Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Int J Technol Assess Health Care. 2024 Apr 17;40(1):e22. doi: 10.1017/S0266462324000217.
The rising costs of drugs have necessitated the exploration of innovative payment methods in healthcare systems. Risk-sharing agreements (RSAs) have been implemented in many countries as a value-based payment mechanism to manage the uncertainty associated with expensive technologies. This study aimed to investigate stakeholder perspectives on value-based payment in the Singaporean context, providing insights for future directions in health technology assessment and financing.
This descriptive qualitative inquiry involved participant interviews conducted between October 2021 and April 2022. Thematic analysis was conducted in two phases to analyze the interview transcripts.
Seventeen respondents participated in the study, and five key themes emerged from the analysis. Stakeholders viewed RSAs as moderately positive, despite limited experience with them. They emphasized the importance of clearly defining objectives and establishing transparent criteria for implementing these schemes. The current data infrastructure was identified as both a barrier and facilitator, as RSAs impose administrative burdens. To successfully implement these payment mechanisms, capacity building, and effective stakeholder engagement that fosters mutual trust and cocreation are crucial.
This study confirms previously identified barriers and facilitators to successful RSA implementation while contextualizing them within the Singaporean setting. The findings suggest that value-based payment has the potential to address uncertainty and improve access to healthcare technologies, but these barriers must be addressed for the schemes to be effective.
药品成本的不断上升使得医疗保健系统需要探索创新的支付方式。风险分担协议（RSA）已在许多国家实施，作为一种基于价值的支付机制，用于管理昂贵技术相关的不确定性。本研究旨在探讨新加坡背景下基于价值的支付的利益相关者观点，为未来的卫生技术评估和融资方向提供见解。
本描述性定性研究采用参与者访谈的方式，于 2021 年 10 月至 2022 年 4 月进行。采用两阶段的方法进行主题分析，以分析访谈记录。
17 名受访者参与了研究，分析中出现了五个关键主题。利益相关者认为 RSA 是中等积极的，尽管他们的经验有限。他们强调了明确定义目标和为实施这些方案建立透明标准的重要性。当前的数据基础设施被认为是一个障碍和促进因素，因为 RSA 会带来行政负担。要成功实施这些支付机制，需要进行能力建设和有效的利益相关者参与，以促进相互信任和共同创造。
本研究证实了先前确定的 RSA 实施成功的障碍和促进因素，同时将其置于新加坡背景下进行了情境化处理。研究结果表明，基于价值的支付有可能解决不确定性问题并改善获得医疗保健技术的机会，但必须解决这些障碍，才能使这些方案有效。
