7．Health Technology Assessment from the Viewpoint of Patients and Patient Groups / 薬剤疫学

Patients can receive advanced medical care at a relatively low burden with the support of the system of the public health insurance for the whole nation and high-cost medical expense benefit in Japan. Despite these systems, some patients feel that they have many economic burden of medical care and cancer patient groups have demanded the reduction of economic burden. On the other hand some claim that the application of insurance to new drugs should be revised as the prices of new drugs are highly rising. As for health technology assessment cost-effectiveness evaluation is now being introduced from the point of cutting costs and patients now do not participate in the process of appraisal.

¿El aseguramiento público en salud mejora la atención en los servicios? El caso de la atención prenatal en adolescentes en México / Does public health insurance improve health care? The case of prenatal care for adolescents in Mexico

Resumen: Objetivo: Comprobar la asociación entre el aseguramiento público en salud y la atención prenatal adecuada en mujeres adolescentes. Material y métodos: Análisis transversal de datos de 3 978 mujeres (N=4 522 296) que reportaron embarazo en la adolescencia (12-19 años), derivados de las Encuestas Nacional de Salud 2000 y de Salud y Nutrición 2006 y 2012. Mediante modelos de regresión logística se analizó oportunidad, frecuencia y contenido de la atención prenatal. Resultados: La probabilidad de recibir atención prenatal oportuna y frecuente aumentó de 0.60 (IC95%:0.56;0.64) en 2000 a 0.71 (IC95%:0.66;0.76) en 2012. En 2012 la probabilidad de recibir atención oportuna, frecuente y con contenido básico fue 0.54 (IC95%:0.49;0.58) siendo mayor en mujeres con Seguridad Social que en aquéllas afiliadas al Seguro Popular o sin aseguramiento. Conclusión: Contar con seguridad social incrementa la probabilidad de recibir atención prenatal adecuada en adolescentes en México.

Abstract: Objective: To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Materials and methods: Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. Results: The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Conclusion: Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries

BACKGROUND/AIMS: The cost of caring for patients with inflammatory bowel disease (IBD) is high. Without government support, the cost burden will unavoidably rest on the patients and their family. However, the government providing full support will place a large financial burden on the health-care systems of a country. The aim of this study is to understand the current status of public medical insurance systems in caring for IBD patients among Asian countries. METHODS: Questionnaires inquiring about the availability of public health systems; medical, diagnostic, and endoscopy costs; and coverage rate of biologics use were designed and sent to IBD experts in each of the Asian countries studied. The results were summarized according to the feedback from the responders. RESULTS: The public health insurance coverage rate is high in Taiwan, Japan, South Korea, China, Hong Kong, and Singapore; but low in Malaysia and India. This probably affected the use of expensive medications mostly, such as biologics, as we found that the percentage of Crohn's disease (CD) treated with biologics were as high as 30%-40% in Japan, where the government covers all expenses for IBD patients. In India, the percentage maybe as low as 1% for CD patients, most of whom need to pay for the biologics themselves. CONCLUSIONS: There were differences in the public health insurance systems among the Asian countries studied. This reportprovidesthe background information to understand the differences in the treatment of IBD patients among Asian countries.