慢病新技术纳入医保报销范围的知证决策模型构建及实证研究

The heavy burden of chronic diseases calls for the evidence-informed decision making, and reimbursement decision makers need to make evidence-informed decision. However, methodology for evidence-informed decision making for the inclusion of new medical technologies for chronic diseases has not been well established, and the model for evidence-informed decision making remains undeveloped. This study will follow the logic research path of theory analysis—influencing factors and evidence types investigation—decision criteria analysis and model construction—demonstration and validation, focus on the evidence-informed decision making of integrating new medical technologies for chronic diseases into the reimbursement list. The study will use both quantitative and qualitative methods, manifest the notion of evidence, context of decision and value, and focus on the key elements of evidence-informed decision making to do the empirical research. As a result, the basis for decision-making and the form for evidence summary will be identified, and the decision criteria which is based on the evidence, reimbursement context, practice of new technology, and value of the insured will be proposed, and the model of evidence-informed reimbursement decision making to include new medical technology for chronic diseases will be developed. New medical technology for diabetes, hypertension, chronic hepatitis B virus infection and cancer will be screened to do empirical analysis and to validate the model. Methods such as multivariate statistical analysis, structural equation modeling, and multi-criteria decision analysis will be adopted in the data analysis. The study will expand the traditional concept of evidence, extend the research perspective of evidence-informed decision making, and propose evidence-based informed reimbursement suggestions, thus promoting the evidence-informed and transparent reimbursement decision making on the integration of new medical technologies for chronic diseases.

慢病带来的沉重社会负担呼吁知证决策，医保决策者需要知证决策，然而目前知证决策面临方法学瓶颈，慢病新技术纳入医保报销范围的知证决策模型缺失。研究遵循“理论分析——决策因素与证据类型研究——决策准则分析与模型构建——实证验证”的研究思路，聚焦于慢病新技术纳入医保报销范围的知证决策。采用定性与定量相结合的研究方法，将证据、决策情境与价值观相结合、围绕知证决策的核心要素进行实证调研，探讨决策依据和证据的呈递形式，提出基于证据、结合医保决策情境、新技术应用和体现参保者利益的决策准则，形成慢病新技术纳入医保报销范围的知证决策模型，并以糖尿病、高血压、慢性乙型肝炎、肿瘤的新技术为例进行实证验证。研究将采用多元统计、结构方程模型和多准则决策分析等方法分析数据。课题将延伸传统的证据内涵，拓展知证决策的研究视角，提出我国慢病新技术纳入医保报销范围的知证决策建议，促进慢病新技术纳入医保报销范围的知证、透明决策。

慢病带来的沉重社会负担呼吁知证决策，本项目基于研究者、决策者、患者、医务人员等多方视角，聚集慢病新技术医保报销的知证决策，探讨可行的决策支持理论与方法。系统评价发现，医保报销决策时最多提及的决策维度是技术的比较结果、技术的经济性和技术的需要。项目组制定的医保报销知证决策框架由通用准则和情景化准则组成。通用准则体了技术的需要、技术的比较结果和技术的经济性；情景化准则体现了医保的使命和任务、优先重点人群和可及性、共同目标和特定利益、政策背景以及医保基金的可承受性。该框架有助于决策者结合证据确定医保报销的优先技术。为了辅助医保报销的知证决策，项目组构建医保报销决策支持系统，设计以患者为中心的证据呈递方式和沟通工具并开发病友网络。项目组以高血压和糖尿病的治疗性新技术为例，分别以慢病患者和医务人员为研究对象开展实证研究。离散选择实验结果表明慢病患者重视新技术对健康产生的益处和风险，新技术的医保报销决策与患者自身的患病经历和感受密切相关；医务人员侧重于新技术对健康产生的风险、益处以及目标慢病的严重程度。本项目综合考虑政策和制度因素、技术的属性、慢病患者的真实体验等多方面考虑，通过实证研究构建了影响慢病患者医保报销满意度的结构方程模型，结果表明慢病患者对医保报销的期望相符程度、政策认知程度和医保价值感知对其满意度产生正向影响。.综上，慢病新技术医保报销的知证决策是基于研究证据，充分考虑患者的价值观和意愿，结合医保报销实情进行决策，有助于提升医保资金的使用效率，改善慢病患者的健康和对医保的满意度。建议决策者知证遴选纳入医保报销的慢病新技术，将具有确切疗效、健康收益和安全性的新技术作为优先级。除了常见的慢病治疗技术，建议进一步考虑针对重症患者的医疗技术，关注现有医保报销目录中无备选方案的新技术。