药品差比价问题研究

药物经济学最早来源于美国,20世纪50年代以来,美国的公共医疗保健费用迅速增长,高昂的保健费用令政府和社会保障机构不堪重负。为了使有限的医疗资源能够得到最大限度的利用,1979年美国国会下属的技术评定局对公共医疗费用进行成本一效用分析,形成药物经济学的雏形。此后到了80年代,产生了Pharmacoeconomics（药物经济学）这一英文词汇;1989年在美国出版了第一本药物经济学专业期刊《Pharmacoeconomics》;1991年专著《药物经济学原理》出版。从此,药物经济学作为一门交叉学科初步形成。国家发展和改革委员会于2005年初出台了《药品差比价规则（试行）））（以下简称为“规则”）。《规则》是对同种药品不同剂型、规格、包装数量等之间的差异,在价格差别上做出的明确规定,并作为政府制定药品价格的重要准则。《规则》是国务院价格主管部门在总结我国药品价格管理工作实践经验的基础上,以马克思主义政治经济学、西方经济学理论为指导,以价格法律法规为依据,借鉴药物经济学评价的思路与方法,运用价格关联性原理形成的一种药品价格规制方法。为了深入研究《规则》的理论基础和法律政策依据、分析和评价《规则》制定和实施效果,以充分说明“规则》的理论基础和法律政策依据,中国价格协会《药品差比价问题研究》课题组于2007年6月至9月对药品差比价问题进行了专题研究,在梳理理论基础和法律依据的同时,广泛收集政府、企业、医疗机构等多方意见,对《规则》的合理性与可行性进行了两个维度的评判,并以此作为《规则》引入市场之后的重要反馈结果与未来政策调整的依据。本着对课题研究过程与结果负责的态度,本杂志将《药品差比价问题研究》报告全文刊登,以保证报告所阐述的问题不引入编者本身的观点。     

两性霉素B两种剂型治疗真菌感染的药物经济学分析

研究背景:对于两性霉素B治疗真菌感染.如果将所有的治疗成本和治疗收益都纳入考虑,那么该药物不同脂质剂型之间安全性、有效性和经济性等方面的差异依然是模糊不清的。研究设计:对于两性霉素B的两种剂型,两性霉素B脂质复合物(amphotericin B lipid complex,ABLC)和两性霉素B脂质体(liposomal amphotericin B,L-AMB),采用回顾性最小成本法进行比较分析,研究角度采用医疗机构角度。治疗成本(以美元计数,2001年的水平)被分成3个层次,第一为只有药品费用,第二为包括相关医疗措施的成本,第三为包括全部住院治疗的相关成本。结果:两组研究对象的社会人口学情况和治疗时间均没有显著性差异。两组的临床有效率比较接近(ABLC为53%,L-AMB为60%,P=0.68),所以本经济学评估采用了最小成本法。ABLC组47%的研究对象血清肌酸酐(SCr)出现上升,而L-AMB组只有10%,P值为0.025。对于3个层次的总治疗成本,两组间均没有明显差异。但当校正了治疗时间因素后,L-AMB组的治疗成本显著地高于ABLC组(第一层次,ABLC为340美元,L-AMB为435美元,P=0.002;第二层次,ABLC为361美元,L-AMB为454美元,P=0.027)。预防或治疗不良事件(adverse events)的成本在两组间并无差异。敏感性分析表明,经济学评估结果对药品价格和用药剂量敏感。二维敏感性分析显示,只要L-AMB的价格高于ABLC的135%,ABLC的经济性优势就可以保持。结论:这两种药品的总院内治疗成本并无差别。但校正了治疗时间因素后,ABLC的治疗成本明显低于L-AMB。治疗成本的计算包括了药品费用、相关治疗费用、不良反应的预防和治疗费用。研究提示药品价格是治疗成本的重要影响因素。     

