柳鹏程 李灿 王文 王敏娇 杜怿 方刚 姚文兵

摘 要 目的：研究歐洲部分国家的医保预算影响分析（BIA）指南或规范性文件，为我国医保BIA指南的制定与实施提供参考。方法：检索爱尔兰、法国、波兰、比利时、英国等欧洲国家的医保BIA指南或相关文件，总结其基本分析框架和特殊规定，进行对比分析，并提出我国医保BIA指南的制定与实施建议。结果与结论：上述5个欧洲国家的医保BIA指南或文件一般从预算持有人的角度出发，研究3～5年内卫生技术的成本对资源的影响。其指南或文件分析框架基本一致，但在医保BIA的定位、成本数据纳入范围、模型设计、人群亚组分析等方面，各国指南或文件均根据本国卫生体系特征进行了调整，如爱尔兰在成本数据纳入、敏感性分析和对数据来源方面有特殊要求，法国则在医保BIA模型、敏感性分析和医保BIA结果呈现方面进行了细节性规定。我国应在医疗卫生决策中重视医保BIA的作用，制定我国的医保BIA指南以规范实证研究，并在制定指南时结合我国卫生体系特点。建议我国医保BIA指南应至少包括研究角度、研究时限及贴现、参比情形、目标人群、成本、市场份额、数据来源、不确定性分析等整体框架或基本要素，充分保障医疗卫生基金的平稳运行。

关键词 欧洲国家;医保;预算影响分析;指南;启示

ABSTRACT   OBJECTIVE： To study the medical insurance budget impact analysis （BIA） guidelines or nomative documents of some European countries， and to provide the suggestions for the formulation and implementation of medical insurance BIA guidelines in China. METHODS： Medical insurance BIA guidelines or related documents in European countries such as Ireland， France， Poland， Belgium and UK were retrieved to summarize and comparatively analyze the general analysis framework and special specification. The formulation of medical insurance BIA guideline in China and the suggestions were put forward. RESULTS & CONCLUSIONS： The above-mentioned medical insurance BIA guidelines or documents of the five European countries generally study the impact of the cost of health technology on resources within 3-5 years from the perspective of budget holders. The analysis framework of the guidelines or documents is basically the same， but the guidelines or documents are adjusted according to the characteristics of national health system in terms of the positioning of medical insurance BIA， the scope of cost data inclusion， model design， population subgroup analysis and so on. For example， Ireland had special requirements on cost data inclusion， sensitivity analysis and data source， while France had detailed regulations on medical insurance BIA model， sensitivity analysis and presentation of medical insurance BIA results. Our country should pay attention to the role of medical insurance BIA in medical and health decision-making， formulate Chinas medical insurance BIA guidelines to standardize empirical research， and combine the characteristics of Chinas health system when formulate the guideline. It is suggested that  Chinas medical insurance BIA guidelines should at least include research perspective， research time limit and discount， reference situation， target population， cost， market share， data source， uncertainty analysis and other overall framework or basic elements to ensure the smooth operation of medical and health funds.

KEYWORDS   European countries; Medical insurance; Budget impact analysis; Guidelines; Englightenment

医保预算影响分析（Budget impact analysis，BIA）是一种药品在进入财政资源有限的药品偿付系统时用来评估和预测其潜在经济影响的工具[1]，也可用于预测一种治疗方案的变化对医疗总费用的影响。……