Faculdade de Economia, Universidade Nova de Lisboa, Campus de Campolide, Lisboa, Portugal.
Health Econ. 2011 Apr;20(4):461-70. doi: 10.1002/hec.1603.
The introduction of new (and expensive) pharmaceutical products is one of the major challenges for health systems. The search for new institutional arrangements is natural. The use of the so-called risk-sharing agreements is one example. Recent discussions have somewhat neglected the economic fundamentals underlying risk-sharing agreements. We argue here that risk-sharing agreements, although attractive due to the principle of paying by results, also entail risks. Too many patients may be put under treatment. Prices are likely to be adjusted upward, in anticipation of future risk-sharing agreements between the pharmaceutical company and the third-party payer. An available instrument is a verification cost per patient treated, which allows obtaining the first-best allocation of patients to the new treatment, under the agreement. Overall, the welfare effects of risk-sharing agreements are ambiguous, and caution is urged regarding their use.
新型（昂贵）药品的引入是医疗体系面临的主要挑战之一。寻求新的制度安排是自然而然的。所谓风险分担协议的使用就是一个例子。最近的讨论在一定程度上忽略了风险分担协议背后的经济基础。我们在此认为，风险分担协议虽然由于按结果付费的原则具有吸引力，但也存在风险。可能会有太多的患者接受治疗。由于预计制药公司和第三方支付者之间会有未来的风险分担协议，价格可能会向上调整。一种可用的手段是每位治疗患者的核查成本，这允许根据协议将患者最佳分配到新的治疗中。总体而言，风险分担协议的福利效应是不确定的，因此在使用时需要谨慎。
