Hammerman Ariel, Greenberg Dan
Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva.
Harefuah. 2012 Jun;151(6):364-7, 376.
In recent years, spending on prescription drugs contributes substantially to the continuous growth in health expenditure in most Western countries. This increase in spending is influenced by both a rise in the use of existing drugs and by the adoption of new and expensive drugs. Risk-sharing agreements between pharmaceutical companies and health insurers have emerged as insurers began to deny reimbursement of expensive innovative treatments with unfavorable cost-effectiveness ratios. This occurred in cases where the expected budgetary impact was too high or when the long-term effectiveness was questionable. Risk sharing agreements serve the interests of both the insurers and the drug manufacturers. Pharmaceutical companies' interests are to dispel the uncertainties encountered by the health insurers white deciding on drug reimbursement. The insurers are interested in these agreements in order to reduce the budgetary risk while allowing their patients access to innovative drugs. Currently, only a few risk sharing agreements have been implemented, and the scientific literature on such schemes is still sparse. Since the health insurers' interest is to develop mechanisms that will contain health costs, without affecting the insured, it appears that this trend will continue to emerge. It is also likely that the adoption of similar mechanisms in the Israeli National List of Health Services updating process, would improve the accuracy of early estimates of the budgetary impact, and the actual use of the new technologies would be close to early estimates. This article reviews the principles of risk-sharing schemes and issues involved in the actual implementation of such agreements.
近年来，在大多数西方国家，处方药支出在医疗保健支出的持续增长中占了很大比例。支出的增加既受到现有药物使用量上升的影响，也受到新的昂贵药物采用的影响。随着保险公司开始拒绝报销成本效益比不佳的昂贵创新疗法，制药公司与健康保险公司之间的风险分担协议应运而生。这种情况发生在预期预算影响过高或长期疗效存疑之时。风险分担协议符合保险公司和药品制造商双方的利益。制药公司的利益在于消除健康保险公司在决定药品报销时所面临的不确定性。保险公司对这些协议感兴趣，是为了降低预算风险，同时让其患者能够使用创新药物。目前，只有少数风险分担协议得到了实施，关于此类计划的科学文献仍然稀少。由于健康保险公司的兴趣在于开发能够控制医疗成本且不影响被保险人的机制，这种趋势似乎将继续出现。在以色列国家医疗服务清单更新过程中采用类似机制，也有可能提高对预算影响的早期估计的准确性，并且新技术实际使用情况将接近早期估计。本文回顾了风险分担计划的原则以及此类协议实际实施中涉及的问题。
