Rodríguez-Monguió Rosa, Antoñanzas Villar Fernando
Centre for Health Outcomes, Policy and Evaluation Studies (HOPES) and School of Public Health, The Ohio State University, Columbus, Ohio 43210, USA.
Pharmacoeconomics. 2006;24(6):537-48. doi: 10.2165/00019053-200624060-00002.
This paper describes the main healthcare rationing policies implemented in Spain over the last 2 decades, and analyses the consequences of these policies on the healthcare system, patients, healthcare practitioners, the pharmaceutical industry and policymakers. The primary explicit healthcare rationing policies utilised in Spain include a catalogue that defines the healthcare rights of citizens. However, the existing system may lead to inequity between regions, and is not structured to direct resources towards the most cost-effective options. Health technology assessment requires further work before it can be utilised widely for the development of rationing strategies. Selective reimbursement of drugs and drug co-payments provide only short-term results and appear to have little long-term impact on expenditure. Implicit rationing instruments, especially waiting lists, have had a significant effect on healthcare quality and the welfare of citizens, and have contributed to keeping the Spanish healthcare budget under control. Newer regulations should integrate some form of economic evaluation within the policy-making processes associated with healthcare. Further research is needed to identify those efficient and equitable rationing instruments that are most likely to improve health interventions for an aging society that is increasingly demanding of health services.
本文描述了西班牙在过去20年里实施的主要医疗资源配给政策，并分析了这些政策对医疗系统、患者、医疗从业者、制药行业和政策制定者的影响。西班牙使用的主要明确的医疗资源配给政策包括一个定义公民医疗权利的目录。然而，现有的系统可能导致地区间的不平等，而且其结构并非旨在将资源导向最具成本效益的选择。在健康技术评估能够广泛用于制定配给策略之前，还需要进一步开展工作。药品的选择性报销和药品共付仅能提供短期效果，而且似乎对支出没有太大的长期影响。隐性配给手段，尤其是等候名单，对医疗质量和公民福利产生了重大影响，并有助于控制西班牙的医疗预算。新的法规应在与医疗相关的决策过程中纳入某种形式的经济评估。需要进一步研究，以确定那些最有可能改善针对日益需要医疗服务的老龄化社会的健康干预措施的高效且公平的配给手段。
