亚太地区老年人慢性病基本药物价格和可及性研究

发布时间：2018-06-06 22:44

本文选题：亚太地区 + 慢性病基本药物　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景随着社会、经济、医疗卫生的发展,世界人口老龄化逐渐加重,人口老龄化对于老年人和整个社会既是机遇又是挑战。随着人均寿命的延长,老年人的健康状况并未得到明显改善。老年人的慢性病患病率明显高于年轻人,特别是高血压、心脑血管疾病、呼吸系统疾病,且有逐年增加的趋势。有数据显示80%的老年人患有慢性病,老年人医疗卫生需求大,人均医疗费用高。人口老龄化始于高收入国家,但现在中低收入国家正在经历巨大的变化,2050年,80%的老年人将会生存在中低收入国家。亚太地区中低收入国家人口老龄化和老年人慢性病患病率逐年升高的形势相比于发达国家更为严峻。各个国家能否为老年人中的慢性病患者提供价格合理、能够保障供应、患者可公平获得的基本药物决定着老年人中的慢性病患者的疾病能否得到治疗、健康能否得到保障。慢性病基本药物较低的可获得性和较高的药品价格都会使得老年人中的慢性病患者难以获得相应的药物治疗。可以说慢性病基本药物的价格与可获得性与老年人的健康息息相关,研究老年人慢性病基本药物的价格、可获得性和可负担性意义重大。研究目的本研究拟对比研究亚太地区11个国家老年人慢性病基本药物的价格、可获得性和可负担性,分析造成亚太地区国家老年人慢性病基本药物可及性现状的可能原因,为亚太地区国家制定政策以应对老龄化、满足老龄人口的卫生需要,提高老年人慢性病基本用药的可及性提供可靠依据。研究方法本研究主要的研究方法为二手数据分析法,对使用世界卫生组织国际健康行动提出的药品价格和可及性标准调查法即《药品价格、可获得性、可负担性和价格构成调查方法》收集的药品价格、可及性数据进行二次分析,包括中国、斐济、印度、印度尼西亚、马来西亚、蒙古、菲律宾、斯里兰卡、泰国和越南在内的11个亚太地区中低收入国家数据库中基本药物的价格、可获得性和可负担性数据。研究药物包括用于治疗高血压、糖尿病、抑郁症、癫痫、哮喘、胃溃疡6种常见慢性病的15种基本药物,分别对比研究了 15种基本药物的原研药和最低价格通用药在公立医疗机构和私立医疗机构的价格、可获得性及可负担性现状。根据HAI网提供的不同年份间药品价格数据的转换方法,将11个国家不同年份的药品价格数据转化为以2014年为基准年的数据,比较分析亚太地区国家老年人慢性病基本药物价格。研究结果(1)亚太地区国家老年人慢性病基本药物可获得性分析亚太地区11个国家老年人慢性病基本药物的可获得性整体较差,公立医疗机构慢性病基本药物原研药的可获得性中位数为10.0%,最大值为19.5%,最小值为0;最低价格通用药可获得性中位数为35.5%,最大值为80.0%,最小值为5.0%;私立医疗机构慢性病基本药物原研药可获得性中位数为37.9%,最大值为69.5%,最小值为10%;私立医疗机构最低价格通用药可获得性中位数为52.4%,最大值为90.0%,最小值为11.7%。中国、越南、印度、印度尼西亚、老挝、泰国公立医疗机构最低价格通用药的可获得性远远高于原研药,马来西亚菲律宾最低价格通用药的可获得性低于原研药。私立医疗机构慢性病基本药物的可获得性普遍高于公立医疗机构。(2)亚太地区国家老年人慢性病基本药物价格分析11个国家慢性病基本药物采购价格大小不一,公立医疗机构原研药采购价格中位价格比(Median price ratio,MPR)的中位数为9.08,最小值为1.19,最大值为23.39;最低价格通用药采购价格的MPR中位数为1.38,最小值为0.36,最大值为32.94。亚太地区国家老年人慢性病基本药物的采购价格整体偏高。亚太地区11个国家老年人慢性病基本药物的零售价均较高,公立医疗机构原研药零售价格的MPR的中位数为21.51、最大值为79.13,最小值为0;最低价格通用药零售价格的MPR的中位数为6.6,最大值为32.88,最小值为0。私立医疗机构原研药零售价格MPR的中位数为32.24,最大值为150.03,最小值为4.96;最低价格通用药零售价格MPR的中位数为11.48,最大值为46.21,最小值为0.92对均有采购价格和零售价格数据的公立医疗机构的采购价格与零售价格进行对比研究:中国基本药物原研药在公立医疗机构的药品加成率为122.0%,其他国家的公立医疗机构原研药的加成率都高于中国,老挝、越南、蒙古国、菲律宾、泰国原研药在公立医疗机构的加成率分别为390.0%、196.0%、220.0%、238.0%、311.0%。中国公立医疗机构的最低价格通用药的药品加成率为43.7%,其他国家公立医疗机构最低价格通用药的药品加成率均高于100.0%,印度尼西亚最高高达660.2%,泰国其次高达495.3%,蒙古国、越南、老挝公立医疗机构最低价格通用药的药品加成率分别为143.5%、246.0%、251.2%。(3)亚太地区国家老年人慢性病基本药物可负担性分析亚太地区11个国家公立医疗机构原研药的可负担性为2.4倍日薪,私立医疗机构原研药的可负担性为2.3倍日薪;最低价格通用药的可负担性较好,11个国家公立医疗机构最低价格通用药可负担性为0.35倍日薪,私立医疗机构最低价格通用药的可负担性为0.44倍日薪。与单个基本药物的可负担性对比,慢性病的疾病的可负担性并没有那么理想,用倍氯米松和沙丁胺醇联合治疗哮喘的可负担性为2.1倍日薪,用格列本脲和二甲双胍治疗糖尿病的可负担性为1.6倍日薪,用阿替洛尔和氢氯噻嗪治疗高血压的可负担性为0.7倍日薪。研究结论(1)亚太地区国家老年人慢性病基本药物可获得性整体较差;(2)采购价格偏高,老年人慢性病基本药物采购效率较低;亚太地区国家老年人慢性病基本药物零售价格偏高,零售价格远远高于采购价格,老年人慢性病基本药物在医疗机构的药品加成较高;(3)亚太地区国家老年人慢性病基本药物的可负担性整体较差,具体来说最低价格通用药的可负担性较好,原研药的可负担性较差,慢性病疾病的可负担性较差。政策建议针对亚太地区国家老年人慢性病基本药物价格和可及性现状,提出建议如下:(1)完善基本药物制度,推动基本药物在医疗机构的采购使用;(2)提高采购效率,完善药品价格监管体系和价格控制法规,加强对药品生产、流通、销售等环节的监督控制;(3)在医疗机构推广使用最低价格通用药,加强通用药质量管理。加强对通用药的宣传,提高病人对通用药的认可度。
[Abstract]:With the development of social, economic and medical health, the aging of the world is becoming more and more serious, and the aging of the population is both an opportunity and an opportunity for the elderly and the whole society. With the prolongation of the average life span, the health of the elderly has not been significantly improved. The prevalence of chronic diseases in the elderly is obviously higher than that of the young people, especially the high. Blood pressure, cardiovascular and cerebrovascular diseases, respiratory diseases, and the trend of increasing year by year. The data show that 80% of the elderly have chronic diseases, the elderly medical and health needs are large, and the per capita medical cost is high. Population aging begins in high income countries, but the middle and low income countries are undergoing great changes. In 2050, 80% of the elderly will survive. In the middle and low income countries, the situation of the aging of the population in the middle and low income countries of the Asia Pacific region and the increase of the prevalence of chronic diseases in the elderly is more severe than that in the developed countries. Can the disease of the chronic