Dear Colleagues
The International issue of Health Affairs for 2003 has just been published. Have attached info on table of contents and some abstracts below. Full table of contents available via
http://www.healthaffairs.org/1100_table_contents.php <http://www.healthaffairs.org/1100_table_contents.php>
Best wishes
David McDaid
LSE Health and Social Care
Features: Health Affairs May/June 2003
Available on line at www.healthaffairs.org
Rx Drugs
Pharmaceutical Reference Pricing in Europe
Panos Kanavos, Uwe E. Reinhardt
To control spending on prescription drugs, health insurance systems abroad have experimented in recent years with a novel form of patient cost sharing called “reference pricing.” Under this approach, the insurer covers only the prices of low-cost, benchmark drugs in therapeutic clusters that are deemed to be close substitutes for one another in treating specific illnesses. Patients who desire a higher-price substitute in a cluster must then pay the full difference between the retail price of that drug and the reference price covered by the insurer. This paper explores the difficult trade-offs that policymakers must make in designing such a system, drawing where relevant from experience abroad.
Pharmaceutical Dilemmas: Controlling Costs, Improving Quality and Ensuring Access
Alan K. Maynard, Karen Bloor
What can be learned from international experience of efforts to control spending and to improve efficiency and access in pharmaceutical markets? Policymakers tend to reinvent many policies to control the behavior of patients, doctors, and industry, despite a lack of evidence of those policies’ cost-effectiveness. There is an emerging consensus that reimbursement in public and private health care systems should be informed by evidence of the cost-effectiveness of treatments and that utilization should be constrained by budget caps and information systems. Whatever the policy chosen, evaluation is as essential as it is rare.
Perspective: The Efficient Use of Pharmaceuticals: Does Europe Have Any Lessons For A Medicare Drug Benefit?
Adrian Towse
Managing drug use in a way that maximizes the value obtained from total health care spending faces obstacles; hence, payers and policymakers tend to look at pharmaceutical expenditures in isolation from the rest of health care spending. Currently there are both regulatory and putative market-based approaches to containing pharmaceutical spending worldwide. But evidence suggests that regulatory efforts in Europe and elsewhere have not proved effective in containing costs or improving efficiency or access, and supposedly market-based solutions now in vogue, such as reference pricing, pose their own set of challenges and may in practice violate market principles. In the end, silo-based budgeting is short-sighted; the emphasis in Europe and in the United States should be on measures that achieve efficient health care rather than the containment of drug spending.
Perspective: Government Commitment And Regulation Of Prescription Drugs
Richard G Frank
Two papers in this volume review efforts worldwide to control the growth of drug spending and discuss the potential role for the U.S. government with respect to rationing of prescription drugs. I put the roles given to government in the two papers in context by focusing on the role of government as a partner with the pharmaceutical industry. I concentrate on the unique features of the prescription drug market, coupled with the fact that government is a payer, regulator, and provider in the health sector. I conclude that the federal government should exercise caution when attempting to regulate prescription drug prices.
Whither Seniors' Drug Benefits: Lessons from (and for) Canada
Steven G. Morgan, Morris L. Barer, Jonathan D. Agnew
Canada’s provincial governments have, until relatively recently, provided virtually all seniors with generous prescription drug coverage. Managers of these programs have implemented a variety of policies to contain spending while ensuring access to necessary medicines. Some of these policies have been successful in temporarily slowing cost growth. However, the lack of comprehensive utilization management tools has resulted in ongoing spending increases that now constitute a threat to the sustainability of a public drug subsidy for Canadian seniors. Sustainable and equitable pharmacare programs require the political willingness to confront opposition to policies that will, if successful, contain program costs without obstructing access.
Taiwan
Does Universal Health Insurance Make Healthcare Costs Unaffordable? The Lessons from Taiwan
J.F. Rachel Lu, William C. Hsiao
National Health Insurance in Taiwan: A Bold Experiment In Health Policy
Tsung-Mei Cheng
Cross National Comparisons
It's Prices Stupid: Why The U.S. is so Different from Other Countries
Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey, Varduhi Petrosvan
2002 Commonwealth Fund International Health Policy Survey of Sicker Adults
Robert J. Blendon, Catherine M. DesRoches, Cathy Schoen, Robin Osborn, Kinga Zapert
Treated and Untreated Mental Disorders in the International Consortium of Psychiatric Epidemiology Surveys
Rob V. Bijl, Ron de Graaf, Eva Hiripi, Ronald C. Kessler, Robert Kohn, David R. Offord, T. Bedirhan Ustun, Benjamin Vicente, Wilma A.M. Vollebergh, Ellen Walters, Hans-Ulrich Wittchen
Reporting On Quality for Benchmarking: Improving Performance and Patient Decisionmaking--A U.S./U.K. Comparison
Martin Marshall, Peter C. Smith, Huw T.O. Davies, Paul Shekelle
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