Soumerai Stephen
Harvard Medical School and Harvard Pilgrim Healthcare, Boston, Mass. 02215, USA.
J Clin Psychiatry. 2003;64 Suppl 17:19-22.
Cost-containment policies frequently focus on reducing drug expenditures, although prescription drug costs are a relatively small proportion of total health care expenditures. Data show that very few drug cost-containment policies can selectively reduce unneeded care while maintaining essential care. In the early 1980s, the New Hampshire Medicaid program introduced a drug-payment limit (a "cap") that set the number of reimbursable medications a patient could receive per month at 3. Analyses reviewed in this article indicate that New Hampshire's drug cap, while in effect, reduced the use of prescription drugs among the elderly and the mentally ill but increased hospital and nursing home admissions, partial hospitalizations, distribution of psychoactive medications by community mental health centers, and use of emergency mental health services. Vulnerable populations are most likely to experience adverse effects from hastily-applied drug cost-containment policies, and resulting compensatory measures may create more expenses than the policy removes.
成本控制政策通常侧重于降低药品支出，尽管处方药成本在医疗保健总支出中所占比例相对较小。数据显示，很少有药品成本控制政策能够在维持必要医疗的同时，有针对性地减少不必要的医疗服务。20世纪80年代初，新罕布什尔州医疗补助计划引入了药品支付限额（“上限”），将患者每月可报销药品数量设定为3种。本文所回顾的分析表明，新罕布什尔州的药品上限在实施期间，减少了老年人和精神病患者的处方药使用，但增加了医院和疗养院的入院人数、部分住院治疗、社区心理健康中心精神活性药物的分发以及紧急心理健康服务的使用。弱势群体最容易因仓促实施的药品成本控制政策而受到不利影响，而且由此产生的补偿措施可能会带来比该政策节省的费用更多的开支。