disease be treated and the health be guaranteed. The low availability of basic drugs for chronic diseases and the higher price of drug will make it difficult for the elderly patients with chronic diseases to obtain the corresponding drug treatment. The purpose of this study is to compare the price, availability and affordability of the basic drugs for chronic diseases in the 11 countries of the Asia Pacific region, and to analyze the availability of basic drugs for chronic diseases in the countries of the Asia Pacific region. We can make policy for the countries of the Asia Pacific region to deal with aging, meet the health needs of the aged and improve the accessibility of basic drugs for chronic diseases of the elderly. The main research method of this research method is the used data analysis method, the price of drug and the price of the use of WHO international health action. The standard survey method of accessibility is the price of drug price, availability, affordability and price composition, the price of drugs collected, and the two analysis of sex data, including the number of 11 middle and low income countries in the Asia Pacific region, including China, Fiji, India, Indonesia, Malaysia, Mongolia, Philippines, Sri Lanka, Thailand and Vietnam. 15 basic drugs for the treatment of 6 common chronic diseases, including hypertension, diabetes, depression, epilepsy, asthma, and gastric ulcers, are studied in contrast to the study of 15 basic drugs and the lowest price general-purpose drugs in public medical institutions and private medical services, respectively. The price, availability and affordability status of institutions. According to the conversion method of drug price data between different years in HAI network, the price data of 11 countries in different years are converted into the data of 2014 as the base year, and the price of basic drugs for chronic diseases in the countries of the Asia Pacific Region is compared and analyzed. (1) the Asia Pacific Region The availability of basic drugs for chronic diseases in the country's elderly people was analyzed in the 11 countries of the Asia Pacific region. The availability of basic drugs for chronic diseases of the elderly in the Asia Pacific region was generally poor. The median of the primary drugs for basic drugs for chronic diseases in public medical institutions was 10%, the maximum was 19.5%, the minimum value was 0, and the median of the lowest price general drug was 35.. 5%, the maximum value is 80%, the minimum value is 5%; the median of the primary medicine for the basic drugs for chronic diseases in private medical institutions is 37.9%, the maximum is 69.5%, the minimum value is 10%; the median of the lowest price general medicine for private medical institutions is 52.4%, the maximum value is 90%, the minimum value is 11.7%. China, Vietnam, India, Indonesia, Laos, and the minimum value. The availability of general medicine at the lowest price in Thailand public medical institutions is much higher than that of original medicine. The availability of the lowest price general medicine in Philippines, Malaysia is lower than that of the original medicine. The availability of basic drugs for chronic diseases in private medical institutions is generally higher than that of public medical institutions. (2) the price of basic drugs for chronic diseases in the countries of the Asia Pacific Region Analysis of the price of basic drugs for chronic diseases in 11 countries is different, the median price ratio of Median price ratio, MPR in public medical institutions is 9.08, the minimum value is 1.19, and the maximum is 23.39. The lowest price of general drug purchase price is 1.38, the minimum value is 0.36, and the maximum value is 32.94. Asia Pacific region. The purchase price of the basic drugs for chronic diseases of the elderly is high. The retail price of the basic drugs for chronic diseases in the 11 