Carlson Josh J, Gries Katharine S, Yeung Kai, Sullivan Sean D, Garrison Louis P
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Box 357630, Seattle, WA, 98195-7630, USA,
Appl Health Econ Health Policy. 2014 Jun;12(3):231-8. doi: 10.1007/s40258-014-0093-x.
Our objective was to identify and characterize publicly available cases and related trends for performance-based risk-sharing arrangements (PBRSAs). We performed a review of PBRSAs over the past 20 years (1993-2013) using available databases and reports from colleagues and healthcare experts. These were categorized according to a previously published taxonomy of scheme types and assessed in terms of the underlying product and market attributes for each scheme. Macro-level trends were identified related to the timing of scheme adoption, countries involved, types of arrangements, and product and market factors. Our search yielded 148 arrangements. From this set, 65 arrangements included a coverage with an evidence development component, 20 included a conditional treatment continuation component, 54 included a performance-linked reimbursement component, and 42 included a financial utilization component. Each type of scheme addresses fundamental uncertainties that exist when products enter the market. The pace of adoption appears to be slowing, but new countries continue to implement PBRSAs. Over this 20-year period, there has been a consistent movement toward arrangements that minimize administrative burden. In conclusion, the pace of PBRSA adoption appears to be slowing but still has traction in many health systems. These remain a viable coverage and reimbursement mechanism for a wide range of medical products. The long-term viability and growth of these arrangements will rest in the ability of the parties to develop mutually beneficial arrangements that entail minimal administrative burden in their development and implementation.
我们的目标是识别并描述基于绩效的风险分担安排（PBRSAs）的公开案例及相关趋势。我们利用现有数据库以及同事和医疗保健专家提供的报告，对过去20年（1993 - 2013年）的PBRSAs进行了回顾。这些案例根据先前发布的计划类型分类法进行分类，并根据每个计划的基础产品和市场属性进行评估。确定了与计划采用时间、涉及国家、安排类型以及产品和市场因素相关的宏观层面趋势。我们的搜索产生了148种安排。在这一组中，65种安排包括带有证据开发部分的覆盖范围，20种包括有条件治疗延续部分，54种包括与绩效挂钩的报销部分，42种包括财务利用部分。每种计划类型都解决了产品进入市场时存在的基本不确定性。采用速度似乎正在放缓，但新的国家仍在继续实施PBRSAs。在这20年期间，一直在朝着将行政负担降至最低的安排发展。总之，PBRSAs的采用速度似乎正在放缓，但在许多卫生系统中仍具有吸引力。对于广泛的医疗产品而言，这些仍然是可行的覆盖和报销机制。这些安排的长期可行性和增长将取决于各方能否制定出互利的安排，在其制定和实施过程中带来最小的行政负担。