美国药品可负担性的影响因素考察

目的考察美国药品可负担性的影响因素,为促进我国药品可负担性的治理提供参考。方法基于文献评阅和综述。结果美国注重药品价格的市场形成机制,促进仿制药的市场进入和竞争。药品研发费用以及药品营销和流通费用作为成本推动始终是影响药品可负担性的重要因素,那些似乎直接减轻患者药费负担的营销策略可能对药品可负担性具有间接影响。尽管美国存在的处方药保险覆盖缺口以及灾难性支付段以上的比例分担模式对药品可负担性带来重要影响,但美国联邦药品折扣项目力度大,政府谈判覆盖面广。结论美国药品可负担性受到药品价格、研发费用、营销和流通、药品进口、保险设计等一系列因素的影响,并构成一个高度交互的复杂体系。美国药品可负担性的影响因素对我国具有一定借鉴意义。     

医药费用将“四降一升”

卫生部日前透露。针对医药费用上涨过快的突出问题。卫生部正在研究“四降一升”的政策措施，即降低药品价格、医院药品批零差率、大型设备检查治疗费、高值区用耗材费用。提高诊疗费。合理调整医疗机构补偿结构。降低群众不合理医药费用负担。国家将通过区域卫生规划，合理布局，调整卫生资源配置，并增加投入，重点加强农村医疗卫生机构建设，组织城市医务人员对口支援农村。     

特征价格模型的发展应用研究

特征价格模型因为其完美的理论思想而成为国际上普遍使用的分析异质品价格和特征关系的主要方法.本文通过对国外核心期刊上一百五十二篇特征价格法相关文献的检阅,梳理了国内外特征价格模型及指数编制的研究现状,对特征价格模型的功能进行了总结性定位,认为特征价格模型的功能主要在于:异质品价格指数的编制,异质品价格预测、价值评估或产品定价,异质品价格影响因素分析,非市场因素的经济效应的检验及对传统经济学模型的改进五方面.文章最后以住宅为例,归纳总结了特征价格法在研究应用中存在的主要问题:一是市场细分;二是特征变量选择和量化;三是模型形式选择;四是模型估计方法的研究;五是指数编制中的问题.这些研究对象为未来特征价格的研究提供了可行参考.     

药品定价浅析

目的:探索我国药品定价的合理模式。方法:对现行药品价格管理模式的现状进行分析。结果与结论:加强政府对药品价格的宏观调控,应用药物经济学方法与成果,提高政府定价的科学性和透明度,使药品定价更加趋于科学与合理。     

因素分析法在石油工程定额结算分析中的应用

石油工程定额结算因素分析是从专业分类、构成要素、价格指数等多个角度开展的一种分析方法,以石油钻井工程为例,采用因素分析法可以从石油钻井工程造价费用构成要素和石油钻井工程主材价格因素两个方面进行分析,关键环节是选择费用构成因素的分析对象和不同时期的主材价格进行对比分析,进而编制各专业单位造价指标的主材价格影响指数和石油专业工程造价综合的主材价格影响指数,对石油工程定额结算分析可以发挥十分重要的作用.     

完善药品托管的财务管理措施研究

实施药品托管是药品管理运行机制的一次改革,能够有效地压缩药品在流通渠道中的不合理利益结构和价格空间。文章分析了实行药品托管后医院财务管理面临的问题,指出切实降低药品价格,缓解群众看病贵的问题,能够规范药品采购行为,遏制行业不正之风,实现群众、医疗机构和医院企业共同受益。     

试分析药事管理中的成本效果

药物经济学即对卫生保健系统以及社会药物治疗成本的描述和分析,是一种评定药物治疗成本的研究方式,CEA分析法是其中最为常用的成本分析方法,CEA分析法反对不惜任何代价过于追求昂贵卫生服务,也反对片面强调经济效益的提高,导致患者由于费用问题无法进行治疗的方法,本文即将探讨的是利用CEA分析法分析新药、进口药品、医疗机构、中药的成本效果.     

