日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 <sup>Δ</sup>

唐璋淳; 卢钰琼; 代展菁; 许佳艺; 虞杰; 路云; 常峰

doi:10.6039/j.issn.1001-0408.2024.13.02

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日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 ^Δ

药事管理 | 更新时间：2026-07-21

- 日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 ^Δ
- Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South Korea on the simple renewal mechanism for negotiated drugs in China
- 中国药房 2024年35卷第13期页码：1552-1557
- 作者机构：
  
  中国药科大学国际医药商学院，南京　211198
- 作者简介：
  
  硕士研究生。研究方向：医药卫生政策与药品采购。E-mail：18783896596@163.com
  教授，博士生导师，博士。研究方向：药品价格与采购政策、卫生技术评估。E-mail：cpucf@163.com
- 基金信息：
  
  中国博士后科学基金第74批面上资助项目(2023M743897)
- DOI：10.6039/j.issn.1001-0408.2024.13.02
  中图分类号： R95
- 收稿：2024-01-02，
  
  修回：2024-05-27，
  
  录用：2024-05-27，
  
  网络首发：2024-07-09，
  
  纸质出版：2024-07-15
- 稿件说明：
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唐璋淳,卢钰琼,代展菁,等.日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 [J].中国药房,2024,35(13):1552-1557.

TANG Zhangchun,LU Yuqiong,DAI Zhanjing,et al.Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South Korea on the simple renewal mechanism for negotiated drugs in China[J].ZHONGGUO YAOFANG,2024,35(13):1552-1557.
唐璋淳,卢钰琼,代展菁,等.日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 [J].中国药房,2024,35(13):1552-1557. DOI： 10.6039/j.issn.1001-0408.2024.13.02.

TANG Zhangchun,LU Yuqiong,DAI Zhanjing,et al.Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South Korea on the simple renewal mechanism for negotiated drugs in China[J].ZHONGGUO YAOFANG,2024,35(13):1552-1557. DOI： 10.6039/j.issn.1001-0408.2024.13.02.

摘要

目的

借鉴日本和韩国医保支付标准调整的实践经验，为我国简易续约规则的完善提供参考。

方法

检索中国知网的相关文献、日本和韩国政府官网的相关政策文件等，从调整条件和调整公式两个方面归纳总结目前日韩调整医保支付标准的做法，并与我国现行简易续约规则进行对比，明晰我国简易续约规则可优化之处，提出政策建议。结果与

结论

在调整方式上日韩与我国相似，对于超量药品根据超量情况计算药品降幅并实施调整；但具体的调整条件和调整公式又有所不同，日韩针对目前超量较大的药品采取线性降价的方式，而我国针对目前和预期均超量较大的药品采取梯度降价的方式。对比分析结果显示，我国已初步建立了符合国情和医保实际的简易续约规则，并采取了一些创新举措，包括考量药品目前与预期的超量情况和在调整公式中引入降幅减半机制；但同时也存在一定不足，如调整条件的指标设置较为单一、调整公式的梯度降价区间过于宽泛，未能充分体现“以量换价”的市场化机制。建议我国医保部门在简易续约时增加对药品基金支出大小的考量、细化调整公式的梯度降价区间、加大对特殊品类药品在新增适应证时的政策倾斜，进一步完善简易续约规则。

Abstract

OBJECTIVE

To learn the practical experience of medical insurance payment standards adjustment in Japan and South Korea， which will serve as a reference for the improvement of simple renewal mechanism in China.

METHODS

Retrieving relevant literature from CNKI and related policy documents from official websites of Japan and South Korea， the medical insurance payment standards adjustment practice in Japan and South Korea would be elucidated from 2 perspectives of adjustment criteria and formulas， and then were compared with the current simple renewal mechanism in China to clarify the areas where simple renewal mechanism in China can be optimized and propose several suggestions.

RESULTS &

CONCLUSIONS

In terms of adjustment methods， Japan and South Korea were similar to China. For excessive drugs， the reduction rate of drugs was calculated based on the situation of excess and adjustments were implemented； however， there were differences in the specific adjustment criteria and formulas. Japan and South Korea adopted a linear price reduction approach for drugs with significant oversupply， while China adopted a gradient price reduction approach for drugs with both current and expected oversupply. The results of the comparative analysis show that China has initially established simple renewal mechanisms that are in line with the national conditions and the actual medical insurance situation， and has taken some innovative measures， including considering the current and expected oversupply of drugs and introducing a halving mechanism in the adjustment formula. However， there are also certain shortcomings， such as a relatively single set of indicators for adjusting conditions and a too broad range of gradient price reduction in adjustment formulas， which fail to fully reflect the market-oriented mechanism of “volume for price”. It is recommended that China’s medical insurance department increase consideration of drug fund expenditures， refine the gradient price reduction range of adjustment formulas， increase policy preferences for special category drugs when adding new indications， and further improve the mechanism for simple renewal.

关键词

Keywords

references

经济日报 . 加速新药准入鼓励行业创新：解读新版国家医保药品目录 [EB/OL ] . （ 2023-06-05 ）[ 2023-12-01 ] . https：//www.gov.cn/zhengce/2023-01/21/content_5738317.htm https://www.gov.cn/zhengce/2023-01/21/content_5738317.htm .

