Launois Robert, Navarrete Lucia Fiestas, Ethgen Olivier, Le Moine Jean-Gabriel, Gatsinga René
French Network for Evaluation in Health Economics, Paris, France.
Research Unit for the Economic Evaluation of Medical Innovation, University of Liege, Liege, Belgium.
J Mark Access Health Policy. 2014 Jun 23;2. doi: 10.3402/jmahp.v2.24988. eCollection 2014.
The objective of our paper is to offer a new, payer-friendly taxonomy of market entry agreements (MEAs) that aims to twin contracts with their methodological designs in an effort to clarify the distinction between contracts that are based on performance and those that are based on demonstrated effect.
Our analysis proceeds in two stages: First, we delimit the scope and framework of pay for performance (P4P) and pay for demonstrated effect (P4E) agreements. Second, we distinguish the methodological designs supporting the implementation of each of these contracts.
We elucidate why P4P contracts prevent the payer from funding the true effectiveness of an innovation by expanding on their limitations. These include: 1) the normative nature of comparisons, 2) the impossibility of true effect imputability for each individual, and 3) the use of intermediary outcome measures. We then explore three main criticisms that payers must take into account when reasoning in terms of performance rather than in terms of the product effectiveness.
The potential effect that performance-based reimbursements may have on dissociating the components of the cost-effectiveness ratio constitutes an obstacle to a true health economic reasoning.
本文的目的是提供一种新的、对支付方友好的市场进入协议（MEA）分类法，旨在将合同与其方法设计相匹配，以厘清基于绩效的合同和基于已证实效果的合同之间的区别。
我们的分析分两个阶段进行：首先，我们界定绩效付费（P4P）和已证实效果付费（P4E）协议的范围与框架。其次，我们区分支持这些合同各自实施的方法设计。
我们通过详述P4P合同的局限性，阐明了为何此类合同会阻碍支付方为创新的真正有效性提供资金。这些局限性包括：1）比较的规范性；2）无法真正将效果归责于每个个体；3）使用中间结果指标。然后，我们探讨了支付方在基于绩效而非产品有效性进行考量时必须考虑的三个主要批评意见。
基于绩效的报销可能对成本效益比各组成部分的分离产生的潜在影响，构成了真正的卫生经济推理的障碍。
