A critical analysis of studies of state drug reimbursement policies: research in need of discipline.
A critical analysis of studies of state drug reimbursement policies: research in need of discipline.
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对国家药品报销政策研究的批判性分析：需要纪律的研究。
DOI：
10.2307/3350399
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
J. Abelson
中科院分区：
文献类型：
--
作者：
S. Soumerai;D. Ross;E. Fortess;J. Abelson
对药品成本和药物使用适当性的担忧导致州医疗补助计划限制药品报销。本文批判性地回顾了20年的研究费用分摊，药品报销限额，并通过处方集，类别排除或事先授权要求获得特定药物的行政限制;评估其方法的严谨性;总结了目前的知识状态;并提出了未来的研究方向。药物报销上限和适度的费用分摊可以减少医疗补助人群中基本药物和不太重要药物的使用;严格的报销上限可能会引发严重的意外影响。对获得特定药物的限制可能会造成合理和不合理的药物替代效应;目前尚不清楚这种限制是否会减少药物支出或总体保健支出。
Concerns over pharmaceutical costs and appropriateness of medication use have led state Medicaid programs to restrict drug reimbursement. This article critically reviews 20 years of research on cost sharing, drug reimbursement limits, and administrative limitations on access to particular drugs via formularies, category exclusions, or prior authorization requirements; evaluates their methodological rigor; summarizes the state of current knowledge; and proposes future research directions. Drug reimbursement caps and modest cost sharing can reduce the use of both essential and less important drugs in Medicaid populations; severe reimbursement caps may precipitate serious unintended effects. Limitations on access to particular drugs can cause both rational and irrational drug substitution effects; it is unclear whether such limits reduce expenditures either for drugs or for overall health care.