我国医保药品支付标准建设的理论与现实分析

建立针对药品的医疗保险支付标准(参考价)是多国控制药品费用不合理增长的重要措施。医保药品支付标准通过药品价格竞争刺激患者需求和增强患者选择的权利来影响医生行为和药品企业定价。我国放开药品政府定价后也亟需建立适应药品市场发展的价格形成机制,建立医保药品支付标准需要从我国药品管理政策转变和现状出发,厘清控费的具体机制,根据当前我国实践中存在的问题,从药物经济学评价、药品分级分类管理、完善医保药品支付方式和补偿机制、合理分配补偿结余等方面入手,提升药品的可及性、费用的可控性和政策的激励性。     

药物经济学评价在药品定价中的应用

目的药物经济学评价在药品定价中的应用进行研究分析。方法合药物经济学评价内容,分析当前我国药品定价机制的局限性、药物经济学应用于药品定价中的意义,探讨药物经济学评价在药品定价中的应用对策。结果品定价过程中,要根据实际的参照药物、价格开展药物经济学评价,同时结合药物经济学评价结果对成本基础的药品申报价格开展评估、调整工作。结论物经济学评价能够显著提升药品定价的科学、合理性,药物经济学评价在我国还面临着多方面的困境与挑战,药物经济学评价在药品定价中的应用仍然还有十分漫长的道路要开拓。     

上海药物经济学论坛：药品定价补偿与药物经济学研讨会在沪召开

本刊讯由复旦大学药物经济学研究与评估中心,ISPOR上海分会主办的＂上海药物经济学论坛：药品定价补偿与药物经济学研讨会＂2011年11月19日在沪召开。国家发改委药品价格评审中心卢凤霞主任、英国卫生经济办公室Adrian Towse教授、人社部医疗保险管理中心医疗服务管理处段政明处长、复旦大学公共卫生学     

国际药品价格管制方式及效果研究的系统综述

目的：分析国际药品价格管制方式及效果。方法：采用系统综述的方法归纳不同国家药品价格管制方式、对象、过程及效果。结果：共纳入来自36个国家的130篇文献,其中包括定价管制政策文献97篇,评价定价管制影响文献33篇,且多为评价参考定价效果研究。大多国家主要对报销药品价格进行控制;国家价格比较和参考定价是两种最主要的政府定价方式;药品加成采用递减加成体系;现有证据表明参考定价对于降低药品价格、节省药品开支和对其他卫生服务的影响效果较好。建议：以药物经济学评价为基础,通过参考定价对药品报销价进行有效管制,通过协商谈判、递减加成和完善医保支付方式来控制药品费用不合理增长。     

我国药品价格政策分析和改革思路探讨

我国政府一直通过不同措施控制药品价格。目前政府对药品实行按社会平均成本,直接制定每一种药品的价格。这种定价机制的困难在于如何获得真实的企业生产成本信息。单纯通过降低药品价格控制药品费用增长,其作用是非常有限的。药品价格改革必须与医院补偿机制改革、社会医疗保险制度改革相协调。在改革药品定价机制时,可以考虑使用参考定价的方法,引入药物经济学的评价;加强对药品价格改革的研究和监督,评价药品价格改革对基本药物可及性的影响。     

试析营利性与非营利性医疗机构的不同点

营利性与非营利性医疗机构的不同点主要表现在 :收益分配不同 ,前者的收益可用作投资者的经济回报 ,后者的收益只能用于医疗事业的自身发展。投资渠道不同 ,前者主要由市场投资者投资 ,后者主要由政府投资。提供的服务项目与承担的社会义务不同 ,前者提供基本医疗以外的服务 ,只对无法支付费用的急诊病人承担社会义务 ,后者提供基本医疗服务 ,即为无力支付医疗费用的病人提供免费医疗服务。定价的基础不同 ,前者以市场为基础定价 ,后者以全成本为基础定价。政府采取管理政策的取向不同 ,对前者应以调动建立和发展营利性医疗机构的积极性为导向 ,对后者应以完善补偿机制和规范经营为导向。     

如何实施药事服务费的补偿政策

老百姓感到＂看病贵＂主要有四个原因：一是没有医疗保险制度的覆盖或是补偿水平不高,仍有较高的自费负担;二是药品定价不合理,药物在流通环节中加价过多;三是医院依赖于药品加成作为主要补偿渠道,缺乏控制医疗费用的支付制度约束;四是没有实行科学的临床诊疗和用药规范,诱导不合理检查和过度用药,出现医疗资源浪费导致费用增长。     

药物经济学及其在控制药品费用中的作用

[目的]探讨如何用药物经济学来控制药品费用的过度上涨.[方法]通过对药物经济学的定义、研究方法、实施步骤、药品费用增长因素叙述,用药物经济学分析控制药品费用.[结果]药物经济学从6个方面控制药品费用:指导新药的研制生产;促进药品定价的合理性;制定基本医疗保险药品目录;帮助医院制订医院用药目录:规范医师用药;确定药物的适...     

