[1]敬睿智,石可凡,王 昌,等.医保医用耗材支付标准制定策略研究[J].卫生经济研究,2026,43(03):29-32.
　JING Ruizhi,SHI Kefan,WANG Chang,et al.Study on Strategies for Establishing Medical Insurance Payment Standards for Medical Consumables[J].Journal Press of Health Economics Research,2026,43(03):29-32.
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医保医用耗材支付标准制定策略研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年03期
页码:
29-32
栏目:
医疗保障
出版日期:
2026-03-03

文章信息/Info

Title:
Study on Strategies for Establishing Medical Insurance Payment Standards for Medical Consumables
作者:
敬睿智1; 石可凡1; 王 昌1; 徐 伟1
1.中国药科大学国际医药商学院，江苏 南京 211198
Author(s):
JING Ruizhi;  SHI Kefan;  WANG Chang;  XU Wei
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China
关键词:
医用耗材; 医保支付标准; 医保目录
Keywords:
medical consumables;  medical insurance payment standards;  medical insurance catalogue
分类号:
R19
文献标志码:
A
摘要:
当前，我国各统筹区的医保医用耗材支付管理存在目录管理精细度不一致、通用名管理不规范、支付标准测算规则不统一等问题。基于我国医用耗材医保目录管理的特点，借鉴国际经验，提出基于15位码医用耗材代码的分层分类支付标准测算规则：对集中采购耗材，以中选价格作为支付标准；对非集中采购耗材，依据变异系数区分价差大小，采用量价加权法测算医保支付标准或形成多个医保支付标准。同时，细化医用耗材通用名，规范医用耗材医保目录动态调整机制。
Abstract:
At present, medical insurance payment management for medical consumables across coordinated regions in China faces issues such as inconsistent precision in catalog management, non-standardized generic name management, and non-uniform rules for calculating payment standards. Based on the characteristics of medical consumables insurance catalog management and drawing on international experience, the calculation rules of hierarchical and classification payment standard are proposed based on the 15 digit medical consumables code. For centralized procured consumables, the winning bid price serves as the payment standard; for non-centralized procured consumables, the price differential is differentiated based on the coefficient of variation, and the volume-based-price weighted method is used to calculate the payment standard or establish multiple payment standards. At the same time, it is necessary to refine generic names of medical consumables, and standardize the dynamic adjustment mechanism of the medical insurance catalog for medical consumables.

参考文献/References:

[1] 熊先军.医保评论[M].北京：工业出版社，2016.
[2] 季煦，王谦，张欲晓，等.德国医用耗材医保准入管理的启示[J].中国卫生政策研究，2021，14（11）：75-80.
[3] 谭清立，周芷婷.医用耗材带量采购的医保支付政策研究[J].卫生经济研究，2021，38（11）：6-9.
[4] 常峰，崔鹏磊，夏强，等.德国药品参考价格体系对构建我国医保支付标准的启示[J].中国卫生政策研究，2015，8（07）：55-60.
[5] 李孜，刘宇刚，陈偲演，等.德国参考定价制度对我国非独家药品医保支付标准的启示[J].中国医疗保险，2023（03）：48-52.
[6] 王琳宁，路云.日本“价格带”汇总的医保支付标准调整方式及启示[J].中国医疗保险，2023（02）：12-18.
[7] 蒋理添，季煦，林艾灵，等.医用耗材管理与支付的相关经验与启示[J].中国医院管理，2023，43（07）：92-96.
[8] 孔维政，牟崇婷，于保荣.医用耗材医保准入机制研究[J].卫生经济研究，2023，40（09）：19-22.
[9] 刘美彤，钟磊，郭武栋，等.医保医用耗材目录准入管理的现状分析与对策[J].中国医院管理，2023，43（08）：67-70.
[10] 艾亚萍，胡善联，赵琨，等.创新高值医用耗材及其配套医疗服务价格项目医保准入管理研究[J].中国医疗保险，2025（02）：68-76.
[11] 谭华伟，焦培峻，王彩云.高值医用耗材医保准入与支付机制的国际经验与中国实践[J].卫生经济研究，2021，38（03）：44-49.
[12] 邱英鹏，赵羽西，赵翔，等.澳大利亚假体类高值医用耗材医保准入管理经验及启示[J].中国卫生质量管理，2021，28（05）：12-15.
[13] 李佳明，杨烁，孟凡月，等.日本医用耗材医保目录管理研究[J].中国医院，2024，28（05）：50-54.

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更新日期/Last Update: 2026-03-03