Dickson M, Redwood H
Pharmacy Practice Department, College of Pharmacy, University of South Carolina, Columbia, USA.
Pharmacoeconomics. 1998 Nov;14(5):471-9. doi: 10.2165/00019053-199814050-00002.
Reference pricing systems are reimbursement ceilings set by payers in an effort to constrain pharmaceutical expenditure for a private or public drug benefit. In recent years, many governments have adopted reference pricing either as a replacement or in addition to product specific price controls. Programme administrators should consider whether these policies are providing the intended benefits or whether there may be a more effective method. This article provides a review of reference pricing in Europe, North America and other countries. There are many similarities in the reference price policies but the markets to which they apply are more likely to be different. The European experience gives a 'once-for-all' lowering effect on pharmaceutical expenditure, often at the expense of compromises on prescribing. In Germany and The Netherlands, reference pricing has been relatively ineffective in lowering expenditure which has led to a succession of other interventions to achieve expenditure control goals. The US also has reference pricing, but it occurs in a very competitive market which may be responsible (at least in part) for the relatively modest growth in expenditure compared with European countries. The review of countries with reference pricing policies suggests that such policies are less effective than competitive markets in moderating pharmaceutical expenditure. Nonetheless, governments continue to pursue reference pricing strategies.
参考定价系统是支付方设定的报销上限，旨在控制私人或公共药品福利的药品支出。近年来，许多政府已采用参考定价作为产品特定价格管制的替代方案或补充方案。项目管理人员应考虑这些政策是否正在提供预期的效益，或者是否可能存在更有效的方法。本文对欧洲、北美和其他国家的参考定价进行了综述。参考价格政策有许多相似之处，但它们所适用的市场可能更不相同。欧洲的经验对药品支出产生了“一劳永逸”的降低效果，这通常是以牺牲处方妥协为代价的。在德国和荷兰，参考定价在降低支出方面相对无效，这导致了一系列其他干预措施以实现支出控制目标。美国也有参考定价，但它出现在一个竞争非常激烈的市场中，这可能（至少部分）是与欧洲国家相比支出增长相对适度的原因。对实施参考定价政策的国家的综述表明，此类政策在控制药品支出方面不如竞争市场有效。尽管如此，各国政府仍继续推行参考定价策略。
