[1]杨泽瀛,李洪超.健康损失严重性方法应用于医保价值评估的 国际经验与本土化展望[J].卫生经济研究,2026,43(06):30-33,38.
　YANG Zeying,LI Hongchao.International Experiences and Localization Prospects of the Application of the Severity Shortfall Method in Health Insurance Value Assessment[J].Journal Press of Health Economics Research,2026,43(06):30-33,38.
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健康损失严重性方法应用于医保价值评估的 国际经验与本土化展望

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年06期
页码:
30-33,38
栏目:
卫生技术评估
出版日期:
2026-06-03

文章信息/Info

Title:
International Experiences and Localization Prospects of the Application of the Severity Shortfall Method in Health Insurance Value Assessment
作者:
杨泽瀛1; 李洪超1; 2
1.中国药科大学国际医药商学院，江苏 南京 211198
2.中国药科大学药物经济学评价研究中心，江苏 南京 211198
Author(s):
YANG Zeying;  LI Hongchao
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China
关键词:
医保价值评估; 健康损失; 疾病严重性; 公平性
Keywords:
health insurance value assessment;  health loss;  disease severity;  equity
分类号:
R19；F840.684
文献标志码:
A
摘要:
在医保基金约束下，如何平衡效率与公平已成为医保制度改革的重要课题。健康损失严重性方法通过绝对健康损失与相对健康损失两项指标量化疾病严重性，突破了依赖专家判断的局限性，提高了医保决策的透明度和公平性。荷兰、挪威和英国已将健康损失严重性方法制度化应用于卫生技术评估，并在医保支付决策中发挥作用。对我国而言，健康损失严重性方法有助于识别临床需求，优化医保资源配置，但其本土化应用在数据可得性、方法适配性、社会接受度等方面面临挑战。未来，应通过试点探索与偏好研究，逐步构建符合我国国情的健康损失严重性量化框架，为医保体系实现“支持真创新”与“保障公平性”的双重目标提供决策支持。
Abstract:
Under the constraints of health insurance funds, balancing efficiency and equity has become a critical issue in health insurance system reform. The Severity Shortfall approach, which quantifies disease severity through Absolute Shortfall(AS) and Proportional Shortfall(PS), overcomes the limitations of expert-based judgments and introduces a transparent and comparable equity dimension into health insurance decision-making. Countries such as the Netherlands, Norway, and the United Kingdom have institutionalized this method within health technology assessment, where it plays a role in reimbursement decisions. For China, this approach can help identify clinical needs and optimize the allocation of health insurance resources. However, localization faces challenges in terms of data availability, methodological adaptation, and social acceptability. In the future, through pilot exploration and preference research, a quantitative framework for the severity of health losses that aligns with China's national conditions should be gradually established, providing decision support for health insurance system to achieve the dual goals of encouraging genuine innovation and ensuring equity.

参考文献/References:

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更新日期/Last Update: 2026-06-03