Centre for Health Economics, University of York, York, UK.
Value Health. 2013 Jan-Feb;16(1 Suppl):S7-13. doi: 10.1016/j.jval.2012.10.007. Epub 2012 Nov 14.
Providing universal access to innovative, high-cost technologies leads to tensions in today's health care systems. The tension becomes particularly evident in the context of scarce resources, where the risk of taking contentious coverage decisions increases rapidly. To ensure economic sustainability, the payers of health care think that the benefits from the use of the new technologies need to be commensurate with the costs. Therefore, many jurisdictions have programs of health technology assessment, which often results in restrictions of access to care, either through complete refusal to reimburse the technology or its restriction of use to only a subset of the eligible patient population. However, manufacturers feel that they should be adequately rewarded for their innovations and require sufficient funds to invest in further research. Finally, patients perceive these technologies to have added benefits, and so they are concerned when they are denied access. If sustainable access to health care is to be maintained in the future, approaches are needed to reconcile these different perspectives. This article explores the approaches, in both methods and policy, to help bring about this reconciliation. These include rethinking the notion of social value (on the part of payers), aligning manufacturers' research more closely with societal objectives, and increasing patient participation in health technology assessment.
为创新的、高成本的技术提供普及机会，会给当今的医疗保健系统带来紧张局势。在资源稀缺的情况下，这种紧张局势变得尤为明显，因为做出有争议的保险覆盖决策的风险迅速增加。为了确保经济可持续性，医疗保健的支付方认为，新技术的使用效益需要与成本相称。因此，许多司法管辖区都有卫生技术评估计划，这往往会导致对医疗保健的获取受限，要么完全拒绝报销该技术，要么将其使用限制在符合条件的患者群体的一部分。然而，制造商认为他们应该为自己的创新获得充分的回报，并需要足够的资金来投资于进一步的研究。最后，患者认为这些技术有额外的好处，因此当他们被拒绝使用时，他们会感到担忧。如果要在未来维持可持续的医疗保健获取，就需要采取一些方法来调和这些不同的观点。本文探讨了在方法和政策方面的一些方法，以帮助实现这种调和。这些方法包括重新思考支付方的社会价值观念，使制造商的研究更紧密地与社会目标保持一致，并增加患者在卫生技术评估中的参与度。
