Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Department of Health Policy and Management, DeGroote School of Business, McMaster University, 4350 South Service Road, Burlington, ON, L7L 5R8, Canada.
Health Care Anal. 2020 Jun;28(2):121-136. doi: 10.1007/s10728-020-00394-x.
The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders (the pharmaceutical companies, third party payers, and the public) involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. We draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, (1) to make drugs financially accessible to the patients who need them, and (2) to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as 'enlightened risk sharing'. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples.
解决高药价问题最常见的方法是通过法规、价格谈判或保险公司对药物覆盖范围的改变来实现。这些措施在很大程度上是在制药公司和支付者之间或支付者之间转移药物支出的负担。本研究旨在为药品定价和采购所涉及的主要利益相关者（制药公司、第三方支付者和公众）之间的关系提出一种替代模式，鼓励采取更合作的方法。我们借鉴了伦理学和卫生经济学的原则，并将其应用于制药行业的背景下。该模式优先考虑两个目标，（1）使需要药物的患者能够负担得起药物，（2）使制药公司保持生存和盈利。它以主要利益相关者之间的财务风险分担为中心，我们称之为“明智的风险分担”。在确定了该模型的基础之后，我们用当前的例子进一步阐述了可以遵循这些原则的政策类型。
