The 21st Century Cures Act: pharmacoeconomic boon or bane?

Barriers to entry in healthcare markets constitute one of the overriding concerns of health economists. The recent enactment of the 21st Century Cures Act in the United States reduces statutory entry barriers to the discovery, development, testing, and licensing of drugs and medical devices. Drug and device makers also see the burdensome and time-consuming requirements of the Food and Drug Administration?s approval process as key barriers to lowering the costs of their products, considering it takes a decade of research amounting to $1 billion just to bring a single drug to the market. Along with novel opportunities for medical product innovation and faster treatment of diseases, the expedited approval process carries with it contentious challenges involving the safety, efficacy and value of drugs and devices. The ensuing trade-offs and unintended consequences of such a regulatory game-changer bring to the fore one of the most enduring debates between medicine and economics: Whether – or to what extent – cost and efficiency factors affect clinical inquiry into possible solutions to human illnesses. The practical and theoretical contributions of pharmacoeconomics should enlighten contemporary and future issues and discussions surrounding the implementation of this landmark legislation. After all, despite its undeniably good intent and far-reaching significance, no law can ever be perfect.     

宁夏政府医疗补助的受益归属

目的测算宁夏不同收入人群医疗补助受益水平及公平性。方法采用受益归属分析法测算补助受益分布,集中指数和Kakwani指数法分析其受益公平性。结果宁夏人均财政医疗卫生支出呈逐年上涨趋势。最低组人群平均受益额高于最高组。2016年和2018年门诊和与住院的集中指数与Kakwani指数为负值,公平性较好,具有累进性。结论提高政府对贫困人群的医疗补助力度,合理安排医疗卫生资源。     

融资租赁对医疗机构设备投入影响的实证研究

融资租赁作为一种新兴的金融服务业务,由于适应经济发展的时代要求而受到越来越多的关注。本文采用我国2003—2009年的省际面板数据,综合运用OLS、PanelData固定效应模型对融资租赁与卫生机构医疗设备投入的关系进行了实证研究。计量检验结果表明：融资租赁对卫生机构医疗设备投入具有积极的正向效应,已成为卫生机构克服资金瓶颈的重要途径。以上结论对制定促进融资租赁医疗设备业务发展、提升卫生机构综合竞争力的政策至关重要。     

新型农村合作医疗中政府角色分析——一种角色理论视野下的阐释

农村合作医疗本身具有的公共物品属性决定了政府在农村合作医疗中作用的不可替代性。新型农村合作医疗的实施和发展离不开各方政府的大力支持,因此文章利用角色理论对新型农村合作医疗中政府的角色冲突、角色义务问题进行分析,探讨政府由权威型管理型政府向服务型政府转换的最佳途径。     

Association between provider specialty and healthcare costs and glycemic control for patients with diabetes

Aims: To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM).

Materials and methods: This cross-sectional study identified adults with type 1 or 2?DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider.

Results: For all patients, HbA1C improvement was greater, and medical costs significantly lower with an endocrinologist rather than a primary care provider. The largest HbA1C improvement (4%) occurred for insulin-dependent patients seen by endocrinologists. Significant medical savings with endocrinologist management occurred within the Medicare Advantage population in every sub-group of patients, with 14% lower costs ($4,767) for patients with T1D, 11% lower costs ($3,160) for patients with macro- and microvascular complications, and 10% lower costs ($2,237) for insulin-dependent patients. Within the commercial insurance population, medical costs were reduced by ≥9% in every sub-group of patients, with a 20% reduction ($8,450) for patients with micro- and macrovascular complications. Overall total costs (medical and pharmacy) were 8% ($1,541) higher for patients receiving endocrinologist rather than primary care, although endocrinologist care resulted in a 9% reduction (–$3,710) in costs for Medicare Advantage patients with T1D. Total medical costs (excluding pharmacy costs) may be a more accurate indicator of costs associated with patients in various stages of DM.

Limitations: There was insufficient data to develop risk-adjustment payments for pharmacy costs based on disease severity. The cross-sectional design identifies associations and not cause–effect relationships.

Conclusion: DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2–9% regardless of insurance type.     

Population ageing in healthcare – a minor issue? Evidence from Switzerland

Our study shows that population ageing is a relevant determinant of healthcare expenditure (HCE). This conclusion supports the popular, but recently strongly contested, view that the coming population ageing will threaten the fiscal sustainability of health systems. We contribute to this debate, first by estimating the determinants of Swiss HCE with outlier-robust dynamic regressions, and second, by projecting Swiss HCE based on the estimates produced and new population scenarios. Medical advances and GDP per capita also play a decisive role. Governments can mitigate HCE growth by improving the health status of the population and by stimulating cost-effective and productive medical advances.     

社会基本医疗保险对家庭消费的影响

文章利用北京大学CFPS调查2010、2012年两期平衡面板数据,以双重差分-倾向匹配法构造了反实事分析框架,估计基本医疗保险对家庭消费支出的影响。研究结果显示,医保政策对于居民消费具有促进作用,医保带动农村消费的同时也加重了农村家庭医疗支出负担;从分收入层次看,医保对于农村低收入家庭的消费支出正向影响显著且大于城镇低收入家庭。     

新型农村合作医疗保险制度参保模式研究

当前新型农村合作医疗保险制度实行自愿加入的参保模式,但在实施中产生了“逆向选择”等诸多问题。笔者从制度设计目标和制度变迁模式等角度分析了实行强制保险的必要性,认为目前实行自愿参保仍然是未来一段时间内的现实选择,但是,当新型农村合作医疗保险制度基本覆盖全国农村居民之后,就必须开始着手推进强制保险工作。     

新型农村合作医疗的运行效率、筹资与基层政府行为

现阶段新型农村合作医疗制度试点的重点之一是如何在公平与效率之间找到新的均衡。这项制度在农村稳步推开,缓解了医疗服务中长期存在的公平效率问题。但自该项制度实施以来.调查点居民卫生可及性公平仍有待改善,筹资存在垂直不公平问题,卫生服务利用公平性有所增强,但改进余地很大。资源配置效率有所提高,但并不明显;医疗机构间缺乏竞争,成本软约束导致医疗机构低效率运行。因此新农合制度实施过程中的公平性,还有待政府进一步改善,同时以公平为前提,提高资源配置和服务效率。     

Chronic Diseases, Labor Supply and Medical Expenditure at Older Age: Evidence from China

China has undergone a rapid epidemiological transition from infectious diseases to chronic diseases. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this paper documents the profile of chronic diseases among older Chinese people, estimates the impact of the onset of chronic diseases on the labor supply, and examines the correlation between the prevalence of chronic diseases, a household’s medical expenditure and the role of health insurance in reducing medical costs. Empirical results show that the prevalence of chronic diseases is extremely high among older Chinese people and increases sharply with age. We find significant negative effects from the onset of chronic diseases on an individual’s livelihood at work. The estimation results by age and education suggest that the labor supply of the older and more highly educated people is more sensitive to the onset of chronic diseases. We also show that there can be a substantial indirect loss of individual and household income due to the onset of chronic diseases by limiting the labor supply. We find that the prevalence of chronic diseases is significantly associated with higher out-of-pocket medical expenditure. The reduced-form estimation results suggest that people with insurance have lower medical expenditure caused by minor chronic diseases, but this is only the case for women and urban residents. However, health insurance contributes little in reducing medical expenditure caused by major chronic diseases.