Drug Policy Research Group and WHO Collaborating Center in Pharmaceutical Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
BMJ Open. 2012 Nov 28;2(6). doi: 10.1136/bmjopen-2012-001686. Print 2012.
In 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes.
Interrupted time-series design, with a non-equivalent comparison group.
Thailand, 1998-2006.
Quarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006.
UCS implementation, April-October 2001.
Total pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status.
The UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors.
Our results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed.
2001 年，泰国实施了全民医疗保险计划（UCS），这是一项旨在实现全民获得医疗保健（包括基本药物）的公共保险制度，并通过对门诊服务的人头付费和其他住院治疗的支付政策，影响初级保健中心和医院有效地利用资源。我们的目的是评估 UCS 对泰国三种非传染性疾病（癌症、心血管疾病和糖尿病）药物使用的影响。
具有非等效对照组的中断时间序列设计。
泰国，1998-2006 年。
IMS Health 在 1998 年至 2006 年间收集的来自医院和零售药店的药品季度采购量。
UCS 实施，2001 年 4 月至 10 月。
按许可状态和国家基本药物清单状态划分的总药品销售总量和市场份额百分比。
UCS 与长期增加治疗通常在门诊初级保健环境下的疾病（如糖尿病、高胆固醇和高血压）的药物销售有关，但与通常在二级或三级保健环境下治疗的疾病（如心力衰竭、心律失常和癌症）的药物销售无关。尽管销售增长的大部分是基本药物，但非基本药物的销售也有所增加。改革后，大多数类别的药品在医院部门的市场份额按许可状态发生了显著变化。政府生产的产品经常取代品牌仿制药或仿制药竞争对手。
我们的结果表明，扩大医疗保险覆盖范围，为泰国全民提供药物福利，增加了初级保健的药物可及性。然而，我们的研究还表明，UCS 可能产生了潜在的不良影响。迫切需要评估全民健康覆盖对药物使用的长期影响。
