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国际药品支出控制经验教训。I：影响患者。

Lessons from international experience in controlling pharmaceutical expenditure. I: Influencing patients.

作者信息

Freemantle N, Bloor K

机构信息

Centre for Health Economics, University of York.

出版信息

BMJ. 1996 Jun 8;312(7044):1469-71. doi: 10.1136/bmj.312.7044.1469.

DOI:10.1136/bmj.312.7044.1469
PMID:8664631
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2351214/
Abstract

This is the first of three papers to review international policies to control spending on drugs and improve the efficiency of drug use. Policies can target three main groups: patients, prescribing doctors, and the drugs industry. In this paper we examine policies aimed at patients, particularly restrictions on reimbursement (such as prescription charges). Rigorous experimental and quasi-experimental studies suggest that policies to limit the level of reimbursement of drugs reduce the use of essential as well as non-essential drugs and may do more harm than good.

摘要

这是三篇系列论文中的第一篇，旨在回顾控制药品支出及提高用药效率的国际政策。这些政策可针对三个主要群体：患者、开处方的医生以及制药行业。在本文中，我们研究针对患者的政策，尤其是对报销的限制（如处方收费）。严格的实验性和准实验性研究表明，限制药品报销水平的政策会减少基本药物和非基本药物的使用，而且可能弊大于利。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5a5/2351214/98ddb0804552/bmj00545-0045-a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5a5/2351214/98ddb0804552/bmj00545-0045-a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5a5/2351214/98ddb0804552/bmj00545-0045-a.jpg

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本文引用的文献

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Examining product risk in context. Market withdrawal of zomepirac as a case study.结合实际情况审视产品风险。以佐美酸的市场撤市为例进行研究。
JAMA. 1993 Oct 27;270(16):1937-42.
2
Effects of a limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia.医疗补助药物报销福利受限对精神分裂症患者使用精神药物及急性心理健康服务的影响。
N Engl J Med. 1994 Sep 8;331(10):650-5. doi: 10.1056/NEJM199409083311006.
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Payment restrictions for prescription drugs under Medicaid. Effects on therapy, cost, and equity.
药品政策：封顶价和共付额对合理用药的影响。
Cochrane Database Syst Rev. 2015 May 8;2015(5):CD007017. doi: 10.1002/14651858.CD007017.pub2.
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International experience in controlling pharmaceutical expenditure: influencing patients and providers and regulating industry - a systematic review.控制药品支出的国际经验：影响患者和医疗服务提供者以及规范行业——一项系统综述
J Health Serv Res Policy. 2015 Jan;20(1):52-9. doi: 10.1177/1355819614545675. Epub 2014 Aug 4.
5
The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression.成本分担方案对意大利药物依从性的影响：基于分位数回归的证据。
Int J Public Health. 2014 Apr;59(2):329-39. doi: 10.1007/s00038-013-0528-4. Epub 2013 Dec 15.
6
Could co-payments on drugs help to make EU health care systems less open to political influence?药品的自付费用能否有助于使欧盟的医疗保健系统减少受到政治影响？
Eur J Health Econ. 2013 Oct;14(5):709-13. doi: 10.1007/s10198-012-0428-1.
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[Could hiring more locums be a tool to have more rational drug prescriptions?].[雇佣更多的临时代理医生会成为实现更合理用药处方的一种手段吗？]
Aten Primaria. 2006 Jun 15;38(1):58. doi: 10.1157/13090032.
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Pharmacy utilization and the Medicare Modernization Act.药房利用与《医疗保险现代化法案》。
Milbank Q. 2005;83(1):101-30. doi: 10.1111/j.0887-378X.2005.00337.x.
9
Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?作为成本控制政策工具的医疗服务提供者支付与患者费用：它们在高收入国家的成效如何？
Hum Resour Health. 2003 Jul 31;1(1):6. doi: 10.1186/1478-4491-1-6.
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Drug reimbursement: indicators of inappropriate resource allocation.药品报销：资源分配不当的指标。
Br J Clin Pharmacol. 2002 Nov;54(5):528-34. doi: 10.1046/j.1365-2125.2002.01690.x.
医疗补助计划下处方药的支付限制。对治疗、成本和公平性的影响。
N Engl J Med. 1987 Aug 27;317(9):550-6. doi: 10.1056/NEJM198708273170906.
4
Withdrawing payment for nonscientific drug therapy. Intended and unexpected effects of a large-scale natural experiment.停止为非科学药物治疗支付费用。一项大规模自然实验的预期和意外效果。
JAMA. 1990 Feb 9;263(6):831-9.
5
Charging for health care: evidence on the utilisation of NHS prescribed drugs.医疗保健收费：关于国民保健制度处方药使用情况的证据
Soc Sci Med. 1991;33(6):681-7. doi: 10.1016/0277-9536(91)90022-5.
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Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes.医疗补助药品支付限额对医院和疗养院入院情况的影响。
N Engl J Med. 1991 Oct 10;325(15):1072-7. doi: 10.1056/NEJM199110103251505.