Burstall M L
REMIT Consultants Ltd, London, UK.
Health Policy. 1997 Sep;41 Suppl:S27-43. doi: 10.1016/s0168-8510(97)00051-1.
The British National Health Service (NHS) provide comprehensive health services, including prescription drugs, to the entire population. Thus pharmaceuticals are seen as part of the provision of health care, not as an isolated cost element. UK expenditures on pharmaceuticals has been relatively low by European and US standards. The basic dilemma facing pharmaceutical policymakers is the need to control public spending on drugs while encouraging a successful UK pharmaceutical industry. A highly centralised policymaking apparatus has historically permitted a fairly collaborative approach with the pharmaceutical industry. Prices are not controlled directly as in some other European countries; rather, producers negotiate an allowable rate of return on all sales to the NHS. This gives producers considerable discretion to set prices for new drugs without government interference. Thus, prices are somewhat higher than in comparable European countries, but utilisation rates are among the lowest. The credit for low utilisation (and high generic substitution rates) goes to the conservative nature and medical education of British general practitioners. A general conclusion is that pharmaceutical spending has been curbed with minimal damage to the UK pharmaceutical sector.
英国国民医疗服务体系（NHS）为全体民众提供包括处方药在内的全面医疗服务。因此，药品被视为医疗保健服务的一部分，而非一个孤立的成本要素。按照欧美标准，英国的药品支出一直相对较低。制药政策制定者面临的基本困境是，在鼓励英国制药行业蓬勃发展的同时，需要控制公共药品支出。从历史上看，高度集中的政策制定机构允许与制药行业采取相当协作的方式。不像其他一些欧洲国家那样直接控制价格；相反，生产商就向NHS销售的所有产品协商一个可允许的回报率。这使得生产商在没有政府干预的情况下，有相当大的定价 discretion。因此，价格比欧洲可比国家略高，但使用率却是最低的。低使用率（以及高仿制药替代率）要归功于英国全科医生的保守性质和医学教育。一个总体结论是，在对英国制药行业造成最小损害的情况下，药品支出得到了控制。
