Journal of market access & health policy最新文献

Background: This paper reviews cost containment policies to control pharmaceutical expenditure either by regulating the pharmaceutical industry or targeting the demand side.

Methods: The method used was the narrative literature review of studies which assessed the effect of pharmaceutical cost containment policies.

Results: Governments worldwide have implemented a great variety of policy measures to manage pharmaceutical expenditure while ensuring fair access to essential medicines. Cost-sharing schemes, value-based pricing, reimbursement, reference pricing, payback mechanisms and the substitution of original drugs with generics and biosimilars are pivotal in these efforts, albeit with differing effectiveness across healthcare systems. Overall, it appears that any gains may be outweighed by the unfavorable effects of policies impacting patients. Although interventions have been created to improve physicians' prescribing practice, they often achieve very minor benefits and at considerable cost. Policy measures pertaining to the regulation of the supply side must be supported by thorough evaluation in order to ascertain costs and effects and guarantee that unintended consequences are minimized.

Conclusions: Policymakers frequently enact numerous laws and regulations to control pharmaceutical expenditure, even if there is limited evidence that they are cost-effective. The most crucial component of any policy's success, regardless of the one selected, is its evaluation. Further research is needed to develop context-specific guidance that balances cost containment, equity and sustainability.

This study evaluates the efficiency of public hospitals in Greece during the COVID-19 epidemic in 2020, using Data Envelopment Analysis (DEA) and the Analytical Hierarchy Process (AHP). Faced with unprecedented pressure from increased demand for medical services, these hospitals had to adapt quickly while playing a crucial role in supporting local economies, similar to the effect of tourism on rural economies. This study reveals that, despite average efficiency scores of 83% for result-oriented models (BCC) and 65% for constant return models (CCR), inefficiencies of scale emerged under the pressures of the pandemic. The AHP, by incorporating qualitative criteria and decision-makers' preferences, offers a valuable perspective but shows little correlation with DEA's quantitative results. This research emphasizes the importance of utilizing integrated methods to formulate a more comprehensive assessment, adapted to the complex challenges of the healthcare sector during crisis periods.

As early as 1978, the World Health Organization set primary healthcare as the basis on which health systems should be built worldwide. However, the health systems of the different countries show considerable variations in terms of the implementation of gatekeeping from primary to secondary healthcare and direct access to specialists and hospital care. This literature review attempts to present the gatekeeping system with references to the UK, Sweden, the Netherlands, and Germany compared to the situation in Greece, where no gatekeeping system exists. Particular emphasis is placed on the impact of gatekeeping on the healthcare system's efficiency, equity of access, and the quality of the services provided. Evidence on the effects of gatekeeping is conflicting or limited by the low internal validity. Making the right gatekeeping implementation decisions is difficult in the absence of data. High-quality research studies on health outcomes, clinical efficacy, cost-effectiveness, quality of life, healthcare quality, utilisation of healthcare services, the burden in the healthcare system, and the opinions of patients, physicians, and policymakers are all necessary for developing policy.

Healthcare is a huge business sector in many countries, focusing on the social function of delivering quality health when people develop illness. The system is essentially financed by public funds based on the solidarity principle. With a large financial outlay, the sector must use economic evaluation methods to achieve better efficiency. The objective of our study was to evaluate and to understand how health economics is used today, taking Belgium as an example of a high-income country. The evaluation started with a historical view of healthcare development and ended with potential projections for its future. A literature review focused on country-specific evaluation reports to identify the health economic methods used, with a search for potential gaps. The first results indicated that Belgium in 2021 devoted 11% of its GDP, 17% of its total tax revenue, and 30% of the national Social Security Fund to health-related activities, totalizing EUR 55.5 billion spending. The main health economic method used was a cost-effectiveness analysis linked to budget impact, assigning reimbursable monetary values to new products becoming available. However, these evaluation methods only impacted at most 20% of the money circulating in healthcare. The remaining 80% was subject to financial regulations (70%) and budgeting (10%), which could use many other techniques of an economic analysis. The evaluation indicated two potentially important changes in health economic use in Belgium. One was an increased focus on budgeting with plans, time frames, and quantified treatment objectives on specific disease problems. Economic models with simulations are very supportive in those settings. The other was the application of constrained optimization methods, which may become the new standard of practice when switching from fee-for-service to pay-per-performance as promoted by value-based healthcare and value-based health management. This economic refocusing to a more constrained approach may help to keep the healthcare system sustainable and affordable in the face of the many future challenges including ageing, climate change, migration, pandemics, logistical limitations, and financial instability.

This study assessed direct-acting oral anticoagulant (DOAC) switching/discontinuation patterns in patients with non-valvular atrial fibrillation (NVAF) in 2019, by quarter (Q1-Q4), and associated socioeconomic risk factors. Adults with NVAF initiating stable DOAC treatment (July 2018-December 2018) were selected from Symphony Health Solutions' Patient Transactional Datasets (April 2017-January 2021). Switching/discontinuation rates were reported in 2019 Q1-Q4, separately. Non-medical switching/discontinuation (NMSD) was defined as the difference between switching/discontinuation rates in Q1 and mean rates across Q2-Q4. The associations of socioeconomic factors with switching/discontinuation were assessed. Of 46,793 patients (78.7% ≥ 65 years; 52.6% male; 7.7% Black), 18.0% switched/discontinued their initial DOAC in Q1 vs. 8.8% on average in Q2-Q4, corresponding to an NMSD of 9.2%. During the quarter following the switch/discontinuation, more patients who switched/discontinued in Q1 remained untreated (Q1: 77.0%; Q2: 74.3%; Q3: 71.2%) and fewer reinitiated initial DOAC (Q1: 17.6%; Q2: 20.8%; Q3: 24.0%). Factors associated with the risk of switching/discontinuation in Q1 were race, age, gender, insurance type, and household income (all p < 0.05). More patients with NVAF switched/discontinued DOACs in Q1 vs. Q2-Q4, and more of them tended to remain untreated relative to those who switched/discontinued later in the year, suggesting a potential long-term impact of NMSD. Findings on factors associated with switching/discontinuation highlight potential socioeconomic discrepancies in treatment continuity.

At least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As illustrated by the provision of COVID-19 vaccines first for the elderly, societies value life-saving actions. Paradoxically, health economic assessments conventionally devalue long-lasting health through the practice of discounting health benefits along with costs. However, health, with its intrinsic and instrumental characteristics, is not synonymous with money cash, a tradeable asset that devalues with time. If improving healthy life expectancy is a societal ambition, it seems counter-intuitive to value future health less as a result of an artificial mathematical construct when evaluating economically new medical interventions. In this paper, we investigate the application of discounting health in healthcare and consider paradoxical findings, especially in relation to disease prevention with vaccination. We argue that there is no economically sustainable argument to discount health gains, except for the benefit of the payer with a goal of spending less on life-saving products. If that is the objective for discounting health, there are other means to achieve the same goal in a more transparent and simpler way. From the long-term perspective of healthcare development, not discounting health gains would encourage research that values long-term effects. This in turn has the potential to benefit the investor, the payer, and the patient/consumer, improving the situation from multiple perspectives.