Are Biopharmaceutical Budget Caps Good Public Policy?

IF 0.4 Q4 ECONOMICS Economists Voice Pub Date : 2016-12-01 DOI:10.1515/ev-2015-0012
D. Goldman, D. Lakdawalla, J. Baumgardner, M. Linthicum
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引用次数: 2

Abstract

Abstract Medical innovation has generated significant gains in health over the past decades, but these advances have been accompanied by rapid growth in healthcare spending. Faced with a growing number of high-cost but high-impact innovations, some have argued to constrain prices for new therapies – especially through global caps on pharmaceutical spending and limits on prices for individual drugs. We show that applying this threshold to past innovations would have limited access to many highly valuable drugs such as statins and anti-retrovirals. We also argue that budget caps violate several important principles of health policy. First, budget caps treat healthcare spending as a consumption good, like going to a movie or buying a meal. However, healthcare spending should be viewed as an investment, whose benefits accrue over many years – much like spending on education. Second, budgetary cost is a poor indicator of value, thereby distorting coverage decisions. Third, affordability arguments often use a short-term horizon, thereby missing that long-term health is society’s ultimate goal. Fourth, assessments of benefit should incorporate not just the immediate clinical benefit to patients, but also long-term health improvements, cost savings, and increased productivity. Fifth, global budget caps arbitrarily anchor spending on the status quo, thereby setting too stringent a threshold for socially-desirable innovation. In sum, a solitary focus on short-term costs can be detrimental to population health in the long-run. When medical treatment decisions are properly viewed as investments, budget caps are not the answer; rather, we need to find mechanisms to encourage spending decisions based on long-term value. Only then can we generate health returns to societal investments, while also encouraging the new research and development necessary to extend the gains of recent decades.
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生物制药预算上限是好的公共政策吗?
在过去的几十年里,医疗创新在健康方面取得了显著的进步,但这些进步伴随着医疗支出的快速增长。面对越来越多的高成本但高影响的创新,一些人主张限制新疗法的价格——特别是通过全球药费上限和个别药物价格限制。我们表明,将这一阈值应用于过去的创新将限制许多高价值药物的获取,如他汀类药物和抗逆转录病毒药物。我们还认为,预算上限违反了卫生政策的几项重要原则。首先,预算上限将医疗支出视为一种消费商品,就像去看电影或吃饭一样。然而,医疗支出应该被视为一种投资,其收益需要多年积累,就像教育支出一样。其次,预算成本是一个很差的价值指标,从而扭曲了覆盖范围的决定。第三,可负担性的论点往往使用短期视角,从而忽略了长期健康是社会的最终目标。第四,效益评估不仅应包括对患者的直接临床效益,还应包括长期健康改善、成本节约和生产力提高。第五,全球预算上限武断地将支出固定在现状上,从而为社会期望的创新设定了过于严格的门槛。总而言之,从长远来看,只注重短期费用可能对人口健康有害。当医疗决策被恰当地视为投资时,预算上限就不是答案;相反,我们需要找到机制,鼓励基于长期价值的支出决策。只有这样,我们才能为社会投资带来健康方面的回报,同时鼓励扩大近几十年来取得的成果所必需的新研究和发展。
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来源期刊
Economists Voice
Economists Voice ECONOMICS-
CiteScore
1.10
自引率
25.00%
发文量
9
期刊介绍: This journal is a non-partisan forum for economists to present innovative policy ideas or engaging commentary on the issues of the day. Readers include professional economists, lawyers, policy analysts, policymakers, and students of economics. Articles are short, 600-2000 words, and are intended to contain deeper analysis than is found on the Op-Ed page of the Wall Street Journal or New York Times, but to be of comparable general interest. We welcome submitted Columns from any professional economist. Letters to the editor are encouraged and may comment on any Column or Letter. Letters must be less than 300 words.
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