我国药品价格调整政策分析：1997—2011年

目的：为全面认识和分析药品价格管理政策提供技术支持。方法：回顾分析了1997年至2011年7月政府针对药品价格的28次调整规定中所涉及的药品种类,利用EXCEL和SPSS17.0统计分析了各类别对应的药品品种数目、调价频率位于前列的部分药品以及其调价幅度等指标。结果：调价药品品种主要集中于抗菌药物、心血管药物、抗肿瘤药物等临床常用和售价相对较高的药品;调价药品所涉及的剂型和规格也为临床常用剂型规格;调价方式主要以降价为主,也有少部分药物的价格略有提升;大多数药物的降价幅度较大,其中对于仿制药的降幅较单独定价药品要大;对于中成药的调价覆盖面广。结论：政府应加强对中药材价格的监管力度;药品价格政策的制定及实施应全面考虑相关利益团体的综合权益,以保证该项政策进入良性运转的轨道。     

Cost-benefit analysis of a national influenza vaccination program in preventing hospitalisation costs in Australian adults aged 50–64 years old

IntroductionInfluenza causes a significant burden among Australian adults aged 50–64, however, vaccine coverage rates remain suboptimal. The National Immunisation Program (NIP) currently funds influenza vaccinations in this age group only for those at high risk of influenza complications.AimsThe main aim of this study was to determine whether a strategy of expanding the government-funded vaccination program to all adults 50–64 in preventing influenza-related hospitalisations will be cost beneficial to the government.MethodsA cost-benefit analysis from a governmental perspective was performed using parameters informed by publicly available databases and published literature. Costs included cost of vaccinations and general practitioner consultation while benefits included the savings from averted respiratory and acute myocardial infarction (AMI) hospitalisations.ResultsIn the base-case scenario, the proposed policy would prevent 314 influenza/pneumonia, 388 other respiratory and 1482 AMI hospitalisations in a year. The government would save $8.03 million with an incremental benefit-cost ratio of 1.40. Most savings were due to averted AMI hospitalisations. In alternative scenarios cost savings ranged from saving of $31.4 million to additional cost to the government of $15.4 million, with sensitive variation in vaccine administration practices (through general practitioner or pharmacists) and vaccine effectiveness estimates.DiscussionExtension of the NIP to include adults 50–64 years of age is likely to be cost beneficial to the government, although this finding is sensitive to vaccine administration cost, which varies if provided through general practitioners or pharmacists; and to variation in vaccine effectiveness. An increased role of pharmacists in immunisation programs would likely result in cost savings in an expanded adult immunisation program.     

How Much Is That Head CT? Price Transparency and Variability in Radiology

PurposeTo extend the investigation of price transparency and variability to medical imaging.MethodsEighteen upper-tier academic hospitals identified by U.S. News & World Report and 14 of the 100 largest private radiology practices in the country identified by the Radiology Business Journal were contacted by telephone between December 2013 and February 2014 to determine the cash price for a noncontrast head CT. The price for a noncontrast head CT was chosen to assess price transparency in medical imaging because it represents a standard imaging examination with minimal differences in quality.ResultsFourteen upper-tier academic hospitals (78%) and 11 private practices (79%) were able to provide prices for a noncontrast head CT. There was no significant difference between the proportions of upper-tier academic hospitals and private practices that were able to provide prices for a noncontrast head CT (P = .96). The average total price for the upper-tier academic hospitals was $1,390.12 ± $686.13, with the price ranging from $391.62 to $2,015. The average total price for the private practices was $681.60 ± $563.58, with the total price ranging from $211 to $2,200.ConclusionsPrices for a noncontrast head CT study were readily available from the vast majority of upper-tier academic hospitals and private practices, although there was tremendous variation in the price estimates both within and between the upper-tier academic hospitals and private practices. Routine medical imaging thus appears to be more price transparent compared with other health care services.     

Price difference as a predictor of the selection between brand name and generic statins in Japan

ObjectivesThis study aimed to explore the predictors of the selection between brand name drug (BR) and generic drug (GE) and to clarify the quantitative relationship about selection.MethodsWe identified “incident users” who dispensed statins between April 2008 and June 2011 in commercially databases consisted of dispensing claims databases (DCD) of out-of-hospital pharmacies and hospital claims databases (HCD) of in-house pharmacies in Japan. Predictors of the selection between BR and GE, including price difference (PD), the price of BR, their interaction and percent change of the price of GE relative to BR were explored by logistic regression using DCD and HCD separately.ResultsWe extracted records of 670 patients who have opportunity for selection both BR and GE. Logistic regression analysis demonstrated that PD, the price of BR, interaction between them, and prescriber affiliation were factors significantly associated with the selection in the DCD; logit (p) = 9.735 − 0.251 × PD − 0.071 × the price of BR + 0.002 × PD × the price of BR − 1.816 × affiliation + 0.220 × gender − 0.008 × age + 0.038 × monthly medical fee. PD was inversely proportional to BR choice in DCD and lead to the opposite result in HCD. Numerical simulation of selection revealed that the quantitative relationships heavily depend on situations.ConclusionsPD and the price of BR are predictors of the selection between BR and GE interactively in out-of-hospital pharmacies, but not in in-house pharmacies of medical facilities. Results may support policies which increase the power of out-of-hospital pharmacies for selection.     

