基本药物政策

Keeping Costs Affordable 控制费 用在可负担范围内
To patient and to the health system 对病人和 卫生体系而言
有效、规范使用
Framework for Improving Use of Medicines with Some Examples
International manufacturers
Manufacture & import Key policy issues: • Market controls • Product quality • Competition • Intellectual property Private sector care
Drug importers
Domestic manufacturers
Wholesalers and distributors
`
Key policy issues: • Licensing & accreditation • Regulatory enforcement • Price & mark-up controls • Balanced promotion Private health facilities
29%
23%
16%
Percent who say yes to at least one of the above
40%
对以上三项至少一项说“是”的调查 SOURCE: USA Today/Kaiser Family Foundation/Harvard School of Public Health: The Public On Prescription Drugs and 者比例 Pharmaceutical Companies (conducted Jan. 3-23, 2008)
Drug Industry
payment product
es
information
n atio m for in ent m pay
k ar m
g tin e
$$
pr om
standards, education
Health Insurance
payment treatment
n info rm atio pay n con ment trol , s
– Shift from medicines sales-based funding 不再依靠药品销售筹资
• Integrate health information 整合医疗信息
– Increasing efficiency 提高效率
SUPPLY OF MEDICINES Key policy issues: • Efficient procurement • Performance standards • Transparency Public sector care Government procurement systems Government health facilities
U.S. Prescription Drug Expenditures by Type of Payer 美国处方药支出：按支付者类型
Kaiser Family Foundation, 2010
Part D Medicines Coverage Helps D部分的保险是有帮助的
Madden et al, JAMA 2009
政府采购系统
批发商
`
政府医疗机构
药店和零售店
私人医生和其他服 务提供者
消费者需求 保险公司和风 险承担着 药品需求 消费者和病人 主要政策问题: • 筹资和保险 • 消费者选择 • 获取信息
A Complex Network of Key Actors in the Pharmaceutical Sector
Regulatory
Regulate, prohibit, sanction Provider certification Enforce Rx-only regulations Change product registration
Pharmacies and retail outlets
Private physicians/ other providers
Consumer demand Insurance and risk carriers Consumers and patients Key policy issues: • Financing and insurance • Consumer choice • Access to information
Serious Problems Paying, Not Filling Prescriptions and Skipping Rx Drug Doses Because of Cost, 2008 因费用原因不买药或不按要求用量用药情况，2008
In past two years, have ever NOT filled a prescription because of the cost 过去两年中曾因费用问题未购买处方药 In past two years, have skipped doses or cut pills in half to make Rx last longer 过去两年为了节约而减量使用对处方药 Say it is a serious problem for self/family to pay for Rx drugs you need 自我报告家庭在支付药费时遇到苦难
Rapid Growth in U.S. Prescription Drug Spending 美国处方药支出增长迅速
IMS Health, 2010
Problems Paying for Prescription Drugs, 2008 处方药费用支付问题， 2008
How much of a problem is it for you or your family to pay for prescription medicines that you need? 家庭在支付所需 的处方药费用时是否有困难？
Health Reform in China 中国医疗卫生改革
• Health system development 卫生体系发展
– – – – Prevention and public health services 预防和公共卫生服务 Medical services 医疗服务 Health insurance 健康保险 Essential medicines 基本药物
Educational
Inform, persuade, motivate Small group health worker training Patients diabetes management groups TV/radio spots
Managerial
Guide, systematize, facilitate STGs for providers Consumers’ price information Feedback about generics rate
Overview 大纲
• U.S. situation 美国的情况 • Chinese context 中国背景 • Pharmaceutical policy challenges 药 品政策面临的挑战 • Pharmaceutical policy tools 药品政策 工具 • ICIUM2011 and MedIC in China ICIUM2011和MedIC在中国
A serious problem 很 大困难
16%
Not much of a problem 没问题
58% 25%
A problem, but not serious 有一 点困难，但不 严重
41%
Companies (conducted Jan. 3-23, 2008).
Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health: The Public On Prescription Drugs and Pharmaceutical
More targeted or tailored
Improved use of medicines
More policy or systems-oriented
Economic
Give incentives, penalize, subsidize Differential generic/brand copayments Limits on mark-ups for essential drugs Pay for performance contracts
老人医疗保险D部分的药品福利
雇员 付5% 保险报销15%， Medicare报销80%
雇员付 100% $3610 保险“缝隙”
总药费$6440 （自付$6440）
雇员付 25%
保险报销75%
Kaiser Family Foundation, 2010
$2830总药费（自 付$940)
$310起伏线
Fragmented Medicines Coverage 不完整的药品保险 无保险
15% 雇主保险 53% 医疗救 助/其 他公共 保险 13%
老人医 疗照护 14%
私人保险 5%（私人 非团体险）
总数：2982万
Kaiser Family Foundation 2008
Medicare Part D Benefit
• Universal insurance coverage by 2020 • 2020年达到全民医保目标
– Increasing access 提高可及性 – Improving quality of care 改善医疗服务质量
• Financing reform of health care institutions 卫生筹资改革
服务提供者
Competing Pharmaceutical Policy Objectives 药品政策目标相互竞争
Improving Equitable Access 提高可及性的公平性 Available to the poor
穷人可以获得
Encouraging Appropriate Use 鼓励合理使用 Necessary, safe, effective, properly taken 必需、安全、
ot io
p s, nts me ay
Consumers
Providers
医药行业主要行为主体的复杂网络
消费者组织
游说 支持
政府（卫生部）
监管
游说
$$
游说 标准
标 ， 准
行业组织
息
信
收
药品产业
信息
营
$$
支付 产品
税
销
营 销
制定标准， 教育
信息 支付
医疗保险
支付 治疗
信息 支付 控制
支 方 付 式
消费者
Medicines Access and Use: Frameworks for and Examples of Policy Decisions 药物可及性和使用：政策决定框架及实例
Anita Wagner, PharmD, MPH, DrPH
Harvard Medical School & Harvard Pilgrim Health Care Institute WHO Collaborating Center in Pharmaceutical Policy Boston, 7 July 2010
DEMAND FOR MEDICINES
药品供应
生产与进口 国际厂商 主要政策问题: • 市场控制 • 产品质量 • 竞争 • 知识产权
主要政策问题: • 高效采购 • 绩效标准 • 透明度 公立医疗领域
药品进口商
国内厂商
私人领域 主要政策问题：: • 评审认证 • 规制的执行 • 价格和利润控制 • 平衡的营销 私人医疗机构
lo g byin b
Consumer Organizations
t po r sup
Government (MOH)
$$
lobbying
rsig ht lobb ying
ove
standards
sta arBiblioteka Baidu nd
Professional Organizations
ati on
in f orm
tax