本文選題：亞太地區(qū) + 慢性病基本藥物　； 參考：《山東大學》2017年碩士論文

【摘要】：研究背景隨著社會、經(jīng)濟、醫(yī)療衛(wèi)生的發(fā)展,世界人口老齡化逐漸加重,人口老齡化對于老年人和整個社會既是機遇又是挑戰(zhàn)。隨著人均壽命的延長,老年人的健康狀況并未得到明顯改善。老年人的慢性病患病率明顯高于年輕人,特別是高血壓、心腦血管疾病、呼吸系統(tǒng)疾病,且有逐年增加的趨勢。有數(shù)據(jù)顯示80%的老年人患有慢性病,老年人醫(yī)療衛(wèi)生需求大,人均醫(yī)療費用高。人口老齡化始于高收入國家,但現(xiàn)在中低收入國家正在經(jīng)歷巨大的變化,2050年,80%的老年人將會生存在中低收入國家。亞太地區(qū)中低收入國家人口老齡化和老年人慢性病患病率逐年升高的形勢相比于發(fā)達國家更為嚴峻。各個國家能否為老年人中的慢性病患者提供價格合理、能夠保障供應、患者可公平獲得的基本藥物決定著老年人中的慢性病患者的疾病能否得到治療、健康能否得到保障。慢性病基本藥物較低的可獲得性和較高的藥品價格都會使得老年人中的慢性病患者難以獲得相應的藥物治療�？梢哉f慢性病基本藥物的價格與可獲得性與老年人的健康息息相關,研究老年人慢性病基本藥物的價格、可獲得性和可負擔性意義重大。研究目的本研究擬對比研究亞太地區(qū)11個國家老年人慢性病基本藥物的價格、可獲得性和可負擔性,分析造成亞太地區(qū)國家老年人慢性病基本藥物可及性現(xiàn)狀的可能原因,為亞太地區(qū)國家制定政策以應對老齡化、滿足老齡人口的衛(wèi)生需要,提高老年人慢性病基本用藥的可及性提供可靠依據(jù)。研究方法本研究主要的研究方法為二手數(shù)據(jù)分析法,對使用世界衛(wèi)生組織國際健康行動提出的藥品價格和可及性標準調查法即《藥品價格、可獲得性、可負擔性和價格構成調查方法》收集的藥品價格、可及性數(shù)據(jù)進行二次分析,包括中國、斐濟、印度、印度尼西亞、馬來西亞、蒙古、菲律賓、斯里蘭卡、泰國和越南在內的11個亞太地區(qū)中低收入國家數(shù)據(jù)庫中基本藥物的價格、可獲得性和可負擔性數(shù)據(jù)。研究藥物包括用于治療高血壓、糖尿病、抑郁癥、癲癇、哮喘、胃潰瘍6種常見慢性病的15種基本藥物,分別對比研究了 15種基本藥物的原研藥和最低價格通用藥在公立醫(yī)療機構和私立醫(yī)療機構的價格、可獲得性及可負擔性現(xiàn)狀。根據(jù)HAI網(wǎng)提供的不同年份間藥品價格數(shù)據(jù)的轉換方法,將11個國家不同年份的藥品價格數(shù)據(jù)轉化為以2014年為基準年的數(shù)據(jù),比較分析亞太地區(qū)國家老年人慢性病基本藥物價格。研究結果(1)亞太地區(qū)國家老年人慢性病基本藥物可獲得性分析亞太地區(qū)11個國家老年人慢性病基本藥物的可獲得性整體較差,公立醫(yī)療機構慢性病基本藥物原研藥的可獲得性中位數(shù)為10.0%,最大值為19.5%,最小值為0;最低價格通用藥可獲得性中位數(shù)為35.5%,最大值為80.0%,最小值為5.0%;私立醫(yī)療機構慢性病基本藥物原研藥可獲得性中位數(shù)為37.9%,最大值為69.5%,最小值為10%;私立醫(yī)療機構最低價格通用藥可獲得性中位數(shù)為52.4%,最大值為90.0%,最小值為11.7%。中國、越南、印度、印度尼西亞、老撾、泰國公立醫(yī)療機構最低價格通用藥的可獲得性遠遠高于原研藥,馬來西亞菲律賓最低價格通用藥的可獲得性低于原研藥。私立醫(yī)療機構慢性病基本藥物的可獲得性普遍高于公立醫(yī)療機構。