The Economic Daily . Accelerating the access of new drugs and encouraging industry innovation：interpreting the new national medical insurance drug catalogue [EB/OL ] . （ 2023-06-05 ）[ 2023-12-01 ] . https：//www.gov.cn/zhengce/2023-01/21/content_5738317.htm https://www.gov.cn/zhengce/2023-01/21/content_5738317.htm .

常峰，崔鹏磊，夏强，等 . 日本医保药品支付价格调整机制对我国的启示 [J ] . 中国医药工业杂志， 2015 ， 46 （ 8 ）： 915 - 920 .

CHANG F ， CUI P L ， XIA Q ， et al . Medical insurance drugs payment price adjustment in Japan and the inspiration to China [J ] . Chin J Pharm ， 2015 ， 46 （ 8 ）： 915 - 920 .

厚生労働省 . 令和5年度薬価改定について [EB/OL ] . （ 2023-02-02 ）[ 2023-12-01 ] . https：//www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00042.html https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00042.html .

Ministry of Health ， Labour and Welfare . About a fiscal year 2023 revision of drug prices [EB/OL ] . （ 2023-02-02 ）[ 2023-12-01 ] . https：//www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00042.html https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00042.html .

SHIBATA S ， UEMURA R ， SUZUKI T . Evaluating the effectiveness of repricing for market expansion in the Japanese drug pricing system [J ] . Ther Innov Regul Sci ， 2016 ， 50 （ 6 ）： 751 - 758 .

NIKI R . Recent debate over how to tackle rapid increases in pharmaceutical expenditure in Japan [J ] . JMA J ， 2020 ， 3 （ 2 ）： 146 - 148 .

국가법령정보센터 . 국민건강보험 요양급여의 기준에 관한 규칙 [EB/OL ] .（ 2022-10-30 ）[ 2023-12-01 ] . https：//law.go.kr/ https://law.go.kr/ 법령/국민건강보험 요양급여의 기준에 관한 규칙.National Legal Information Center. Detailed rules of National Health Insurance medical benefit standards[EB/OL ] .（ 2022-10-30 ）[ 2023-12-01 ] . https：//law.go.kr/ https://law.go.kr/ 법령/국민건강보험 요양급여의 기준에 관한 규칙.

국가법령정보센터 . 약제의 결정 및 조정 기준 [EB/OL ] . （ 2022-11-13 ）[ 2023-12-01 ] . https：//law.go.kr/admRulLsInfoP.do?chrClsCd=&admRulSeq=2100000215259.National Legal Information Center. Criteria for decision-making and adjustment of medications https://law.go.kr/admRulLsInfoP.do?chrClsCd=&admRulSeq=2100000215259.NationalLegalInformationCenter.Criteriafordecision-makingandadjustmentofmedications [EB/OL ] .（ 2022-11-13 ）[ 2023-12-01 ] . https：//law.go.kr/admRulLsInfoP.do?chrClsCd=&admRulSeq=2100000215259 https://law.go.kr/admRulLsInfoP.do?chrClsCd=&admRulSeq=2100000215259 .

HAN E ， PARK S Y ， LEE E K . Assessment of the price-volume agreement program in South Korea [J ] . Health Policy ， 2016 ， 120 （ 10 ）： 1209 - 1215 .

KIM S ， LEE J H . Price-cutting trends in new drugs after listing in South Korea：the effect of the reimbursement review pathway on price reduction [J ] . Healthcare ， 2020 ， 8 （ 3 ）： 233 - 242 .

雷清强，何紫璇，胡敏，等 . 新增适应证情形下医保药品价格调整的国际经验及其启示 [J ] . 世界临床药物， 2022 ， 43 （ 10 ）： 1292 - 1298 .

LEI Q Q ， HE Z X ， H M ， et al . International experiences and its lessons of medical insurance drug price adjustment in case of indication expansion [J ] . World Clin Drug ， 2022 ， 43 （ 10 ）： 1292 - 1298 .

KANG Y R ， KO S H ， LEE J H . An overview and suggestions of the post-listing control system for pharmaceutical pricing in Korea [J ] . Yakhak Hoeji ， 2017 ， 61 （ 1 ）： 55 - 63 .

国家医疗保障局 . 关于《谈判药品续约规则》的解读 [EB/OL ] . （ 2023-07-21 ）[ 2023-12-01 ] . http：//www.nhsa.gov.cn/art/2023/7/21/art_105_11062.html http://www.nhsa.gov.cn/art/2023/7/21/art_105_11062.html .

National Healthcare Security Administration . Interpretation of the Negotiated Drug Renewal Rules [EB/OL ] . （ 2023-07-21 ）[ 2023-12-01 ] . http：//www.nhsa.gov.cn/art/2023/7/21/art_105_11062.html http://www.nhsa.gov.cn/art/2023/7/21/art_105_11062.html .

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日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 Δ

Enlightenment of the adjustment methods of medical insurance payment standards in Japan and South Korea on the simple renewal mechanism for negotiated drugs in China

DOI：10.6039/j.issn.1001-0408.2024.13.02

摘要

Abstract

关键词

Keywords

references

日韩医保支付标准调整方式对我国谈判药品简易续约规则的启示 ^Δ