Pharmacoeconomics in ChinaEssentialities and Issues.docx
- 文档编号:9618490
- 上传时间:2023-02-05
- 格式:DOCX
- 页数:9
- 大小:20.30KB
Pharmacoeconomics in ChinaEssentialities and Issues.docx
《Pharmacoeconomics in ChinaEssentialities and Issues.docx》由会员分享,可在线阅读,更多相关《Pharmacoeconomics in ChinaEssentialities and Issues.docx(9页珍藏版)》请在冰豆网上搜索。
PharmacoeconomicsinChinaEssentialitiesandIssues
PharmacoeconomicsinChina:
EssentialitiesandIssues
HaitaoLi[1],AixiaMa[1]andShixueLi[2]*
1.SchoolofInternationalPharmaceuticalBusiness,ChinaPharmaceuticalUniversity,Nanjing,Jiangsu,People’sRepublicofChina
2.SchoolofPublicHealth,ShandongUniversity,Ji’nan,Shandong,People’sRepublicofChina
*Correspondenceandreprints:
Prof.ShixueLi,SchoolofPublicHealth,WestCampusofShandongUniversity,44WenhuaxiRoad,Ji’nan,Shandong250012,P.R.China.Tel:
+86-531-88382127;Fax:
+86-531-88382553;E-mail:
sxli1961@
KeyWords:
pharmacoeconomics;decision-making;guidance;healthcaredecisionmakers
ABSTRACT
Theuseofpharmacoeconomictoolhasgrowndramaticallyinthepastdecadeastheprovisionofhealthcarethroughouttheindustrializedworldhasrequiredincreasedcostconsciousness.However,pharmacoeconomicanalysishasnotyetbeenfullyexploitedasaconceptualunderpinningforpublicandprivatehealthpolicydecisioninChina.Inthisarticle,wewilldemonstratewhypharmacoeconomicsshouldbecomeanincreasinglyimportanttoolforhealthdecisionmakingasanumberofsignificantdynamics,including:
(ⅰ)highpriceofpharmaceuticals;(ⅱ)misuseofpharmaceuticals;and(ⅲ)needofpharmaceuticalindustries.However,therearealsosomeissuesthathinderthesufficientutilizationofpharmacoeconomicsinhealthcaredecisionmakingamongalllevels,suchasinsufficientexperts,influenceofpharmacoeconomicsandlackofguidelines.Therefore,pharmacoeconomicsshouldbeintroducedintohealthreformandsomeeffortsshouldbedonetoassistdomesticdecisionmakerstoenhancethecontinualdevelopmentandsufficientutilizationofpharmacoeconomicsinhealthcaredecision-makinginChina.
Introduction
Inmanycountries,pharmacoeconomicshasplayedanimportantroleinhealthcaredecision-making.Fordecisionmakerswhoconcernswithanationalorregionalhealthcareperspective,pharmacoeconomicscanhelptodeterminearationalpriceandreimbursementfordrugs.Also,pharmacoeconomicscanhelptoformulatehospitalformularyandclinicalguidelinesfordecisionmakersinsidehealthcareorganizations.Pharmacoeconomicscanalsoinfluencetheactivitiesofindividualhealthcareprofessionalsatthepatientlevel.Therefore,pharmacoeconomicsasanimportanttoolhasalreadybeengenerallyusedtoinformthedecision-making.
Thisarticlewillidentifytheessentialitiesof,andcurrentissueswith,pharmacoeconomicsasagoodtooltoprovideinformationtodecisionmakers,whichmeanswhyitisessentialforChinatointroduceitasatoolinhealthcaredecisionmaking.Wehopetoprovideabetterunderstandingofthesignificanceandissuesfacedwiththeutilizationofpharmacoeconomics,inordertoassistdomesticresearchersanddecisionmakersintheireffortstoenhancethecontinualdevelopmentandsufficientutilizationofpharmacoeconomicsinhealthcaredecision-making.Andalso,wehopetodrawattentionofinternationalbodiestothedevelopmentofpharmacoeconomicsinChina.
1EssentialitiesfortheUseofPharmacoeconomicsinChina
1.1HighPriceofPharmaceuticals
ThehighpriceofpharmaceuticalsinChinaismainlycausedbytworeasons.First,theissuesexistinthe“obedientadditionpricingmethod”,including:
(ⅰ)withtheessencetopursuethemaximumprofit,drugindustrieswillprovidefalse-highcostfortheirproductstoseekexorbitantprofit;(ⅱ)whensettingthepriceforthedrugs,onlythecostisconsideredbutnotthebenefitofthem,sowhetherornotthelimitedhealthresourceshavebeenutilizedreasonablycannotbeexplainedobjectively;and(ⅲ)meanwhile,thedrugpriceissetfromthegovernmentperspective,ratherthanthesocietalperspective,whichwillleadtobiasandirrationaldrugprices,andultimatelyun-optimumallocationandirrationaluseofhealthresources.
Second,thesystemofunderpaiddoctorscompensatedbytheexcessivemedicalexpenseistheimmediatecauseofthehighpriceofdruginChina.Becauseoftheinsufficientfinancialsubsidyandrevenueofhealthservices,profitfromdrugsasthethirdchannelisthemajorrevenuesourceofhospitals.Thedrugrevenueconstituentratiowasabove50%from1993to2003,anditwouldriseto70%,ifthehighlypriceddiscountisconsidered(SeetableⅠ).Simultaneously,thead-libitumandun-reasonablephenomenonexistwhenpurchasingdrugs,forexample,onlyprofitisunderconsiderationwithoutconsideringthevarietyandquantity,andthecostisignoredespeciallyforimporteddrugs.
