗治疗HER2阳性转移性胃癌的经济学评估主要基于ToGA试验结果.曲妥珠单抗在治疗HER2阳性转移性胃癌方面,一项英国的研究结果显示当HER2阳性胃癌患者定义为IHC3+患者时,曲妥珠单抗的增量成本-效果比值(ICER)为45000～50000英镑/QALY;在一项日本的研究中,根据HER2阳性晚期胃癌患者的细分不同ICER值为610～1200万日元(55000～110000欧元)/QALY;在一项爱尔兰的研究中,针对治疗IHC3+或IHC2+且FISH阳性的HER2阳性晚期胃癌患者ICER值为68000欧元/QALY;而在两项中国的研究中,曲妥珠单抗治疗HER2阳性转移性胃癌的成本-效果分别为250163美元/QALY和27911.3元/月.结论 曲妥珠单抗治疗HER2阳性胃癌患者的成本-效果受到患者人群定义范围的影响,曲妥珠单抗治疗HER2阳性转移性胃癌仅在英国和日本的研究中针对IHC3+患者具有成本-效果优势.

基于我国医疗服务价格项目管理现状,对卫生技术评估在医疗服务价格项目申报、定价与调整、医保准入和支付标准确定中的应用进行深入探讨.卫生技术评估(Health Technology Assessment,HTA)作为一项决策支持工具,能够为医疗服务价格项目的定价(包括后期确定医保准入和支付标准)提供循证依据,并有望成为解决我国医疗服务价格项目定价方式单一、医保准入缺乏全面证据、更新慢、价格调整频率低等问题的一个路径.为了进一步发挥卫生技术评估在医疗服务价格项目管理中的功能,还需继续强化各方对HTA认识,提高HTA能力,利用大数据解决HTA难题.

Background This study investigated different patterns of emotional labor among community nurses in China and analyzed the relationships between the sense of career success and emotional labor. Methods A total of 385 community nurses from Beijing participated in this investigation. Latent class analysis was used to identify meaningful subgroups of participants, and analysis of variance was used to analyze relationships between emotional labor classes and the sense of career success. Results Emotional labor among community nursing staff in China was divided into three latent classes: active (n = 90, 25.6%), apathetic (n = 65, 18.5%), and moderate (n = 197, 55.9%). The active emotional labor classes had significantly higher career success (p<0.05). The “gaining recognition” dimension showed significant differences across the three classes. Conclusion Our findings suggested managers to implement a variety of measures to strengthen interventions for employees’ emotional labor that are targeted to incentive mechanisms, which will improve nurses’ sense of career success.

国家药品谈判机制是当前我国推动医疗保障改革高质量发展的重要制度安排,本文在政策扩散理论视角下,从时间、空间、主体、内容和路径五个维度出发,探讨2009—2021年我国谈判药政策的扩散机制.结果表明,我国谈判药政策扩散存在一定的独特性,但整体符合我国医改特色路径.时间维度上,扩散曲线呈近似的S型分布;空间维度上,国家行政推动会改变层级效应和地缘邻近效应的效果;主体维度上,扩散主体的合作关系存在明显的阶段性;内容维度上,扩散后期更注重创新,政策的关注点呈现由服务创新逐渐向流程创新和辅助创新过渡、三者并行的趋势;路径维度上,相同政策领域可能存在不同的扩散路径,以特殊药品管理和"双通道"机制为例,扩散路径略有不同,表现出地方政府探索、中央政府政策吸纳后垂直影响和高位推动的扩散模式.综合理解药品谈判政策创新扩散规律,为推进我国卫生领域公共政策创新扩散进程、保障政策落地质量提供参考.

英国建立了相对完善合理的药品定价制度机制,并随其国情变化而不断更新.其品牌药品定价和准入自愿计划、高度专业化技术评估以及社区药房合同框架等新政的推行在合理控制卫生支出、保证患者用药、强化创新活力这些矛盾目标之间取得了较好的平衡.本文对英国的药品定价政策及最新进展进行研究,借鉴其有益思路与方法,在中国药价形成领域的管控方式、参与机制、评估评价方法以及药品补偿机制等4个方面提出启示和政策建议.

目的:研究美国Medicaid项目处方药费用控制措施,为我国医保药品支出控制改革提供参考.方法:通过研读政策文件、学术论文和新闻报道等,梳理美国Medicaid项目的药品费用控制政策的做法和对医保费用影响,并提出对我国医保药品控费的建议.结果与结论:美国Medicaid项目处方药费用控制措施包括药品利用管理和药品控费新措施,前者包括首选药品清单、事先授权和分步治疗、处方限额,后者包括药品支出增长上限控制、封闭式药品目录管理等.首选药品清单是一系列药品控费措施的基础,为事先授权和分步治疗提供了政策框架;事先授权和分步治疗是控费的具体做法,通过对具体病例的引导鼓励低价药品的使用;处方限额从控制单一患者用药费用入手,从另一个角度节省医保支出;药品支出增长上限控制是从医保支出总费用角度进行的控费,是对传统方法的补充;封闭式药品目录管理是突破首选药品清单局限性的新的政策尝试.Medicaid项目采用的处方药控费措施一定程度上能够有效缩减其药品支出,但也因可干预医师处方权,存在损害患者利益的可能性.我国应通过加强医保在医疗服务体系中的作用,谨慎借鉴美国Mdeicaid药品利用管理措施;健全医保支出费用动态控制机制,针对重点药品采取特别措施;健全药品目录管理机制,抓好准入、退出和动态调整三个环节,引导医疗机构合理用药.