药品定价及价格补偿的研究

文章阐述了药物经济学研究对药品定价及补偿的作用。控制药品费用的不合理增长,需要采取综合措施。从管制药品定价和利润着手,在医疗保险药品报销补偿方面可采取参考定价、药品分类补偿等多种方法。在市场经济条件下,对需方采用总额预算及按人头付费的方式可能是较为有效的控制药品费用增长的措施。     

基本药物制度对基层医疗机构住院服务影响研究

文章通过分析某县乡镇卫生院医疗费用和住院人次的变化,探讨基本药物制度和支付制度改革对乡镇卫生院住院服务产生的影响。基本药物制度和支付制度改革的综合作用使乡镇卫生院的次均住院费用明显下降,但是补偿费用并没有提高;基本药物制度的实施约束了医生的用药习惯,同时也影响了医务人员的工作积极性。为此,建议政府调整基本药品结构,扩大基本药品种类,适当增加财政补偿额度,加强监管,防止县级医院重蹈城市大医院盲目发展的覆辙。     

Pharmacoeconomic component of a clinical trial conducted in Latin America. Conceptual and empirical considerations.

BACKGROUND: Although pharmacoeconomic studies constitute a valuable tool for better managing drug consumption, the conditions under which such studies would be performed in Latin American countries have not been explored. OBJECTIVES: The aim of this paper is to evaluate the potential advantages of and pitfalls in doing pharmacoeconomic research in Latin America and to propose avenues to facilitate the development of this field in the region. METHODS: The Canadian guidelines for the economic evaluation of pharmaceuticals served as a structured framework to assess, both prospectively and retrospectively, the conditions under which the pharmacoeconomic component of a clinical trial held in Mexico and Brazil would be and actually was conducted. RESULTS: The conditions under which pharmacoeconomic evaluations are conducted must be improved if studies are to contribute to the better management of scarce resources across the entire health care system. CONCLUSIONS: The creation of a public funding agency, the reappraisal of administrative data as a management tool in both the public and the private sectors, and the establishment of national guidelines should be considered within the framework of reforms aimed at allowing healthcare systems to meet their objectives of efficiency and equity.     

药物经济学评价在韩国医保报销决策中的应用

目的 :介绍韩国药物经济学评价应用于医保报销决策的经验,从而为我国开展类似探索提供借鉴。方法:文献综述。结果:韩国是亚洲第一个将规范的药物经济学证据应用于医保报销决策的国家,也是目前亚洲唯一一个强制执行药物经济学评价的国家。韩国医保报销政策改革对于缓解医疗费用过快上涨发挥了重要作用。结论:药物经济学评价应用于医保报销决策是合理配置稀缺医疗卫生资源的重要手段,韩国在这方面进行了积极的探索,但研究和实践都有待进一步深入,总结其经验和问题对我国今后开展类似工作有重要借鉴意义。     

Economic,Patient Preference,and Health-Related Quality of Life Considerations for Intranasal Corticosteroids in Allergic Rhinitis

