School of Projects, Processes and Systems, Henley Management College, Henley-on-Thames, United Kindgom.
PLoS One. 2007 Jul 4;2(7):e592. doi: 10.1371/journal.pone.0000592.
The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment).
Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro) and females (195.12 euro). After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals.
If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources to regional authorities and general practices.
本研究的主要目的是通过建立一个考虑一般实践中人口统计学差异的加权人头付费模型，来对意大利的药物需求进行建模，这也是首次尝试。实验模型被称为 ASSET（年龄/性别标准化治疗估计）。
个体处方费用和人口统计数据来自意大利的 3175691 名受试者，这些数据是在 2004 年 10 月至 2005 年 9 月的 12 个月期间直接从三个地区卫生当局收集的。男性（196.13 欧元）和女性（195.12 欧元）的个体年平均处方费用相似。65 岁以后，男性的平均处方费用明显高于女性。一般来说，一个 75 岁的男性患者的费用是 25-34 岁患者的 12 倍，如果是女性，则是 8 倍。65 岁以上的患者（占总人口的 22%）占总处方费用的 56%。尽管在 2000-2005 年期间意大利的定价和报销出现了波动，但权重解释了总处方费用变化的约 90%。ASSET 权重只能解释个体间处方费用变化的约 25%。
如果主要是全科医生的个体处方导致了无法解释的差异，那么基于人头付费的预算将逐渐使高处方费用的实践向全国平均水平靠拢。不过，也有可能无法解释的个体处方费用差异是实践人群临床特征或社会经济条件的差异所致。如果是这种情况，基于人头付费的预算可能会导致资源分配不公。ASSET 的年龄/性别权重应作为指导，而不是最终决定，为地区当局和一般实践公平分配处方资源。
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