药品全额保障政策实施效果的系统评价
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摘要
目的 系统评价药品全额保障政策实施效果,为完善中国基本药物制度提供参考。方法 计算机检索ProQuest、PubMed、CNKI和WanFang Data数据库中与药品全额保障政策相关的研究,检索时限均为建库至2018年6月30日。由2名研究人员独立筛选文献和提取资料后,采取定性分析的方法评价药品全额保障政策的实施效果。结果 共纳入35篇文献,10篇评价了对疾病控制效果的影响,12篇评价了对药物依从性的影响,9篇评价了对医疗费用与药品费用的影响,2篇评价了公平性影响,7篇评价了经济性,11篇阐述了不当利用与浪费。结论 在完善遴选机制和管理制度前提下,实施基本药物全额保障政策有利于促进药品公平可及性,提高服药依从性,最终提高患者的诊疗效果,且政策更具经济性。
Objectives To systematically review the implementation effects of the full coverage policy for medicines, and to provide evidence for the improvement of National Essential Medicine Policy in China. Methods We searched databases including ProQuest, PubMed, CNKI and WanFang Data databases from inception to June 30 th 2018 to collect the studies on full coverage policy for medicines. Two reviewers screened literature and extracted related information independently. Then, qualitative analyses were applied to evaluate the impact of the full coverage policy for medicines. Results A total of 35 studies on the full coverage policy for medicines were included. Ten studies evaluated the effects of disease control, 12 studies evaluated the impact of the compliance of the patients, 9 studies evaluated the impact on medical expenses and drug costs, 2 studies evaluated the effects of equality, 7 studies evaluated economics, and11 studies described the improper use and waste of medicines. Conclusions In the content of perfecting the selection mechanism and management system, the implementation of the full coverage policy for essential medicines is conducive to promoting equality and accessibility, enhancing drug compliance, improving the diagnosis and treatment of patient diseases ultimately, and making the policy more economical.
Objectives To systematically review the implementation effects of the full coverage policy for medicines, and to provide evidence for the improvement of National Essential Medicine Policy in China. Methods We searched databases including ProQuest, PubMed, CNKI and WanFang Data databases from inception to June 30 th 2018 to collect the studies on full coverage policy for medicines. Two reviewers screened literature and extracted related information independently. Then, qualitative analyses were applied to evaluate the impact of the full coverage policy for medicines. Results A total of 35 studies on the full coverage policy for medicines were included. Ten studies evaluated the effects of disease control, 12 studies evaluated the impact of the compliance of the patients, 9 studies evaluated the impact on medical expenses and drug costs, 2 studies evaluated the effects of equality, 7 studies evaluated economics, and11 studies described the improper use and waste of medicines. Conclusions In the content of perfecting the selection mechanism and management system, the implementation of the full coverage policy for essential medicines is conducive to promoting equality and accessibility, enhancing drug compliance, improving the diagnosis and treatment of patient diseases ultimately, and making the policy more economical.
引文
1 Yang H, Dib HH, Zhu M, et al. Prices, availability and affordability of essential medicines in rural areas of Hubei province, China.Health Policy Plan, 2010, 25(3):219-229.
2 管晓东,信枭雄,刘洋,等.我国基本药物可获得性评价实证研究.中国药房, 2013,(24):2216-2219.
3 Fang Y, Wagner AK, Yang S, et al. Access to affordable medicines after health reform:evidence from two cross-sectional surveys in Shanxi province, Western China. Lancet Glob Health, 2013, 1(4):e227-e237.
4 管晓东,王宝敏,信枭雄,等.免费用药政策对促进中国药品公平可及的启示.中国卫生政策研究, 2015, 8(2):54-59.
5 张小娟,于保荣,马吉祥,等.山东省农村贫困高血压患者药费补偿政策的评价研究.中国初级卫生保健, 2012, 26(5):9-13.
6 郭颖燕,金灵江,王良友,等.台州市主要慢性病综合管理的基本做法和成效.中国农村卫生事业管理, 2015, 35(3):339-341.
7 朱裔彦,张一英,陶敏亚,等.慢性病综合防治示范点高血压患者免费给药效果评价.健康教育与健康促进, 2011, 6(4):274-275.
8 裴婕,常峰,路云,等.老年人基本药物全额保障的经验及启示.卫生经济研究, 2017,(9):44-47.
9 尹曦华,秦大明,汪胜隆.加强军队医疗包干管理的几点思考.人民军医, 1998, 41(2):112.
