Application of Actuarial Technology in the Negotiation of National Medical Insurance Drug List

In order to reduce the personal burden of medical expenses and improve the Chinese patients’ sense of acquisition, happiness and security, in 2017, the Ministry of Human Resources and Social Security organized the negotiation of National Medical Insurance Drug List. For the first time, 44 proprietary drug with definite curative effect, clinical necessity, safety and reliability but high price determined by experts’ review were negotiated for the admission of medical insurance payment standards, among which, 36 medicines were successfully admitted into the Category B of National Medical Insurance Drug List. The goal of this program is to significantly improve the medical insurance medication usage security, greatly reduce patients’ personal burden, effectively control the fund expenditure, strongly support the medicine innovative, and achieve win-win results for multi-parties. In order to achieve the above-mentioned goals, the negotiation has achieved great results by applying actuarial technology to analyze the medical insurance big data, evaluating the supporting capacity of medical insurance fund, and scientifically calculating the standard of medical insurance payment. The average price reduction of 36 admitted drugs was 44%, with a maximum reduction of 70%, giving full play to the group purchasing capacity of basic medical insurance.

Authorize publication by ISSA
Yes
Award Year
2018
Contact address
No 3, Hepingli Dongjie
CN- Dongcheng District, Beijing, 100013
China
Contact email
fenglimin@mohrss.gov.cn
Country
Main country
Main region