Basu Anirban, Sullivan Sean D
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy and Department of Health Services, University of Washington, Seattle, WA, USA; Department of Economics, University of Washington, Seattle, WA, USA; National Bureau of Economic Research, Cambridge, MA, USA.
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy and Department of Health Services, University of Washington, Seattle, WA, USA.
Value Health. 2017 Feb;20(2):261-265. doi: 10.1016/j.jval.2016.11.022.
In well-functioning markets, a hedonic pricing scheme can reflect the marginal valuation of various attributes of a differentiated product at market equilibrium. It serves as an important tool to inform pricing of a new product with a specific combination of attributes. Because health cannot be bought and sold in a market setting, and health care markets are distorted by insurance or government subsidies, direct valuation of a health intervention as a differentiated good through observed market prices is difficult. In this article, we discuss the rationale of using stated preference methods for developing a hedonic value framework for health insurance products to inform the decision on whether a product should be covered or subsidized by insurance, given its price. This value index will not reflect marginal value at market equilibrium, as in a hedonic pricing scheme, but would capture the distribution of marginal value in the population. We discuss how affordability concerns can be integrated into the development of a hedonic valuation model. We compare this framework with traditional cost-effectiveness analysis and also the existing value frameworks put forth by various organizations. The framework can be adopted to inform other decisions such as pricing. We argue that developing such a comprehensive and decision-theoretic value framework is feasible and, if successful, can serve to inform health care resource allocation in this country for decades to come in a systematic manner.
在运转良好的市场中，享乐定价方案能够反映差异化产品的各种属性在市场均衡状态下的边际估值。它是为具有特定属性组合的新产品定价提供信息的重要工具。由于健康无法在市场环境中进行买卖，且医疗保健市场因保险或政府补贴而扭曲，所以通过观察到的市场价格直接将健康干预措施作为差异化商品进行估值是困难的。在本文中，我们讨论使用陈述偏好方法为健康保险产品建立享乐价值框架的基本原理，以便在已知产品价格的情况下，为产品是否应由保险承保或补贴的决策提供依据。这个价值指数不会像享乐定价方案那样反映市场均衡状态下的边际价值，而是会捕捉人群中边际价值的分布情况。我们讨论了如何将可负担性问题纳入享乐估值模型的开发过程。我们将这个框架与传统的成本效益分析以及各组织提出的现有价值框架进行了比较。该框架可用于为定价等其他决策提供依据。我们认为，开发这样一个全面的、基于决策理论的价值框架是可行的，如果成功，它能够在未来几十年以系统的方式为该国的医疗保健资源分配提供参考。