countries of the Asia Pacific region is high, the median of the MPR of the retail price of the public medical institutions is 21.51, the maximum is 79.13, the minimum value is 0, and the median of the MPR of the lowest price for the retail price of the lowest price is 6.6. The median of the retail price MPR of the 0. private medical institutions is 32.24, the maximum value is 150.03, the minimum value is 4.96, the median retail price of the lowest price general drug MPR is 11.48, the maximum is 46.21, and the minimum value is the purchase price of the public medical institution with the purchase price and the retail price data on the minimum value. Comparative study with retail prices: the rate of drug addition for Chinese basic drugs in public medical institutions is 122%, and the rate of addition of original medicine in public medical institutions in other countries is higher than that of China, Laos, Vietnam, Mongolia, Philippines, and Thailand are added to public medical institutions by 390%, 196%, 220%, 238%, respectively. 311.0%. the lowest price of general medicine in China's public medical institutions is 43.7%, and the lowest price of general medicine in other public health institutions is higher than 100%, Indonesia is up to 660.2%, Thailand is next to 495.3%, Mongolia, Vietnam, and Laos public medical institutions are at the lowest price of generic drugs. The rate of addition is 143.5%, 246%, 251.2%. (3) an analysis of the affordability of the basic drugs for chronic diseases in the countries of the Asia Pacific region. The affordability of the original research drugs for public medical institutions in 11 countries in the Asia Pacific region is 2.4 times a day, the burden of the original medicine for private medical institutions is 2.3 times a day, the lowest price is more affordable and 11 countries are more affordable. The lowest price of a public medical institution is 0.35 times a day's pay, and the lowest price of a private medical institution is 0.44 times a day's pay. Compared with the burden of a single basic drug, the burden of chronic disease is not so ideal, and the combination of betamethasone and salbutamol is negative for the treatment of asthma. 2.1 times a day's pay, the affordability of diabetes with glibenclamide and metformin was 1.6 times a day's pay, and the affordability of atenolol and hydrochlorothiazide was 0.7 times more affordable. (1) the overall poor availability of basic drugs for chronic diseases in the countries of the Asia Pacific region was poor; (2) the purchase price was high, and the elderly were chronic. The purchase efficiency of basic drugs for the disease is low; the retail prices of the basic drugs for the chronic diseases of the elderly people in the Asia Pacific region are high, the retail prices are far higher than the purchasing prices, and the addition of the basic drugs for the chronic diseases of the elderly in the medical institutions is higher; (3) the burden of the basic drugs for the chronic diseases of the countries in the Asia Pacific region is generally poor and the most specific. The affordability of low price general drug is better, the burden of the original medicine is poor, and the burden of chronic disease is poor. Suggestions are given as follows: (1) improving the basic drug system and promoting the purchase and use of basic drugs in medical institutions; (2) Improve the efficiency of procurement, improve the regulatory system of drug prices and price control regulations, strengthen supervision and control of drug production, circulation, sales and other links; (3) promote the use of the lowest price general medicine in medical institutions, strengthen the quality management of general drugs, strengthen the publicity of general drugs and improve the degree of recognition of general drugs.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R95

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