药物经济学在我国药品定价中应用的定位分析

目的为药物经济学在我国药品定价中的正确应用提供政策建议。方法通过介绍我国药品价格管制措施的局限性,探讨药物经济学在药品定价中应用的可行性及必要性,进一步分析药物经济学在药品定价中应用所需的明确定位。结果与结论在药品定价中药物经济学所评价的药物范围应为新药和专利期内的垄断药品。作为应用主体的定价部门应站在全社会角度通过制定权威的药物经济学评价指南,委托第三方专家组对制药企业提交的药物经济学评价报告进行评估,将评估结果作为药品定价部门与制药企业谈判协商价格时的科学依据,在达到对新药和专利期内垄断药品控费的同时,鼓励药品创新和研发,最终保证患者对药品持续的可及性。     

Pleasure and belief in Hume's Decision Process

Abstract

The purpose of this paper is to introduce explicitly pleasure and belief in what aims at being a Humean theory of decision, like the one developed in Diaye and Lapidus (2005a). Although we support the idea that Hume was in some way a hedonist – evidently different from Bentham's or Jevons' way – we lay emphasis less on continuity than on the specific kind of hedonism encountered in Hume's writings (chiefly the Treatise, the second Enquiry, the Dissertation, or some of his Essays). Such hedonism clearly contrasts to its standard modern inheritance, expressed by the relation between preferences and utility.

The reason for such a difference with the usual approach lies in the mental process that Hume puts to the fore in order to explain the way pleasure determines desires and volition. Whereas pleasure is primarily, in Hume's words, an impression of sensation, it takes place in the birth of passions as reflecting an idea of pleasure, whose “force and vivacity” is precisely a “belief”, transferred to the direct passions of desire or volition that come immediately before action. As a result, from a Humean point of view, “belief” deals with decision under risk or uncertainty, as well as with intertemporal decision and indiscrimination problems.

The latter are explored within a formal framework, and it is shown that the relation of pleasure is transformed by belief into a non-empty class of relations of desire, among which at least one is a preorder.     

Globalization,Neoliberalism and the attack on social security

Neoliberal political movements advocate privatization of public pension systems. Globalization imposes pressure on nations to conform to neoliberal policy views with respect to the design and structure of social insurance, including public pension systems. The paper begins with an investigation of the economic, ethical and ideological dimensions of the privatization debates in the U.S.; it argues that privatization advocates may be largely moved by ideology, since the other reasons advanced appear weak or unfounded. The second part discusses the history of Social Security, the purposes for its creation, and some of its economic effects. Differences between public and private pension systems are considered. A brief international comparison of some aspects of public pension system finance and benefit structures is presented. The final section considers the ethical, macroeconomic and distributional implications of privatization, prefunding and payroll tax funding, and argues for a pay as you go system financed with income taxes. In order to promote equity, economic security, community, and social cohesion, public pension systems should be universal in coverage. In order to reduce the inequality, income insecurity, and aged poverty generated by market economies, public pension systems ought to be progressive: benefit/contribution ratios should be inversely proportional to income, and progressive income taxes should finance the system. To promote economic growth, the systems should be financed on a pay-as-you-go basis, and should not be prefunded except for an emergency reserve. The fiscal policy recommendations partially depend upon the theory developed by Abba Lerner in the 1940s, and recently advanced by Wynne Godley and Randy Wray: Lerner's “principle of functional finance.”     

John Stuart Mill's Theories of Wealth and Income Distribution

Although he was much influenced by David Ricardo when he wrote the classical part of his Principles , John Stuart Mill was not a Ricardian when he penned his theories of wealth and distribution. They are based on a triple foundation. First, a belief that economics is a moral discipline. Second a theory of custom-driven human behavior. Third, an empirically formed conviction that the institutions of state, education and business cooperate to structure the distribution of income. On the basis of these presuppositions, Mill formulated 1) an institutional theory of the formation of human and non-human wealth and 2) an even more institutional theory of distribution demonstrating how the aforementioned institutions malignantly skew the distribution of income to the advantage of the propertied classes and to the extreme disadvantage of the working class. As a social economist, Mill recommended institutional reforms designed to eradicate the poverty of the working class.     