10 严健,蒋文荣.军队人员及医疗包干人员医疗改革初探.华南国防医学杂志, 2004, 18(1):42-43.
11 王燕燕,李金琴,李淮涌.某医院免费患者住院诊疗费用与效率分析.海军总医院学报, 2008, 21(4):219-221.
12 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Available at:http://handbook-5-1 .cochrane.org/.
13 Wells GA, Shea B, Connell DO, et al. Newcastle-Ottawa Scale(NOS)for assessing the quality of non-randomized studies in metaanalysis. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14 Crombie I. Pocket guide to critical appraisal. London:BMJ Publishing Group, 1996.
15 Husereau D, Drummond M, Petrou S, et al. ISPOR health economic evaluation publication guidelines-CHEERS good reporting practices task force. Consolidated Health Economic Evaluation Reporting Standards(CHEERS)-explanation and elaboration:a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health, 2013, 16(2):231-250.
16 Hannes K, Lockwood C, Pearson A. A comparative analysis of three online appraisal instruments'ability to assess validity in qualitative research. Qual Health Res, 2010, 20(12):1736-1743.
17 Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med,2011, 365(22):2088-2097.
18 Choudhry NK, Bykov K, Shrank WH, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff(Millwood), 2014, 33(5):863-870.
19 Kulik A, Desai NR, Shrank WH, et al. Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery:analysis from the post-myocardial infarction free Rx event and economic evaluation(FREEE)randomized trial.Circulation, 2013, 128(11 Suppl 1):S219-S225.
20 于保荣,马吉祥,张小娟.农村高血压、糖尿病患者实施免费药物补偿的做法及效果研究.卫生经济研究, 2010,(9):31-33.
21 胥玉萍,杨海波,薄艳青,等.社区高血压病人免费给药管理模式初探.中国社会医学杂志, 2013, 30(1):48-50.
22 胥玉萍,周黎峰,杨海波.农村合作医疗高血压免费服药的成本-效益分析.临床荟萃, 2012, 27(5):393-394.
23 吴同浩,秦小燕,许倩青,等.农村社区免费和自费治疗原发性高血压效果对比.中国校医, 2014, 28(2):122-123.
24 王红,李全生,丁鹏,等.迁安市农村社区高血压药物干预效果评价.现代预防医学, 2016, 43(21):3910-3914.
25 Emmerick ICM, Campos MR, Luiza VL, et al. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the'Farmácia Popular'programme in Brazil. BMJ Open, 2017, 7(11):e017308.
26 Duru OK, Turk N, Ettner SL, et al. Adherence to metformin,statins, and ACE/ARBs within the diabetes health plan(DHP). J Gen Intern Med, 2015, 30(11):1645-1650.
27 González López-Valcárcel B, Librero J, García-Sempere A, et al.Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart, 2017, 103(14):1082-1088.
28 Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives:a cross-sectional study. PLoS One, 2015, 10(11):e0138869.
29 Yu B, Zhang X, Wang G. Full coverage for hypertension drugs in rural communities in China. Am J Manag Care, 2013, 19(1):e22-e29.
30 江宗星,王晓燕,王平,等.免费药物治疗对高血压患者服药依从性的影响.健康教育与健康促进, 2018, 13(1):75-77.
31 薄艳青,陈霄雯,蔡雨阳.免费给药情景下农村社区高血压患者用药情况调查.中国全科医学, 2014, 17(16):1910-1912.
32 Puig-Junoy J, García-Gómez P, Casado-Marín D. Free medicines thanks to retirement:impact of coinsurance exemption on pharmaceutical expenditures and hospitalization offsets in a national health service. Health Econ, 2016, 25(6):750-767.
33 Cutrona SL, Woolhandler S, Lasser KE, et al. Free drug samples in the United States:characteristics of pediatric recipients and safety concerns. Pediatrics, 2008, 122(4):736-742.
34 Ito K, Elkin E, Blinder V, et al. Cost-effectiveness of full coverage of aromatase inhibitors for medicare beneficiaries with early breast cancer. Cancer, 2013, 119(13):2494-2502.
35 Ito K, Avorn J, Shrank WH, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes, 2015, 8(3):252-259.
36 Choudhry NK, Patrick AR, Antman EM, et al. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction medicare beneficiaries. Circulation,2008, 117(10):1261-1268.
37 Rosen AB, Hamel MB, Weinstein MC, et al. Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes. Ann Intern Med, 2005,143(2):89-99.
38 Dhalla IA, Smith MA, Choudhry NK, et al. Costs and benefits of free medications after myocardial infarction. Healthc Policy, 2009,5(2):68-86.
