Lopez Marianne Hamilton, Daniel Gregory W, Fiore Nicholas C, Higgins Aparna, McClellan Mark B
Marianne Hamilton Lopez is research director for value-based payment reform at the Duke-Margolis Center for Health Policy, Duke University, in Washington, D.C.
Gregory W. Daniel is head, U.S. Healthcare Policy, at Edwards Lifesciences in Washington, D.C. He was the deputy director of the Duke-Margolis Center for Health Policy and a clinical professor at the Fuqua School of Business, Duke University, in Durham, North Carolina, when this work was performed.
Health Aff (Millwood). 2020 Jun;39(6):1018-1025. doi: 10.1377/hlthaff.2019.00771.
Innovative medical products offer significant and potentially transformative impacts on health, but they create concerns about rising spending and whether this rise is translating into higher value. The result is increasing pressure to pay for therapies in a way that is tied to their value to stakeholders through improving outcomes, reducing disease complications, and addressing concerns about affordability. Policy responses include the growing application of health technology assessments based on available evidence to determine unit prices, as well as alternatives to volume-based payment that adjust product payments based on predictors or measures of value. Building on existing frameworks for value-based payment for health care providers, we developed an analogous framework for medical products, including drugs, devices, and diagnostic tools. We illustrate each of these types of alternative payment mechanisms and describe the conditions under which each may be useful. We discuss how the use of this framework can help track reforms, improve evidence, and advance policy analysis involving medical product payment.
创新型医疗产品对健康具有重大且可能具有变革性的影响，但它们引发了人们对支出不断增加以及这种增长是否转化为更高价值的担忧。结果是，通过改善治疗效果、减少疾病并发症以及解决可负担性问题，以与产品对利益相关者的价值挂钩的方式支付治疗费用的压力越来越大。政策应对措施包括越来越多地应用基于现有证据的卫生技术评估来确定单价，以及基于价值的支付替代方案，即根据价值预测指标或衡量标准调整产品支付。在现有的医疗保健提供者基于价值的支付框架基础上，我们为医疗产品（包括药品、器械和诊断工具）开发了一个类似的框架。我们阐述了每种类型的替代支付机制，并描述了每种机制可能有用的条件。我们讨论了使用该框架如何有助于跟踪改革、改进证据以及推进涉及医疗产品支付的政策分析。
