Gavious Arieh, Greenberg Dan, Hammerman Ariel, Segev Ella
Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel.
Eur J Health Econ. 2014 Jun;15(5):553-61. doi: 10.1007/s10198-013-0544-6. Epub 2013 Dec 11.
As part of the process of updating the National List of Health Services in Israel, health plans (the 'payers') and manufacturers each provide estimates on the expected number of patients that will utilize a new drug. Currently, payers face major financial consequences when actual utilization is higher than the allocated budget. We suggest a risk-sharing model between the two stakeholders; if the actual number of patients exceeds the manufacturer's prediction, the manufacturer will reimburse the payers by a rebate rate of α from the deficit. In case of under-utilization, payers will refund the government at a rate of γ from the surplus budget. Our study objective was to identify the optimal early estimations of both 'players' prior to and after implementation of the risk-sharing scheme.
Using a game-theoretic approach, in which both players' statements are considered simultaneously, we examined the impact of risk-sharing within a given range of rebate proportions, on players' early budget estimations.
When increasing manufacturer's rebate α to be over 50 %, then manufacturers will announce a larger number, and health plans will announce a lower number of patients than they would without risk sharing, thus substantially decreasing the gap between their estimates. Increasing γ changes players' estimates only slightly.
In reaction to applying a substantial risk-sharing rebate α on the manufacturer, both players are expected to adjust their budget estimates toward an optimal equilibrium. Increasing α is a better vehicle for reaching the desired equilibrium rather than increasing γ, as the manufacturer's rebate α substantially influences both players, whereas γ has little effect on the players behavior.
作为以色列更新国家医疗服务清单过程的一部分，医疗计划机构（“支付方”）和制药商各自提供对新药预计使用患者数量的估计。目前，当实际使用量高于分配预算时，支付方面临重大财务后果。我们建议在这两个利益相关者之间建立一种风险分担模式；如果实际患者数量超过制药商的预测，制药商将从赤字中按α的回扣率向支付方偿还费用。在使用不足的情况下，支付方将从盈余预算中按γ的比率向政府退款。我们的研究目标是确定在风险分担计划实施之前和之后，两个“参与者”的最优早期估计。
采用博弈论方法，同时考虑双方参与者的声明，我们研究了在给定回扣比例范围内风险分担对参与者早期预算估计的影响。
当将制药商的回扣α提高到超过50%时，制药商将公布更大的患者数量，而医疗计划机构公布的患者数量将比没有风险分担时更低，从而大幅缩小他们估计之间的差距。提高γ只会轻微改变参与者的估计。
为应对对制药商实施大幅风险分担回扣α的情况，预计双方参与者都会将其预算估计调整到最优均衡状态。提高α是实现理想均衡的更好手段，而不是提高γ，因为制药商回扣α对双方参与者都有重大影响，而γ对参与者行为影响很小。
