Huttin C
Faculty of Economics, University of Paris X, France.
Health Policy. 1994 Jan 31;27(1):53-73. doi: 10.1016/0168-8510(94)90157-0.
This paper makes a contribution concerning the effectiveness of the direct payment for drugs by the patient through a review of the most important empirical US and UK contributions. It confirms that the demand for prescription drugs, and even the demand for OTC to a lesser extent, is reduced by a direct contribution from the patient. The price elasticities which measure the scope of the decrease of drug consumption, range however at low levels from -0.1/or -0.2 to -0.6 [1]. In order to be able to draw some policy conclusions from these studies, the health analyst will also want to have clinical or quality assessments of the changes of consumption or the health conditions of the patient. Some of the works reviewed offer some preliminary answers, but on a limited share of the population (the Medicaid population in the USA). Applied to some non-essential medications, however, this type of work highlights the phenomena of substitution between drugs, lack of change in overall drug use and uncertain changes in the quality of prescribing. This review paper will allow the policy makers to discuss some areas of change for various types of direct payments of the patient, and the use of unique versus selective schemes.
本文通过回顾美国和英国最重要的实证研究成果，对患者直接支付药费的有效性做出了贡献。研究证实，患者直接支付会降低处方药需求，非处方药需求虽受影响但程度较小。衡量药品消费下降幅度的价格弹性处于较低水平，范围从-0.1或-0.2到-0.6[1]。为了能够从这些研究中得出一些政策结论，健康分析师还需要对患者的消费变化或健康状况进行临床或质量评估。部分被审查的研究给出了一些初步答案，但针对的是有限的人群（美国的医疗补助人群）。然而，应用于一些非必需药物时，这类研究凸显了药物之间的替代现象、总体用药量未变以及处方质量变化不确定等情况。这篇综述文章将使政策制定者能够讨论针对患者不同类型直接支付的一些变革领域，以及采用统一方案与选择性方案的情况。
