Garrison Louis P, Towse Adrian
Pharmaceutical Outcomes Research & Policy Program, Department of Pharmacy, Health Sciences Building, H375, 1959 NE Pacific St., H-375A, Box 357630, University of Washington, Seattle, WA 98195-7630, USA.
The Office of Health Economics, Southside, 7th Floor, 105 Victoria Street, London SW1E 6QT, UK.
J Pers Med. 2017 Sep 4;7(3):10. doi: 10.3390/jpm7030010.
'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.
如今，“基于价值”的结果、定价和报销作为卫生部门改革的内容被广泛讨论。在本文中，我们将在个性化医疗的背景下讨论它们的含义和关系，个性化医疗被定义为根据基于生物标志物的诊断测试结果来接受治疗。我们探讨这样一个问题：“在个性化医疗中应采用何种定价和报销模式？”简单的答案是，相互竞争的创新者和技术采用者应拥有促进长期动态效率的激励措施。我们认为，为实现个性化医疗中最佳创新的这一社会目标，作为计划参与者代理人的支付方，应旨在向其供应商明确传达他们所看重的内容。我们首先从经济角度重新审视价值概念，并认为在个性化医疗背景下需要一个更宽泛的价值概念。我们讨论个性化医疗市场以及价格与报销之间的相互作用。最后，我们强调了僵化的或基于成本的报销系统所带来的潜在障碍，尤其是对于基于生物标志物的预测性测试而言，以及这些个性化技术如何具有全球公共产品的特征，这就需要基于全球价值的差异化定价，以在最佳创新和采用率方面实现动态效率。
