China

In China's healthcare insurance system, expert teams play a crucial role, particularly in the process of updating and adjusting the medical insurance drug list. Chinese healthcare insurance experts are typically divided into three main groups:

Clinical Group: This group consists of experts with extensive clinical experience. They are responsible for evaluating the clinical necessity and effectiveness of drugs in the medical insurance drug list. The clinical group experts are selected from a national expert pool designated by the government, and their clinical judgments are critical in determining which drugs should be included or excluded from the insurance list.

Economics Expert Group: This group focuses on the economic impact of drug usage. They assess the costs required to use the drugs on patients and the resulting health benefits. Through detailed cost-benefit analyses, these experts ensure that the use of healthcare funds maximizes health returns.

Healthcare Insurance Fund Assessment Group: This group specializes in assessing the financial feasibility of including certain drugs in the insurance list. Their task is to evaluate whether the healthcare insurance fund has sufficient resources to cover the drugs once they are included, ensuring the balance and sustainability of the insurance fund.

These expert groups work collaboratively within China's healthcare insurance system, ensuring that the medical insurance drug list is scientifically sound, equitable, and sustainable.