Forecasting the price of gold

This article seeks to evaluate the appropriateness of a variety of existing forecasting techniques (17 methods) at providing accurate and statistically significant forecasts for gold price. We report the results from the nine most competitive techniques. Special consideration is given to the ability of these techniques to provide forecasts which outperforms the random walk (RW) as we noticed that certain multivariate models (which included prices of silver, platinum, palladium and rhodium, besides gold) were also unable to outperform the RW in this case. Interestingly, the results show that none of the forecasting techniques are able to outperform the RW at horizons of 1 and 9 steps ahead, and on average, the exponential smoothing model is seen providing the best forecasts in terms of the lowest root mean squared error over the 24-month forecasting horizons. Moreover, we find that the univariate models used in this article are able to outperform the Bayesian autoregression and Bayesian vector autoregressive models, with exponential smoothing reporting statistically significant results in comparison with the former models, and classical autoregressive and the vector autoregressive models in most cases.     

Interest on reserves and inflation

The payment of interest on reserves has been a common practice in inflationary economies. This policy may seem paradoxical since it involves returning part of the seigniorage, generated by the inflation process, with the intention to finance the fiscal deficit. This paper argues that the motivation for this policy can be captured by the discretionary regime, where the policymaker pays interest on reserves because he is concerned with the erosion of real liquidity by inflation, which is in part beyond his control. However, this policy is an unlikely outcome in the commitment regime, where the policymaker is in full control of inflation.     

Planned adaptation in risk regulation: An initial survey of US environmental, health, and safety regulation

In principle, we want regulatory programs to be based on current realities, as reflected for example in the best knowledge of relevant experts. That would imply that old rules now on the books should be consistent with today's knowledge base, not just what was known when a rule or standard was originally set. This paper reports on a survey of US programs, examining how often existing rules are actually updated in light of better knowledge, and identifies five programs that attempt to make policy routinely adaptive. These programs exhibit what we term Planned Adaptation: they both revise rules when relevant new knowledge appears, and take steps to produce such improved knowledge. While Planned Adaptation is rare, it is used in several nationally prominent programs, including air pollution, airplane safety, and drug safety. Planned Adaptation is a policy tool that deserves more attention.     

Information infrastructure: Who builds broadband networks?

This paper examines the essential difference between the U.S. and Japan, when one considers information infrastructure. There are seven perception gaps between the U.S. and Japan concerning Information Infrastructure policies. These gaps must be understood in order to compare the countries' governmental policies in this area. In looking at the present circumstances, the essential question to answer concerns who is to build, own and operate the network(s) of the infrastructure. Liberalization is certain to be a central factor in the ongoing telecommunications debates. Now that customers have had a taste of the liberalized market-place, the movement toward more open markets will be difficult to stop. When considering options, it is necessary to pay close attention to standardized network access and the increasingly important role software plays. These issues are causing us to take a new approach to the traditional role played by regulators. They also force a closer look at the appropriate structure of utility companies. This paper addresses the above issues in hopes of stimulating dialog on the new telecommunications infrastructure paradigm.     

海岛地区产业演替及资源基础分析--以舟山群岛为例

改革开放以来,舟山市产业构成发生了显著变化,其经济发展过程可以划分为三个阶段。1992年前,是以产业结构渔业占绝对地位的单一结构阶段;1993—1998年,以旅游业为主的第三产业快速发展阶段;上世纪末以来,又进入了新一轮的经济发展时期,即工业产值比重快速增加阶段。根据海岛的自然资源基础和特点,在新世纪的经济发展过程中,舟山市应定位为生态型的港口旅游城市。以港口及临港工业为主导,以海岛旅游和海洋经济为特色,大力发展第二产业和第三产业。海岛地区的主导产业应体现海岛资源优势及区位优势,以集群性环保型产业为主。同时由于海岛地区淡水资源缺乏,主导产业也应着重选择低耗水型产业。     

风险视角下企业治理结构和研发创新——基于委托代理模型的研究

本文基于委托代理模型,从风险的视角研究企业治理结构对研发创新能力的影响。本文构建了一个包含创新活动的委托代理模型进行理论分析,利用动态DEA 模型测算创新能力,并使用2015-2018年我国上市制造业企业数据进行实证检验。实证部分检验了理论结论:委托代理问题不利于企业提升研发创新能力,且客观风险和主观风险厌恶会加剧该负面影响。基于此,本文认为上市企业应根据企业自身研发活动特点有针对性地改善企业治理结构,提出了适当延长代理人任期、推动股权激励计划、提升代理人的风险承担能力等建议。