Allergic rhinitis, as a medical condition, merits attention because of its prevalence in the population as well as the substantial economic impact of treating it. By virtue of their efficacy and low adverse effect profile, intranasal corticosteroids have gained recognition by healthcare providers as the first-line therapy for allergic rhinitis. For managed care decision makers, the use of intranasal corticosteroids as the gold standard of treatment in allergic rhinitis makes comparative economic and humanistic (patient preference or health-related quality of life [HR-QOL]) data between the various intranasal corticosteroids increasingly important for formulary decisions.Although the equal efficacy and safety of intranasal corticosteroid products in the treatment of allergic rhinitis is well documented, research that compares the different economic and humanistic aspects of intranasal corticosteroid products is limited and less conclusive. In this article, we review published studies reporting pharmacoeconomic and humanistic analyses of intranasal corticosteroids in the treatment of allergic rhinitis and make recommendations for managed care decision makers in the selection of intranasal corticosteroids for allergic rhinitis. Based on inclusion/exclusion criteria, 15 pharmacoeconomic and 19 patient preference/HR-QOL studies were selected and reviewed.The literature reviewed does not provide evidence of the superiority of a single intranasal corticosteroid product with respect to pharmacoeconomic, patient preference, or HR-QOL considerations. This finding is primarily owing to the lack of published head-to-head studies comparing pharmacoeconomic or humanistic outcomes between the different intranasal corticosteroids. Without further head-to-head studies on intranasal corticosteroids for the treatment of allergic rhinitis, cost minimization results may be the best decision strategy for managed care organizations (MCOs). Ideally, the results of cost-effectiveness or cost-utility studies comparing the different intranasal corticosteroids should guide the final formulary decision. In the absence of such studies, pharmacoeconomic and humanistic outcomes data from studies reported in the literature should be included into a pharmacoeconomic model, which considers the prevalence of allergic rhinitis in the MCOs to guide formulary inclusion decisions. Managed care decision makers will increasingly need to request this information from drug manufacturers if an informed, evidence-based decision is to be made.     

与临床试验平行的经济学评价设计面临的挑战

目的:探讨临床试验同期平行进行的卫生经济学评价(以下简称平行研究)在数据收集和设计上可能出现的问题及所遇到的质疑,以及可能的解决方法。方法:回顾平行研究的方法学文献以及经选择的经验类研究文章。结果:平行研究在某些方面优于其他药物经济学评价方法,在(临床)试验过程中同时收集数据而不需要专门开展独立的经济学研究。但在平行研究的设计及数据收集中仍存在许多挑战和争论。结论:平行研究仍是测量医学干预在经济上影响的适当方式。     

药物经济学评价指南研究与应用的进展

药物经济学评价指南是一些政府为了控制快速增长的药费和有限的卫生预算下分配资源的有效途径。作通过比较欧洲四国经济学指南的制订背景和异同点，认为药物经济学评价指南的制订必须与各国国情、卫生保健体系和政策目标相适应，药物经济学指南亟待完善和发展。     

Reimbursement of glitazones in treatment of type 2 diabetes patients in Denmark in the context of a voluntary system for submitting pharmacoeconomic studies

In 1998, guidelines for pharmacoeconomic evaluation were issued in Denmark. It was left to the discretion of the industry for which products to submit a pharmacoeconomic study. The impact of this voluntary system is illustrated by a case study on reimbursement of two types of glitazones. A review is presented of the evidence on safety, effectiveness and cost-effectiveness of glitazones that was available in the public domain at the time of reimbursement decision making, which was matched to the Danish criteria for general reimbursement of new pharmaceuticals. The study concludes that the voluntary system has not supported the inclusion of efficiency considerations in reimbursement decision making on glitazones. The decision-making process may be improved by mandatory pharmacoeconomic evaluations for selected products such as glitazones, which potentially represent a benefit to patients and potentially improve the cost-effectiveness of care, while at the same time having a considerable budget impact.     

卫生投入机制的核心问题探讨——以浙江省卫生投入改革实践为例

通过分析浙江省卫生投入机制的改革实践，认为完善卫生投入机制的核心问题是，必须明确卫生机构的公共职能与政府的相应投入责任，加强省级政府的转移支付责任以促进区域内基本卫生服务的均等化，通过加强卫生投入绩效评价转换卫生投入机制。     

Cholesterol-Lowering Therapy Interventions

Elevated cholesterol levels are associated with an increased risk of cardiovascular diseases. Treatment strategies promoting the associated health benefits from a reduction in elevated cholesterol levels have been outlined in guidelines published by the National Cholesterol Education Program. Clinicians and researchers have also examined the economic benefits associated with reducing elevated cholesterol levels. Most of these studies have employed traditional pharmacoeconomic techniques like cost-effectiveness analysis. Results from these studies indicated that certain types of therapy interventions (such as the use of cholesterol-lowering pharmaceutical agents) are cost effective. However, the majority of these studies are clinically driven and rely heavily on cost-outcome ratios as decision variables.This traditional approach to pharmacoeconomic evaluation is starting to be questioned by managed care organisations in the US. These organisations are increasingly interested in assessing the global (or health systems-based) impact associated with the introduction of a therapy intervention (such as cholesterol lowering agents). Subsequently, there is a need for pharmacoeconomic studies to provide a health systems-based view to assess a range of competing cholesterol-lowering treatment options.