取消药品加成对医疗费用的影响分析

目的为了解取消药品加成对医疗费用的影响,特选取药品零加成后（2018年第一季度）及药品零加成前（2017年第一季度）医院住院病例中的8个病种,对之进行费用分析。方法采用文献分析法分析费用构成变化情况;使用SAS 8.0统计软件和Excel表格进行数据分析;利用复利系数计算法,减少时间因素对费用的影响。结果药品零加成后,8个病种的平均住院费用均有不同程度降低,其中药费因素贡献程度最大。费用结构中,药费比重大幅度下降,治疗费、检查费、化验费、手术病种手术费用均有一定程度上升,平均住院日有不同程度缩短;平均住院床日费用有不同程度下降。药品零加成在一定程度上缓解了“看病贵”问题。结论取消药品加成对降低患者药品费用起到了明显促进作用。医院应进一步加强医院管理和成本核算,提高运行效率。     

Viral infections of the autonomic nervous system and its target organs: Pathogenetic mechanicsms

The possibility that viruses can infect the peripheral autonomic nervous system (ANS) and cause a variety of acute, chronic or recurrent diseases, including such disorders as peptic ulcer, is proposed. By altering the functional activity of autonomic neurons or by seeding the target organs of these neurons with virus, infection of the ANS may produce a broad spectrum of clinical manifestations. Whether these manifestations are anatomically circumscribed or widespread will depend upon the route by which autonomic infection is acquired as well as the character of interaction between the virus and the infected autonomic neuron. In addition, it is proposed that autonomic ganglia may serve as reservoirs of latent viruses, insuring their preservation and intermittent transmission in the human community.     

山东省基层医疗机构基本检验设备国产化现状

目的 调查山东省基层医疗机构检验科4种基本检验设备的配置现状,为国产设备的推广提供依据。 方法 采用分层随机抽样调查的方法,对山东省48家区、县级医院检验科的生化分析仪、血液细胞分析仪、尿液分析仪和化学发光测定仪4种仪器的配置及使用现状进行问卷调查。资料使用 EPIDATA 3.0进行录入,使用SPSS 19.0进行数据分析。 结果 4类设备的国产化比例在不同级别医院之间存在差异,设备产地来源对血液细胞分析仪(P=0.047)、尿液分析仪(P=0.028)和化学发光测定仪(P=0.004)3类设备的价格造成的差异有统计学意义;进口设备超期使用比例高于国产设备,基层医院对国产设备存在一定的未来需求。 结论 国产检验设备可以满足基层医疗机构的基本医疗需求,国家应当加大对国产医疗设备厂家的扶持力度,鼓励基层医院优先购置国产检验设备,提高我国国产医疗设备的市场占有率。     

社区安宁疗护服务项目成本测算研究

背景　安宁疗护项目面临总体经费补偿不足问题,致使安宁疗护服务发展受限,而合理的补偿依赖于对安宁疗护服务项目成本的精确核算。现有研究对安宁疗护补偿分析,多从机构收支缺口入手,缺乏对各项成本消耗的精确核算。目的　测算社区安宁疗护服务项目成本,为安宁疗护服务项目的合理补偿提供参考。方法　以上海市静安区静安寺街道社区卫生服务中心2018年开展的安宁疗护服务项目为研究对象,进行服务项目成本数据的采集和测算。结果　共234项服务项目,检验项目合并后共179项,成本46.5（23.0,84.0）元。其中,总成本最低的为人工辅助通便（1.3元）,最高的为Ⅰ级护理（401.7元）。179项服务中共包含138项收费项目,仅37项（26.8%）成本低于收费价格;3项（2.2%）成本等于收费价格;成本高于收费价格的有98项（71.0%）,包含全科14项、中医7项、护理32项、放射27项、心电B超4项、检验14项。结论　社区安宁疗护服务项目经费投入需重视分类补偿,且全科、中医、护理、放射、心电B超、检验等安宁疗护服务项目补偿不足。     

英国患者用药可及性方案实施经验及对我国的启示

风险分担协议在提高患者对药品的可及性、降低药品成本效果的不确定性和控制医保基金财务风险等方面取得了显著成效,受到各国政府或保险人的广泛关注。本文系统梳理了英国患者用药可及性方案,包括方案的起源、分类、应用流程、实施效果等。指出我国已基本具备了实施风险分担协议的条件,但仍需进一步明确风险分担协议实施主体,构建风险分担协议标准化流程,同时加强卫生技术评估在卫生资源配置中的应用,以逐步推进风险分担协议的实施等建议,以期完善我国药品谈判制度,提高药品谈判的科学性和效率。