39 尹曦华.军队医疗包干管理现状及改进对策.解放军医院管理杂志, 1997, 4(3):332-333.
40 杨骅,陈新年,孟垂祥.经济发达城市军人免费医疗管理的思考.解放军医院管理杂志, 1997,(2):181-183.
41 常雁军,李维国,柴春雨,等.免费患者部分常见病种住院费用分析.第四军医大学学报, 2002, 23(S1):25-27.
42 Shepherd-Smith A. Free drugs for India's poor. Lancet, 2012,380(9845):874.
43 隋艺,孙仁峰,韩鲁宁.军队医疗制度改革前后随军家属就医情况分析.沈阳部队医药, 2004, 17(5):350-351.
44 王松梅,张勇.《医院免费药品信息管理系统》的开发与应用.武警医学, 1997, 8(3):61-62.
45 蔡绍丽,王登高.“军字一号”在军队免费医疗管理中的运用及意义.重庆医学, 2005, 34(6):838-839.
46 Robinson JC, Brown TT, Whaley C, et al. Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications. JAMA Intern Med, 2015,175(11):1783-1789.
47 张永庆,毛记云.“免费”商业模式的经济学分析.商业经济, 2012,(7):34-35.
48 李永强,史亚莉,李剑南.免费经济学视角下免费顾客网络价值研究综述.经济学动态, 2012,(8):88-91.
49 Guo Z, Guan X, Shi L. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions:a cross-sectional study in China. BMC Health Serv Res, 2017, 17(1):723.
2 管晓东,信枭雄,刘洋,等.我国基本药物可获得性评价实证研究.中国药房, 2013,(24):2216-2219.
3 Fang Y, Wagner AK, Yang S, et al. Access to affordable medicines after health reform:evidence from two cross-sectional surveys in Shanxi province, Western China. Lancet Glob Health, 2013, 1(4):e227-e237.
4 管晓东,王宝敏,信枭雄,等.免费用药政策对促进中国药品公平可及的启示.中国卫生政策研究, 2015, 8(2):54-59.
5 张小娟,于保荣,马吉祥,等.山东省农村贫困高血压患者药费补偿政策的评价研究.中国初级卫生保健, 2012, 26(5):9-13.
6 郭颖燕,金灵江,王良友,等.台州市主要慢性病综合管理的基本做法和成效.中国农村卫生事业管理, 2015, 35(3):339-341.
7 朱裔彦,张一英,陶敏亚,等.慢性病综合防治示范点高血压患者免费给药效果评价.健康教育与健康促进, 2011, 6(4):274-275.
8 裴婕,常峰,路云,等.老年人基本药物全额保障的经验及启示.卫生经济研究, 2017,(9):44-47.
9 尹曦华,秦大明,汪胜隆.加强军队医疗包干管理的几点思考.人民军医, 1998, 41(2):112.
10 严健,蒋文荣.军队人员及医疗包干人员医疗改革初探.华南国防医学杂志, 2004, 18(1):42-43.
11 王燕燕,李金琴,李淮涌.某医院免费患者住院诊疗费用与效率分析.海军总医院学报, 2008, 21(4):219-221.
12 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Available at:http://handbook-5-1 .cochrane.org/.
13 Wells GA, Shea B, Connell DO, et al. Newcastle-Ottawa Scale(NOS)for assessing the quality of non-randomized studies in metaanalysis. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14 Crombie I. Pocket guide to critical appraisal. London:BMJ Publishing Group, 1996.
15 Husereau D, Drummond M, Petrou S, et al. ISPOR health economic evaluation publication guidelines-CHEERS good reporting practices task force. Consolidated Health Economic Evaluation Reporting Standards(CHEERS)-explanation and elaboration:a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health, 2013, 16(2):231-250.
16 Hannes K, Lockwood C, Pearson A. A comparative analysis of three online appraisal instruments'ability to assess validity in qualitative research. Qual Health Res, 2010, 20(12):1736-1743.
17 Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med,2011, 365(22):2088-2097.
18 Choudhry NK, Bykov K, Shrank WH, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff(Millwood), 2014, 33(5):863-870.
19 Kulik A, Desai NR, Shrank WH, et al. Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery:analysis from the post-myocardial infarction free Rx event and economic evaluation(FREEE)randomized trial.Circulation, 2013, 128(11 Suppl 1):S219-S225.
20 于保荣,马吉祥,张小娟.农村高血压、糖尿病患者实施免费药物补偿的做法及效果研究.卫生经济研究, 2010,(9):31-33.