(2)亞太地區(qū)國家老年人慢性病基本藥物價格分析11個國家慢性病基本藥物采購價格大小不一,公立醫(yī)療機構原研藥采購價格中位價格比(Median price ratio,MPR)的中位數(shù)為9.08,最小值為1.19,最大值為23.39;最低價格通用藥采購價格的MPR中位數(shù)為1.38,最小值為0.36,最大值為32.94。亞太地區(qū)國家老年人慢性病基本藥物的采購價格整體偏高。亞太地區(qū)11個國家老年人慢性病基本藥物的零售價均較高,公立醫(yī)療機構原研藥零售價格的MPR的中位數(shù)為21.51、最大值為79.13,最小值為0;最低價格通用藥零售價格的MPR的中位數(shù)為6.6,最大值為32.88,最小值為0。私立醫(yī)療機構原研藥零售價格MPR的中位數(shù)為32.24,最大值為150.03,最小值為4.96;最低價格通用藥零售價格MPR的中位數(shù)為11.48,最大值為46.21,最小值為0.92對均有采購價格和零售價格數(shù)據(jù)的公立醫(yī)療機構的采購價格與零售價格進行對比研究:中國基本藥物原研藥在公立醫(yī)療機構的藥品加成率為122.0%,其他國家的公立醫(yī)療機構原研藥的加成率都高于中國,老撾、越南、蒙古國、菲律賓、泰國原研藥在公立醫(yī)療機構的加成率分別為390.0%、196.0%、220.0%、238.0%、311.0%。中國公立醫(yī)療機構的最低價格通用藥的藥品加成率為43.7%,其他國家公立醫(yī)療機構最低價格通用藥的藥品加成率均高于100.0%,印度尼西亞最高高達660.2%,泰國其次高達495.3%,蒙古國、越南、老撾公立醫(yī)療機構最低價格通用藥的藥品加成率分別為143.5%、246.0%、251.2%。(3)亞太地區(qū)國家老年人慢性病基本藥物可負擔性分析亞太地區(qū)11個國家公立醫(yī)療機構原研藥的可負擔性為2.4倍日薪,私立醫(yī)療機構原研藥的可負擔性為2.3倍日薪;最低價格通用藥的可負擔性較好,11個國家公立醫(yī)療機構最低價格通用藥可負擔性為0.35倍日薪,私立醫(yī)療機構最低價格通用藥的可負擔性為0.44倍日薪。與單個基本藥物的可負擔性對比,慢性病的疾病的可負擔性并沒有那么理想,用倍氯米松和沙丁胺醇聯(lián)合治療哮喘的可負擔性為2.1倍日薪,用格列本脲和二甲雙胍治療糖尿病的可負擔性為1.6倍日薪,用阿替洛爾和氫氯噻嗪治療高血壓的可負擔性為0.7倍日薪。研究結論(1)亞太地區(qū)國家老年人慢性病基本藥物可獲得性整體較差;(2)采購價格偏高,老年人慢性病基本藥物采購效率較低;亞太地區(qū)國家老年人慢性病基本藥物零售價格偏高,零售價格遠遠高于采購價格,老年人慢性病基本藥物在醫(yī)療機構的藥品加成較高;(3)亞太地區(qū)國家老年人慢性病基本藥物的可負擔性整體較差,具體來說最低價格通用藥的可負擔性較好,原研藥的可負擔性較差,慢性病疾病的可負擔性較差。政策建議針對亞太地區(qū)國家老年人慢性病基本藥物價格和可及性現(xiàn)狀,提出建議如下:(1)完善基本藥物制度,推動基本藥物在醫(yī)療機構的采購使用;(2)提高采購效率,完善藥品價格監(jiān)管體系和價格控制法規(guī),加強對藥品生產(chǎn)、流通、銷售等環(huán)節(jié)的監(jiān)督控制;(3)在醫(yī)療機構推廣使用最低價格通用藥,加強通用藥質量管理。加強對通用藥的宣傳,提高病人對通用藥的認可度。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R95

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