Expanding Canadian Medicare to include a national pharmaceutical benefit while controlling expenditures: possible lessons from Israel
Expanding Canadian Medicare to include a national pharmaceutical benefit while controlling expenditures: possible lessons from Israel
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扩大加拿大医疗保险，将国家药品福利纳入其中，同时控制支出：以色列可能的经验教训
DOI：
10.1017/s174413311700041x
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
B. Rosen
中科院分区：
文献类型：
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作者：
B. Rosen
摘要在加拿大，关于是否扩大医疗保险以在普遍的基础上包括国家药品福利的争论正在进行中。据了解，潜在的健康益处是显著的，但人们对负担能力的担忧仍在继续。在以色列，国家健康保险福利一揽子计划包括一项全面的药品福利。尽管如此，人均医药支出远低于加拿大和经济合作与发展组织的平均水平。本文重点介绍了以色列为限制药品支出所采取的七项策略：（1）在全球预算约束下优先考虑新技术;（2）利用法规和市场力量确保公平合理的价格;（3）建立有效的药品分销系统;（4）促进有效的处方行为;（5）避免人为的消费者需求膨胀;（6）建立有效的药品分销系统。（6）在尊重知识产权、获取和成本控制之间取得适当的平衡;（7）就药品支出的价值和限度形成社会共识。其中一些战略已经在加拿大的一些地区实施。其他的可以引入加拿大，可能有助于国家医药福利的负担能力，但需要进行实质性的调整。例如，在以色列，健康维护组织（HMO）在促进有效的处方行为方面发挥着核心作用，而在没有HMO的加拿大，需要其他机制来推进这一重要目标。
Abstract In Canada, there is an ongoing debate about whether to expand Medicare to include a national pharmaceutical benefit on a universal basis. The potential health benefits are understood to be significant, but there are ongoing concerns about affordability. In Israel, the National Health Insurance benefits package includes a comprehensive pharmaceutical benefit. Nonetheless, per capita pharmaceutical spending is well below that of Canada and the Organization for Economic Co-operation and Development average. This paper highlights seven strategies that Israel has employed to constrain pharmaceutical spending: (1) prioritizing new technologies, subject to a global budget constraint; (2) using regulations and market power to secure fair and reasonable prices; (3) establishing an efficient pharmaceutical distribution system; (4) promoting effective prescribing behavior; (5) avoiding artificial inflation of consumer demand; (6) striking an appropriate balance between respect for IP rights, access and cost containment; and (7) developing a shared societal understanding about the value and limits of pharmaceutical spending. Some of these strategies are already in place in some parts of Canada. Others could be introduced into Canada, and might contribute to the affordability of a national pharmaceutical benefit, but substantial adaptation would be needed. For example, in Israel the health maintenance organizations (HMOs) play a central role in promoting effective prescribing behavior, whereas in HMO-free Canada other mechanisms are needed to advance this important goal.