GregsonNetal.[1]explainedthatpharmacoeconomicscouldbeausefultooltopricethedrugs,foritisabletoputbothcostandbenefitintoconsiderationandbalancethemtoarationalextent.Goldetal.[2]pointedoutthatthesocialperspectiveisthemostcomprehended,althoughdifferentperspectives,includingsociety,healthservicesproviders,third-payersandsoon,canbeused.Therefore,pharmacoeconomicshasthesameobjectivewithdrugpricing,whichimpliesthatitisnotforthemaximumsavingofhealthresources,butfortheoptimumallocationandthemostreasonableutilizationofhealthresources.Simultaneously,pharmacoeconomicscanprovideevidencesfortheformulationofrelativelawsandregulationstoconstrainthebehaviorofdoctorsandhospitals,andtoenhancedrugadministration[3].
1.2MisuseofPharmaceuticals
Chinesehealthcareprovidershaveadualrole:
notonlydotheydeterminethepatient’sneedfordrugs,butalsotheysellthedrugs,fromwhichtheycanmakeaprofit.Thismayresultinaneconomicincentivefortheprovider,asanagentforthepatient,tobehaveinhisorherowneconomicinterests,tothedetrimenttothepatients,bothmedicallyandfinancially.Medicalserviceproviderscanearnamark-uprateof15%forWesternmedicineand30%forChinesemedicine[4].Sincemoreprescriptionsmeangreaterprofit,theprovidersaremorelikelytoprescribegreatquantitiesofmoreexpensivedrugs.
Anotherproblemisthepoor-qualitydrugs,whichareproducedatalowercostandsoldatmorecompetitiveprices.Inaddition,medicalproviderscanpurchasethesedrugsatfavorablehighlypriceddiscounts.Drugproducersandmedicalprovidersmaytakeadvantageofthepatients’lackofknowledgetoincreasetheirprofits.Thisexplainswhycompetitionhasfailedtoincreasethequalityofdrugs.Samplinginspectionsshowedthat15%werepoor-qualitydrugs[5].
Therehavebeenseveralpublicationsaddressingtheissuethatpharmacoeconomicevaluationshouldbeconductedfordrugstoformulatethenationalessentialdruglist,hospitalformulariesandclinicalguidelines,whichcanbeconsultedbydoctorstofacilitatetherationaluseofdrug[6-8].Meanwhile,Rameckers[9]pointedoutthatpatientscanchoosecost-effectivedrugsaccordingtotheevaluationoutcometodecreasethemisuseofpharmaceuticals.
1.3RequirementsofPharmaceuticalIndustries
Inrecentyears,withthedevelopmentofChinaanditsentrancetoWTO,pharmaceuticalindustriesarefacingglobalcompetitions.Theintensifiedcommercialenvironmentcanbeindicatedby(ⅰ)increasingnumbersofenterprisesmergesandacquisitions;(ⅱ)occupyingagreatermarketsharebyasmallnumberoflargecompanies;(ⅲ)increasingnumbersofenterprisestoimplementcomplementaryadvantages;and(ⅳ)enduringgreatercompetitivepressureforenterprises’highdrugpricefortheenhancedconsumers’negotiationcapacity.Then,whatshouldpharmaceuticalindustriesdotosurviveinsuchcircumstances?
Then,pharmacoeconomicsshouldbeintroducedintothepharmaceuticalindustriestoinformdecisionmakingforstakeholders,bothinternallyandexternally,fromwhichtoreinforcethecompetitivestrength.Forexternalstakeholders,thepharmaceuticalindustrycanusetheevaluationoutcometoinformdecision-makingaboutpricing,reimbursement,clinicalguidelinesandhospitalformularies[10].Forinternalstakeholders,pharmacoeconomicscanhelpresourceallocationdecisions,whichmeansitcanhelpthemanufacturersdevelopmoreefficientproductsinmoreefficientways.
Inaword,whatwehavediscussedabovecanbesummarizedbythreeimportantadvantagesof(ⅰ)productdifferentiation;(ⅱ)economicsofscale;and(ⅲ)pursuingcomparisonsuperiority.pharmacoeconomicevaluationcannotmakeabaddruggood,whatitcandoistoenhancethedrugdevelopers’understandingofitscharacteristics.Decision-making,inlightofthisinformation,islikelytobebetterwiththanwithoutit.
2CurrentIssues
2.1InsufficientExperts
Thebiggestobstacletohindersufficientutilizationofpharmacoeconomicsisthelackofexperts.AstudyconductedbyChenetal.[11]showedthatfrom1995to2002,almost87.70%pharmacoeconomicstudieswereconductedbydoctors(10.30%),pharmacists(29.30%)andmedicaltechnologists(48.10%).Sothestudiesstayatalowlevelforalackofsystemiccomprehensionofthebasictheoriesandmethodsofpharmacoeconomics[12],forexample(ⅰ)nostandardizedcourseandnormaltrainingplansforpharmacoeconomics;(ⅱ)nosufficientteacherswithadequatepharmacoeconomicknowledgeandexperiences;and(ⅲ)nostandardizedteachingmaterialofpharmacoeconomics.
2.2InfluenceofPharmacoeconomics
Anotherissueistheinfluenceofpharmacoeconomics.Twofactorswillinfluencetheoptimaluseofpharmacoeconomics:
(ⅰ)thepowerofthepharmacoeconomistachievingchangewithindecisionmakers;and(ⅱ)theperceivedimpactofevaluationoutcomesatalllevelsofdecision-making.
Thefirstfactorisaninformationissue.Astudyshowedthat85.90%decisionmakersregardedthedifficultyofthetransformationofevaluationoutcomtospecificrecommendationsrestraine
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Pharmacoeconomics in ChinaEssentialities and Issues
![提示](https://static.bdocx.com/images/bang_tan.gif)
链接地址:https://www.bdocx.com/doc/9618490.html