Noyce P R, Huttin C, Atella V, Brenner G, Haaijer-Ruskamp F M, Hedvall M, Mechtler R
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester, UK.
Health Policy. 2000 Jun;52(2):129-45. doi: 10.1016/s0168-8510(00)00066-x.
The study compares the cost-sharing (co-payment) arrangements for prescribed medicines in a sample of EU countries. Through a set of typical prescription scenarios, the cost burden to individual patients of prescriptions are examined, in the context of drug price, and from the perspective of therapeutic need. The cost to patients of medicines is consistently lower in some, and higher in other, countries, regardless of the type of prescription charge system. Fixed charge systems, as opposed to graduated co-payment systems, are obviously more likely to lead to similar charges for the treatment of comparable clinical conditions, but depending on the level of the charge, can result in the patient paying a higher charge than the price of the drug to the health organisation. Exemption from charges for prescription medicines, commonly relate to clinical condition and level of income. Some systems also have age-related criteria and apply ceilings to the total prescription cost burden borne by the patient. The impact on patient costs of specific policy formulations is discussed and a proposal is made for cost convergence for comparable therapies. The method used in this study may also provide a route for investigating model systems prior to implementation.
该研究比较了部分欧盟国家中处方药的费用分担（共付额）安排。通过一系列典型的处方情景，在药品价格背景下并从治疗需求角度，研究了处方给个体患者带来的费用负担。无论采用何种处方收费系统，药品费用在一些国家始终较低，而在另一些国家则较高。与分级共付系统不同，固定收费系统显然更有可能导致在治疗类似临床病症时收取类似费用，但根据收费水平，可能会使患者支付的费用高于药品对卫生机构的价格。处方药费用豁免通常与临床病症和收入水平有关。一些系统还有与年龄相关的标准，并对患者承担的总处方费用负担设定上限。讨论了特定政策制定对患者费用的影响，并提出了可比疗法费用趋同的建议。本研究中使用的方法还可为在实施前调查模型系统提供一条途径。
