Nauenberg Eric, Yurga Emre
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Canadian Centre for Health Economics, University of Toronto, Toronto, Canada.
J Pharm Policy Pract. 2023 Feb 6;16(1):21. doi: 10.1186/s40545-023-00526-3.
Recently, the government and an opposition party cut a deal that involved a promise to consider implementing a single-payer pharmacare scheme in Canada in exchange for supporting the current minority government. There have been political headwinds from the private extended health insurance industry, the provinces of Ontario and Quebec, as well as the pharmaceutical industry. We suggest a new multiple-payer of mixed-resort framework that achieves both the goal of universal coverage and preserves the private extended health insurance industry through a scheme based on the current coordination of benefits between private payers in this sector.
We employ game theory to better understand the dynamics within a market that involves multiple payers. In particular, we use the game of Collective Action to help illustrate the problems of free-ridership.
An analysis of the dynamics of this market suggests that ex-ante agreements need to be struck between all payers in a multi-payer marketplace to achieve both stability and sustainability of such a framework.
We show that universal coverage is still possible while leveraging the existing system of private extended health insurance so long as a well-established system for coordinating benefits between public and private payers is established. A stable public/private partnership can achieve universal coverage so long as a system for coordinating benefits is instituted. The proposed alternative will achieve the same goals, but maintain a niche for the private sector thereby maintaining therapeutic variety in the marketplace.
最近，加拿大政府与一个反对党达成了一项协议，其中包括承诺考虑在加拿大实施单一支付者药物保险计划，以换取对现任少数党政府的支持。这一举措面临来自私人扩展医疗保险行业、安大略省和魁北克省以及制药行业的政治阻力。我们提出了一种新的混合支付框架，通过基于该行业当前私人支付者之间的福利协调计划，既能实现全民覆盖的目标，又能保留私人扩展医疗保险行业。
我们运用博弈论来更好地理解涉及多个支付者的市场动态。特别是，我们使用集体行动博弈来帮助说明搭便车问题。
对该市场动态的分析表明，在多支付者市场中，所有支付者之间需要达成事前协议，以实现这种框架的稳定性和可持续性。
我们表明，只要建立一个完善的公共和私人支付者之间的福利协调系统，在利用现有私人扩展医疗保险系统的同时，全民覆盖仍然是可能的。只要建立一个福利协调系统，稳定的公私伙伴关系就能实现全民覆盖。提议的替代方案将实现相同的目标，但为私营部门保留一个利基市场，从而保持市场上的治疗多样性。
