Lorente Reyes, Antonanzas Fernando, Rodriguez-Ibeas Roberto
Departamento de Economiay Empresa, Universidad de La Rioja, Ciguena 60, 26004, Logrono, Spain.
Health Econ Rev. 2019 Jul 17;9(1):25. doi: 10.1186/s13561-019-0242-x.
Concerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements. Nevertheless, few insights have been derived, due to their confidentiality. The purpose of this study is to analyze to what extent these agreements have been implemented in Spain and the importance of several clinical and management variables concerning their use. We also explore whether risk-sharing agreements promote the adoption of personalized medicine. We give a descriptive analysis based on a questionnaire sent to members of the Spanish Society of Hospital Pharmacy, asking about the implementation of risk-sharing contracts in their hospitals.
There were 80 replies. Implementation of risk-sharing agreements was high (90%), being oncology, neurology, dermatology and infectious diseases the main specialties. The most relevant variables were the number of units of medication per year (89%) in price-volume agreements, and the efficacy and uncertainty of treatments (over 75%) in pay-for-performance agreements. Price-volume agreements were suitable for both conventional and personalized medicine and pay-for-performance more specific for personalized medicine. Paying for performance promotes genetic testing (85%).
The results suggest health authorities should encourage the assessment of financial and health outcomes of real-world contracts of conventional and personalized medicine to better know the variables influencing their use.
对卫生系统财务可持续性的担忧促使人们采用风险分担协议。然而，由于这些协议的保密性，从中获得的见解很少。本研究的目的是分析这些协议在西班牙的实施程度以及与使用相关的几个临床和管理变量的重要性。我们还探讨了风险分担协议是否促进个性化医疗的采用。我们基于向西班牙医院药学协会成员发送的问卷进行描述性分析，询问他们医院风险分担合同的实施情况。
共收到80份回复。风险分担协议的实施率很高（90%），肿瘤学、神经病学、皮肤病学和传染病是主要专业领域。在价格 - 数量协议中，最相关的变量是每年的药品单位数量（89%），在绩效付费协议中，治疗的疗效和不确定性（超过75%）最为重要。价格 - 数量协议适用于传统医学和个性化医疗，而绩效付费协议对个性化医疗更具针对性。绩效付费促进基因检测（85%）。
结果表明，卫生当局应鼓励评估传统医学和个性化医疗实际合同的财务和健康结果，以便更好地了解影响其使用的变量。
