Access to orphan drugs – comparison across Balkan countries

The aim of this study was to compare orphan drug access in a sample of Balkan countries: five EU Member States (Bulgaria, Croatia, Greece, Romania, Slovenia) and two EU Candidates (Serbia, Montenegro). The comparative analysis was based on a cross-sectional study and included medicinal products with an active orphan designation and market authorisation on January 1, 2017.Access to orphan drugs is an ongoing challenge in these countries. Three clusters of countries were identified in terms of orphan drug access: Greece and Slovenia, making the top tier, Romania, Bulgaria, and Croatia, being in the middle, and EU Candidates, Serbia and Montenegro, forming the bottom tier, where a substantial number of EU market approved orphan drugs was not even registered. Available public health resources and market size are probably among the contributing factors for such inequalities. Sizeable part of EMA market authorised orphan medicinal products is not even priced in the Balkan countries. This is a serious issue, which is putting rare disease patients from this region in a particularly vulnerable situation.There is a need for further improvement in accessibility of orphan drugs in the Balkan countries. Cross-border collaboration in the field of pricing, health technology assessment, and reimbursement negotiation of orphan drugs may help to address these challenges.     

B2C药品交易市场中的平台服务定价研究

目的:探讨不同类型B2C药品交易平台的服务定价问题及影响因素,为网络医药零售实现高效运营提供参考。方法:以双边市场为理论基础,结合互联网交易服务的特点,构建联营模式以及自营+联营模式两类B2C药品交易平台的服务定价模型,探讨分成比例、搜索匹配度、选择自营消费者比例对平台服务定价的影响,并利用层次分析法等进行实证验证。结果:成功构建了联营模式以及自营+联营模式两类B2C药品交易平台的服务定价模型;确定了分成比例、搜索匹配度对平台服务定价(供应商)分别呈逆向作用和正向作用,在自营+联营模式药品交易平台中,当选择平台自营的消费者比例过高时,平台将会降低供应商的注册费,当选择平台自营的消费者比例过低时,平台将会提高供应商的注册费;实证验证中采用层次分析法确定自营消费者比例为0.648,在此条件下对两类运营模式的定价模型进行比较,与上述结果一致;同时,自营+联营模式的服务定价整体上总是低于联营模式。结论:无论是联营模式还是自营+联营模式的平台,可设置不同的注册费与广告收入分成比例,实行差异化定价;也可通过增加更多专业咨询服务,脱离同质化竞争,增加用户黏度,提高平台搜索匹配度;对于自营+联营模式的平台,需要控制好自营与联营的比例,实现平台的健康有效运营。     

Mental health: market power and governance

This paper is concerned with the pricing behaviour of providers of residential care for people with mental health problems. Two aspects of pricing were considered. First, are there differences between providers' market power and their actual mark-up rates (e.g. due to differences in motivation)? Second, do the different governance arrangements used in sectors of the industry, such as unified public and non-profit organisation and private bilateral contracting, affect pricing behaviour? A theoretical model was developed to underpin the empirical analysis of 496 residents in 112 mental health care facilities. Private, bilateral organisation was found to be associated with comparatively lower potential price-cost mark-up but a greater propensity to use this power to make profits/surpluses.     

社区卫生服务定价与补偿机制研究(四)

为了制定适当的社区卫生服务价格，对社区卫生服务进行合理的补偿，本文在对4省12市46个社区卫生服务中心(或站)的项目成本进行测算的基础上，应用标准成本计算方法得出各项服务的建议价格对社区卫生服务政府补偿额进行了测算，提出了社区卫生服务补偿的政策建议。     

武汉市7家医院头孢菌素类抗生素的供应调查

目的:调查并分析武汉市7家医院头孢菌素类抗生素的供应情况。方法:对武汉市7家医院2004年3月~6月间供应头孢菌素类抗生素的品种、类型、价格差异进行数据处理。结果:武汉市7家医院供应的头孢菌素类抗生素以第3代为主,供应企业多,相同品种规格重复,药品同质性强,同品种价格差异大。结论:医院药品供应结构的合理化是促进临床合理用药的基础。     

Alternative access schemes for pharmaceuticals in Europe: Towards an emerging typology

European governments employ sophisticated health technology assessment and regulatory procedures to identify which pharmaceuticals to fund publicly. However, there are persisting demands from patients for those drugs excluded from positive reimbursement lists, leading to the emergence of what are here termed “alternative access schemes”. This paper presents a purposive review of these schemes based on available scholarly and grey literature, illustrated with real-world examples from recent practice. It puts forward an original typology of alternative access schemes based on their marketing authorization (regulation) and reimbursement (redistribution) status. We describe the complex, multidimensional policy trade-offs between the principles of patient freedom of choice, clinical autonomy, encouragement of innovation, evidence-informed decisions on safety and quality, access to treatment, and financial sustainability, involved in marketing authorization and reimbursement decisions. We discuss the ways in which alternative access schemes differ and conclude that our typology can illuminate salient policy dilemmas raised by alternative access schemes in national drug reimbursement systems.     

关于我国医疗服务价格项目规范的思考

介绍了我国医疗服务价格项目规范的研究现状,描述了<全国医疗服务价格项目规范>在卫生改革中的作用,提出要进一步完善医疗服务价格体系:①"按项目付费"是其他医疗支付方式的基础;②加强各省的师资培训,确保<项目规范>的正确实施;③建立特殊医疗消耗用品目录,加强耗材使用管理;④制定全国统一的医疗服务项目价格系数;⑤深入开展符合我国国情的医疗付费方式研究;⑥制定各学科临床诊疗规范;⑦建立与国际接轨的编码体系.     

严格执行国家政策强化军队医院物价管理

就军队医院物价管理的现状,阐述了完善军队医院物价管理工作的必要性,分析了军队医院物价管理的难点,提出了提高物价管理认识以构建有效的价格管理体系、建立健全医疗收费的规章制度以使物价管理工作步入正轨、发挥计算机网络化管理作用以增强医疗费用透明度、加强收费审核以杜绝不合理收费、提高物价管理人员的综合素质以规范医院物价管理5项强化军队医院物价管理的措施.     

社区卫生服务定价与补偿机制研究(三)

为了制定适当的社区卫生服务价格，对社区卫生服务进行合理的补偿，本文在对4省12市46个社区卫生服务中心(或站)的项目成本进行测算的基础上，应用标准成本计算方法得出各项服务的建议价格。对社区卫生服务政府补偿额进行了测算，提出了社区卫生服务补偿的政策建议。