欧美国家卫生改革——控制药品费用措施

Health Reform in European Countries and America the Measures of Cost-containment

本文介绍了在欧美国家使用的7种控制药品费用措施(参考价格、药品作用清单、药品部分自费或共同负担费用、调整药品价格、开业医生预算、补偿柜台药品与使用非商标药品)的原理与使用情况。应用这些措施的目的不仅在于控制药品的消费,而且还在于促进合理用药行为。它们的经验表明,在控制药品费用方面,这些措施都有一定的效果(虽然各国之间有差别),但在促进合理用药方面效果不明显,如共同负担费用措施可导致卫生服务利用下降,而不是有选择性地降低那些不合理的服务利用。

This article introduces the principles and practice of seven cost-containment measures (reference pricing,positive and negative lists,patient copayment,direct price controls,drug budget for GPs, OTC drugs reimbursed and generic substitution)taken by the government authorities in European countries and in America- The purposes of these measures are not only to control drug expensiture but also to improve rational use of drugs. These countries' experiences show that these rational use of drugs. These countries' experiences show that these measures have been successfully in controlling drug expenditure to a certain extent, but have not improved rational use of drugs as expected. Patient copayment, for example .can result in the decrease of health service utilization,but does not selectively target unnecessary or irrational utilization.