CAJ | 학술논문

药品支出上涨是全球问题。为应对这一压力，多数高收入国家制定并实施了一系列的药品定价和采购政策。然而，尽管中低收入国家希望能够有效控制药品支出预算，但其药品市场不规范，并缺乏可行的药品定价或采购政策。高收入国家药品支出通常由国家或社会医疗保险机构支付，而中低收入国家大多是个人自付，这会给政策执行造成阻力。由于对药品定价和采购政策是否高效缺乏严谨的调查研究，因而一定程度上阻碍了中低收入国家政策方案的实施。本文对已发表的有关药品定价和采购政策的文章进行综述发现，许多有效的政策也伴随着各种风险。全球尚没有一种最佳的政策选择，各国应根据具体国情，多种政策结合使用。中低收入国家的实证研究尚不足，由于缺乏完善的法律体系以及未建立专门的药品采购机构，任何一种政策选择所伴随的风险在这些国家都会引起更大的争议，然而这或许是帮助其改善药品定价和采购体系的关键因素。
약품지출상창시전구문제。위응대저일압력，다수고수입국가제정병실시료일계렬적약품정개화채구정책。연이，진관중저수입국가희망능구유효공제약품지출예산，단기약품시장불규범，병결핍가행적약품정개혹채구정책。고수입국가약품지출통상유국가혹사회의료보험궤구지부，이중저수입국가대다시개인자부，저회급정책집행조성조력。유우대약품정개화채구정책시부고효결핍엄근적조사연구，인이일정정도상조애료중저수입국가정책방안적실시。본문대이발표적유관약품정개화채구정책적문장진행종술발현，허다유효적정책야반수착각충풍험。전구상몰유일충최가적정책선택，각국응근거구체국정，다충정책결합사용。중저수입국가적실증연구상불족，유우결핍완선적법률체계이급미건립전문적약품채구궤구，임하일충정책선택소반수적풍험재저사국가도회인기경대적쟁의，연이저혹허시방조기개선약품정개화채구체계적관건인소。
Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries ( LMICs) , however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-ofpocket which creates a dif-ferent dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively pre-ferred;rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems.