Miot Jacqui, Thiede Michael
Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Scenarium Group GmbH, Berlin, Germany.
Front Pharmacol. 2017 Oct 10;8:715. doi: 10.3389/fphar.2017.00715. eCollection 2017.
Pharmacoeconomics is receiving increasing attention globally as a set of tools ensuring efficient use of resources in health systems, albeit with different applications depending on the contextual, cultural and development stages of each country. The factors guiding design, implementation and optimisation of pharmacoeconomics as a steering tool under the universal health coverage paradigm are explored using case studies of Germany and South Africa. German social health insurance is subject to the efficiency precept. Pharmaco-regulatory tools reflect the respective framework conditions under which they developed at particular points in time. The institutionalization and integration of pharmacoeconomics into the remit of the Institute for Quality and Efficiency in Health Care occurred only rather recently. The road has not been smooth, requiring political discourse and complex processes of negotiation. Although enshrined in the National Drug Policy, South Africa has had a more fragmented approach to medicine selection and pricing with different policies in private and public sectors. The regulatory reform for use of pharmacoeconomic tools is ongoing and will be further shaped by the introduction of National Health Insurance. A clear vision or framework is essential as the regulatory introduction of pharmacoeconomics is not a single event but rather a growing momentum. The path will always be subject to influences of politics, economics and market forces beyond the healthcare system so delays and modifications to pharmacoeconomic tools are to be expected. Health systems are dynamic and pharmacoeconomic reforms need to be sufficiently flexible to evolve alongside.
作为一套确保卫生系统资源有效利用的工具，药物经济学在全球范围内受到越来越多的关注，尽管根据每个国家的背景、文化和发展阶段，其应用方式有所不同。本文通过德国和南非的案例研究，探讨了在全民健康覆盖模式下，指导药物经济学作为一种指导工具进行设计、实施和优化的因素。德国社会医疗保险遵循效率原则。药物监管工具反映了它们在特定时间点所形成的各自的框架条件。药物经济学在卫生保健质量和效率研究所的制度化和整合只是最近才出现的。这条路并不平坦，需要进行政治讨论和复杂的谈判过程。尽管南非的《国家药物政策》中有所规定，但该国在药品选择和定价方面采取了更为分散的方法，私营部门和公共部门实行不同的政策。使用药物经济学工具的监管改革正在进行中，并且将因引入国家医疗保险而进一步形成。由于药物经济学的监管引入不是一个单一事件，而是一种不断增长的趋势，因此明确的愿景或框架至关重要。这条道路将始终受到医疗保健系统之外的政治、经济和市场力量的影响，因此药物经济学工具出现延迟和修改是可以预料的。卫生系统是动态的，药物经济学改革需要足够灵活，以便与之同步发展。
