Medicine reference price system in Germany and its implication for healthcare payment stand-ard in China / 中国卫生政策研究

It is significantly important but difficult to establish healthcare payment standard system in case our country has cancelled government and government guidance prices. In 1989, Germany was the first country to intro-duce the medicine reference price system in Statutory Health Insurance. It does not only aim to regulate the medicine prices, but also defines a reimbursement level for a cluster of products considered to be therapeutically equivalent, and has a good influence on lowering the price of medicine. This paper systematically reviews the medicine reference price system in Germany, including four aspects:the reference price system overview, the reference price groups’ de-termination procedure, the reference prices calculation and the co-payment mechanisms. Based on the Germany refer-ence price system, we can establish healthcare payment standard in over-the-counter or chronic market first, then sci-entifically divide the reference price groups, formulate and adjust payment standard based on the market price, and perfect the co-payment mechanism to avoid moral hazard.

Quem acessa o Programa Farmácia Popular do Brasil? Aspectos do fornecimento público de medicamentos / The "Farmácia Popular do Brasil" Program and aspects of public provision of medicines in Brazil

Em 2004, o Governo federal lançou o Programa Farmácia Popular do Brasil, que surge como uma inovação para a política pública de assistência farmacêutica através da adoção do copagamento como estratégia de ampliação do acesso a medicamentos. O trabalho analisou o modelo inicial do Programa, baseado na implantação das unidades de dispensação de medicamentos. Os dados foram obtidos por entrevistas com atores-chave, análise documental e registros de atendimentos. A análise permitiu identificar a origem da população que utiliza o Programa e descrever o perfil de utilização dos medicamentos dispensados. Os resultados demonstraram grande expansão da rede e do número de atendimentos. Observou-se grande demanda por parte dos usuários do Sistema Único de Saúde (SUS). Do ponto de vista do pacto federativo, o Programa Farmácia Popular do Brasil reedita o modelo de compra centralizada de medicamentos essenciais, que, na lógica do sistema público descentralizado, está sob responsabilidade de provisão dos estados e municípios. As evidências apontam para problemas com a provisão descentralizada, principalmente nas regiões Norte e Nordeste, fazendo com que a população usuária do SUS recorra ao PFPB para provisão dos medicamentos que não logram obter nas unidades públicas de dispensação.

In 2004, the Federal Government introduced the "Farmácia Popular do Brasil" Program, which was an example of policy innovation, establishing a co-payment scheme as a strategy for access to medication. The study analyzed the original model of the Program. Data were obtained from interviews with key stakeholders, program documents and user prescriptions and registers. The results showed widespread expansion of the PFPB network and in the number of people attended. Despite the ever-increasing number of people attended with prescriptions from the private sector, a large demand from public sector users, namely the original focus of the program, was observed. From the standpoint of the federative pact, the program reinstates the centralized model of essential medication distribution which, in the decentralized public system is under state and municipal responsibility. The results point to the difficulty in compliance by states and municipalities with medication distribution responsibilities, mainly in the North and Northeast regions of Brazil. The study concludes that the population has been consistently turning to the PFPB for essential medication it has not been able to access in the public sector.

The Problem of Forced Insurance Coverage on Prenatal Ultrasound

On January 2007, the government announced its policy "Total Care of Pregnancy and Delivery; National Responsibility on Pregnancy and Delivery." While the policy is welcome, there are currently two problems with the plan. First, there is no provision for high-risk pregnancy. Second, the government's plan to cover the expenses on prenatal ultrasound is limited to payments for obstetrics only. The reasons why the government should not be so hasty in forcing its plan to cover current co-payment on prenatal ultrasound are the followings: first, physicians' techniques in making proper ultrasound images and doctors' abilities of ultrasound image interpretation cannot be standardized. Second, the types of ultrasound are diverse: conventional ultrasound, level II ultrasound, 3D ultrasound, doppler ultrasound, portable ultrasound, etc. Third, ultrasound fees are also charged by radiology, internal medicine, and other clinical fields. It raises a question of fairness if the government covers ultrasound expenses for obstetrics and gynecology alone. Lastly, the current medical fees are computed only by the Health Insurance Review Agency (HIRA) without consultation with medical suppliers. Furthermore, there is no systematic principle for estimating medical fees. The Korean Society of Obstetrics and Gynecology proposes alternative plans: "Total Care of Pregnancy and Delivery" should include support for high-risk pregnancy, support for prenatal care fees except those for sonography, and payments of cash bounties to mothers upon delivery of their babies. After sufficient government budget is secured, harmonious arrangements between the government and the clinical fields that use ultrasound should be made for the systematic computation of ultrasound fees.