Elek Péter, Takács Eszter, Merész Gergo, Kaló Zoltán
Department of Economics, Eötvös Loránd University (ELTE), Budapest, Hungary.
Parexel Hungary, Budapest, Hungary.
Health Policy Plan. 2017 Apr 1;32(3):349-358. doi: 10.1093/heapol/czw133.
External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that-after controlling for compounding factors such as GDP, the proportion of the old-age population or life expectancy-the annual growth rate of pharmaceutical expenditure was 2.1% points larger in the lower- than in the higher-income members of the European Union between 2000 and 2008. This difference in trends became non-significant (0.6% points) after the onset of the global economic crisis. There was no significant difference between lower- and higher-income countries in the growth rate of non-pharmaceutical health expenditure in either period. Our results indirectly support the presence of price convergence of pharmaceuticals among European countries, and EPR and parallel trade may provide a reasonable explanation to the observed trend difference of pharmaceutical expenditure in the two groups of countries between 2000 and 2008. This higher growth rate of pharmaceutical expenditure put extra burden on public health care budgets in lower-income countries and resulted in disproportionately more cost-containment measures compared to higher-income countries after 2008. It remains to be seen whether the disappearance of the difference in trend growth rates due to special health policy interventions in countries with economic difficulties is temporary or permanent.
支付方在全球范围内越来越频繁地采用外部价格参考（EPR）来控制药品价格。与药品平行贸易一起，EPR可能导致高收入国家的药品价格降低，而低收入国家的药品价格升高，这意味着药品支出在后一类国家的增长速度比前一类国家更快。我们的目标是评估这一假设。我们对国家层面的面板数据使用分层线性模型，结果表明，在控制了国内生产总值、老年人口比例或预期寿命等复合因素后，2000年至2008年期间，欧盟低收入成员国的药品支出年增长率比高收入成员国高2.1个百分点。全球经济危机爆发后，这种趋势差异变得不显著（0.6个百分点）。在这两个时期，低收入和高收入国家在非药品卫生支出增长率方面均无显著差异。我们的结果间接支持了欧洲国家药品价格趋同的存在，并且EPR和平行贸易可能为2000年至2008年两组国家药品支出观察到的趋势差异提供合理的解释。药品支出的这种较高增长率给低收入国家的公共医疗保健预算带来了额外负担，并且与高收入国家相比，2008年后导致了更多的成本控制措施。经济困难国家的特殊卫生政策干预导致趋势增长率差异消失，这是暂时的还是永久的，还有待观察。