21 胥玉萍,杨海波,薄艳青,等.社区高血压病人免费给药管理模式初探.中国社会医学杂志, 2013, 30(1):48-50.
22 胥玉萍,周黎峰,杨海波.农村合作医疗高血压免费服药的成本-效益分析.临床荟萃, 2012, 27(5):393-394.
23 吴同浩,秦小燕,许倩青,等.农村社区免费和自费治疗原发性高血压效果对比.中国校医, 2014, 28(2):122-123.
24 王红,李全生,丁鹏,等.迁安市农村社区高血压药物干预效果评价.现代预防医学, 2016, 43(21):3910-3914.
25 Emmerick ICM, Campos MR, Luiza VL, et al. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the'Farmácia Popular'programme in Brazil. BMJ Open, 2017, 7(11):e017308.
26 Duru OK, Turk N, Ettner SL, et al. Adherence to metformin,statins, and ACE/ARBs within the diabetes health plan(DHP). J Gen Intern Med, 2015, 30(11):1645-1650.
27 González López-Valcárcel B, Librero J, García-Sempere A, et al.Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart, 2017, 103(14):1082-1088.
28 Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives:a cross-sectional study. PLoS One, 2015, 10(11):e0138869.
29 Yu B, Zhang X, Wang G. Full coverage for hypertension drugs in rural communities in China. Am J Manag Care, 2013, 19(1):e22-e29.
30 江宗星,王晓燕,王平,等.免费药物治疗对高血压患者服药依从性的影响.健康教育与健康促进, 2018, 13(1):75-77.
31 薄艳青,陈霄雯,蔡雨阳.免费给药情景下农村社区高血压患者用药情况调查.中国全科医学, 2014, 17(16):1910-1912.
32 Puig-Junoy J, García-Gómez P, Casado-Marín D. Free medicines thanks to retirement:impact of coinsurance exemption on pharmaceutical expenditures and hospitalization offsets in a national health service. Health Econ, 2016, 25(6):750-767.
33 Cutrona SL, Woolhandler S, Lasser KE, et al. Free drug samples in the United States:characteristics of pediatric recipients and safety concerns. Pediatrics, 2008, 122(4):736-742.
34 Ito K, Elkin E, Blinder V, et al. Cost-effectiveness of full coverage of aromatase inhibitors for medicare beneficiaries with early breast cancer. Cancer, 2013, 119(13):2494-2502.
35 Ito K, Avorn J, Shrank WH, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes, 2015, 8(3):252-259.
36 Choudhry NK, Patrick AR, Antman EM, et al. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction medicare beneficiaries. Circulation,2008, 117(10):1261-1268.
37 Rosen AB, Hamel MB, Weinstein MC, et al. Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes. Ann Intern Med, 2005,143(2):89-99.
38 Dhalla IA, Smith MA, Choudhry NK, et al. Costs and benefits of free medications after myocardial infarction. Healthc Policy, 2009,5(2):68-86.
39 尹曦华.军队医疗包干管理现状及改进对策.解放军医院管理杂志, 1997, 4(3):332-333.
40 杨骅,陈新年,孟垂祥.经济发达城市军人免费医疗管理的思考.解放军医院管理杂志, 1997,(2):181-183.
41 常雁军,李维国,柴春雨,等.免费患者部分常见病种住院费用分析.第四军医大学学报, 2002, 23(S1):25-27.
42 Shepherd-Smith A. Free drugs for India's poor. Lancet, 2012,380(9845):874.
43 隋艺,孙仁峰,韩鲁宁.军队医疗制度改革前后随军家属就医情况分析.沈阳部队医药, 2004, 17(5):350-351.
44 王松梅,张勇.《医院免费药品信息管理系统》的开发与应用.武警医学, 1997, 8(3):61-62.
45 蔡绍丽,王登高.“军字一号”在军队免费医疗管理中的运用及意义.重庆医学, 2005, 34(6):838-839.
46 Robinson JC, Brown TT, Whaley C, et al. Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications. JAMA Intern Med, 2015,175(11):1783-1789.
47 张永庆,毛记云.“免费”商业模式的经济学分析.商业经济, 2012,(7):34-35.
48 李永强,史亚莉,李剑南.免费经济学视角下免费顾客网络价值研究综述.经济学动态, 2012,(8):88-91.
49 Guo Z, Guan X, Shi L. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions:a cross-sectional study in China. BMC Health Serv Res, 2017, 17(1):723.