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The Bayh-Dole Act at 40: Accomplishments, Challenges, and Possible Reforms. 《贝-多尔法案》40周年:成就、挑战和可能的改革。
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041247
Ameet Sarpatwari, Aaron S Kesselheim, Robert Cook-Deegan

More than 40 years have passed since the enactment of the Patent and Trademark Amendment (Bayh-Dole) Act, which authorized institutions to patent inventions arising from federally funded research. Although some experts have heralded the Bayh-Dole Act as ushering in a new era of technological advances, others have been less sanguine about its impact. In recent years, the high price of prescription drugs and the patenting of COVID-19 therapeutics and vaccines developed with substantial federal government support have rekindled the debate over whether companies should receive more restricted rights to products originating with government funding. This article traces the history leading to the enactment of the Bayh-Dole Act and critically assesses its strengths and weaknesses as well as unresolved questions concerning its scope. Based on this analysis, the authors propose reforms to better align the Bayh-Dole Act with public values and health outcomes, including clarifying government-use rights, making it easier to invoke march-in rights for failure to meet health and safety needs, increasing transparency in how patents are licensed, and testing different approaches to foster the development and application of inventions.

自《专利和商标修正案》(Bayh-Dole)颁布以来,已经过去了40多年,该法案授权机构为联邦资助的研究产生的发明申请专利。尽管一些专家认为《拜杜法案》开启了一个技术进步的新时代,但其他人对其影响却不那么乐观。近年来,处方药的高价格以及在联邦政府大力支持下开发的COVID-19疗法和疫苗的专利重新引发了关于公司是否应该对政府资助的产品获得更多限制权利的辩论。本文追溯了导致颁布《Bayh-Dole法》的历史,并批判性地评估了该法案的优点和缺点以及有关其范围的未解决问题。基于这一分析,这组作者提出了改革建议,使《Bayh-Dole法案》更好地与公共价值观和健康结果保持一致,包括澄清政府的使用权,使未能满足健康和安全需求时更容易援引“进步权”,提高专利许可方式的透明度,以及测试促进发明开发和应用的不同方法。
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引用次数: 1
Value-Based Insurance Design: Clinically Nuanced Consumer Cost Sharing to Increase the Use of High-Value Medications. 基于价值的保险设计:临床细致入微的消费者成本分担以增加高价值药物的使用。
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041191
Nicholas K Smith, A Mark Fendrick

Consumer cost sharing is widely employed by payers in the United States in an effort to control spending. Most cost-sharing strategies set patient contributions on the basis of costs incurred by payers and often do not consider medical necessity as a coverage criterion. Available evidence suggests that increases in cost sharing worsen health disparities and adversely affect patient-centered outcomes, particularly among economically vulnerable individuals, people of color, and those with chronic conditions. A key question has been how to better engage consumers while balancing appropriate access to essential services with increasing fiscal pressures. Value-based insurance design (VBID) is a promising approach designed to improve desired clinical and financial outcomes, in which out-of-pocket costs are based on the potential for clinical benefit, taking into consideration the patient's clinical condition. For more than two decades, broad multistakeholder support and multiple federal policy initiatives have led to the implementation of VBID programs that enhance access to vital preventive and chronic disease medications for millions of Americans. A robust evidence base shows that when financial barriers to essential medications are reduced, increased adherence results, leading to improved patient-centered outcomes, reduced health care disparities, and in some (but not most) instances, lower total medical expenditures.

在美国,纳税人广泛采用消费者成本分担来控制支出。大多数费用分摊战略根据付款人产生的费用确定病人的分摊额,往往不把医疗需要作为覆盖标准。现有证据表明,费用分摊的增加加剧了健康差距,并对以患者为中心的结果产生不利影响,特别是在经济弱势群体、有色人种和慢性病患者中。一个关键问题是如何更好地吸引消费者,同时在适当获得基本服务与日益增加的财政压力之间取得平衡。基于价值的保险设计(VBID)是一种很有前途的方法,旨在改善预期的临床和财务结果,在这种方法中,自付费用是基于潜在的临床效益,同时考虑到患者的临床状况。二十多年来,在多方利益相关者的广泛支持和多项联邦政策举措的推动下,VBID项目得以实施,使数百万美国人更容易获得重要的预防和慢性疾病药物。强有力的证据表明,当基本药物的财务障碍减少时,依从性就会增加,从而改善以患者为中心的结果,减少医疗保健差距,并在某些(但不是大多数)情况下降低医疗总支出。
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引用次数: 3
Scripting Death: Stories of Assisted Dying in America 死亡脚本:美国协助死亡的故事
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-23 DOI: 10.1215/03616878-10358710
V. Rodwin
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引用次数: 3
The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America 下一个转变:美国铁锈地带工业的衰落和医疗保健的崛起
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-23 DOI: 10.1215/03616878-10358766
P. Rocco
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引用次数: 13
Health Policy in Asia: A Policy Design Approach 亚洲卫生政策:政策设计方法
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-23 DOI: 10.1215/03616878-10358780
R. Gauld
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引用次数: 0
Medicare for All—Running Down a Dream 全民医保——梦想破灭了
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-11-23 DOI: 10.1215/03616878-10358752
J. Oberlander
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引用次数: 0
The Privatized State: Why Government Outsourcing of Public Powers Is Making Us Less Free 私有化的国家:为什么政府外包公共权力使我们更不自由
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-09-27 DOI: 10.1215/03616878-10234254
L. Morales
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引用次数: 0
Dreamscapes of World Health and the History of the World Health Organization 世界卫生的幻景和世界卫生组织的历史
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-09-27 DOI: 10.1215/03616878-10234240
L. T. Larsen
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引用次数: 0
Health Politics in Europe: A Handbook 欧洲卫生政治:一本手册
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-09-07 DOI: 10.1215/03616878-10171146
E. Stewart
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引用次数: 11
Beyond Medicine: Why European Social Democracies Enjoy Better Health Outcomes Than the United States 超越医学:为什么欧洲社会民主国家比美国享有更好的健康结果
IF 4.2 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2022-09-07 DOI: 10.1215/03616878-10171132
D. Chinitz
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引用次数: 0
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