Bellanger Martine M, Cherilova Veneta, Paris Valérie
Institut de Recherche et de documentation en Economie de la Santé, France.
Eur J Health Econ. 2005 Dec;Suppl(Suppl 1):24-9. doi: 10.1007/s10198-005-0315-0.
The French "Health Benefit Basket" is defined principally by positive lists of reimbursed goods and services; however, global budget-financed hospital-delivered services are more implicitly defined. The range of reimbursable curative care services is defined by two coexisting positive lists/fee schedules: the Classification Commune des Actes Médicaux (CCAM) and the Nomenclature Générale des Actes Professionnels (NGAP). The National Union of Health Insurance Funds has been updating these positive lists since August 2004, with the main criterion for inclusion being the proposed procedure's effectiveness. This is assessed by the newly created High Health authority (replacing the former ANAES). In addition, complementary health insurers are consulted in the inclusion process due to their important role in French health care financing.
法国的“医保福利篮子”主要由可报销商品和服务的正面清单来界定;然而,由全球预算资助的医院提供的服务界定则较为模糊。可报销的治疗护理服务范围由两个并存的正面清单/收费表界定:医疗行为通用分类(CCAM)和专业行为通用命名法(NGAP)。自2004年8月以来,全国医疗保险基金联盟一直在更新这些正面清单,纳入的主要标准是所提议程序的有效性。这由新成立的高级卫生管理局(取代了前ANAES)进行评估。此外,在纳入过程中会咨询补充健康保险公司,因为它们在法国医疗保健融资中发挥着重要作用。