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題名 製藥產業創新核價模式
Innovative Pricing Model in Pharmaceutical Industry作者 王宥人 貢獻者 李仁芳
王宥人關鍵詞 創新核價模式
風險分攤
價量協議
結果導向給付方案成
效為基礎給付模式
製藥產業日期 2011 上傳時間 1-Sep-2016 23:40:55 (UTC+8) 摘要 由於醫療科技的進步以及人口老化造成各國政府對於健康支出越來越高，導致財務上的壓力；很多創新的藥品因為研發成本高或是病人族群太少所以價格高昂。醫療保險也因為財務衝擊過大而無法給付，最後演變成醫療的需要無法被完全滿足。因此藥品公司採用創新核價模式，透過分擔財務上風險來降低交易成本，近年來更有藥品公司與保險公司或政府簽訂契約，以分擔治療結果上的風險來降低市場進入障礙。本篇論文嘗試以新制度經濟學交易成本理論，初探製藥產業為了降低市場進入障礙採用創新核價模式的可行性。透過文獻整理、外在環境與兩個個案分析發現，創新核價/給付模式提供政府與藥品公司足夠的誘因，讓雙方願意坐下來協商雙方都可接受的可能性。因此，創新核價/給付模式確實能有效降低市場進入障礙，提高新藥的可近性。適合採用創新核價模式的產品通常有以下三個共同特點：交易頻率相對較低，單價高或財務衝擊大，有明確的審查依據並能取得客觀可靠的資訊。台灣目前已有產品部份採用創新核價/給付模式。不確定性是影響交易成本的主要因素，事實上台灣也有越來越多的創新核價/給付模式用來增加市場可近性，除了個案所提的價量協議合約以外，事實上健保局早就將以成效為基礎給付的創新核價/給付模式隱身在給付規定中。未來，創新核價/給付模式除了財務上的風險分攤以外，依實證發展給付（coverage with evidence development, CED）模式或許會成為下一個發展的重點。 參考文獻 1. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision. http://esa.un.org/unpp, Saturday, September 25, 2010.2. Bill Mitchell, The US should have universal public health care. http://bilbo.economicoutlook.net/blog/?p=8909 Sunday, Oct 3,2010.3. WHO (May 2009). "World Health Statistics 2009" http://www.who.int/whosis/whostat/2009/en/index.html, Sunday, Oct 3, 20104. Institute for research and information in health economics. OECD Health Data 2010 – Frequently Requested Data. http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls, Monday, Oct 4, 2010.5. Claus Moldrup No Cure, No Pay. BMJ 2005;330:1262-4.6. 全民健康保險藥品論質計酬計畫實施要點(草案）. 全民健康保險藥事小組第8屆第16次會議紀錄附件5. http://www.nhi.gov.tw/webdata/AttachFiles/Attach_15849_2_第8屆第16次會議紀錄(990728).pdf, Saturday, Oct 9, 2010.7. 全民健康保險藥價基準(民國99年9月24日修正） http://dohlaw.doh.gov.tw/Chi/FLAW/FLAWDAT0202.asp?lsid=FL037963, Feb 12, 2011.8. Ferris, J. & S. Tang, The New Institutionalism and Public Administration: An Overview. Journal of Public Administration: Research and Theory 1993;3(1):4-10.9. North, D.C. Economic Performance through Time. 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Brown GC etal. Difference between ophthalmologists` and patients` perceptions of quality of life associated with age-related macular degeneration. Can J Ophthalmol. 2000;35(3):127-33.48. Philip J. Rosenfeld et al. for the MARINA Study Group. Ranibizumab for Neovascular Age-Related Macular Degeneration. N Engl J Med 2006;355:1419-31.49. David M. Brown et al. for the ANCHOR Study Group. Ranibizumab versus Verteporfin for Neovascular Age-Related Macular Degeneration. N Engl J Med 2006;355:1432-44.50. National Institute for Health and Clinical Excellence, NICE technology appraisal guidance 155. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. Aug 2008. http://www.nice.org.uk/nicemedia/live/12057/41719/41719.pdf51. National Institute for Health and Clinical Excellence, Audit Support. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. Sep 2008. http://www.nice.org.uk/nicemedia/live/12057/41926/41926.doc 52. 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Health Policy 2006;75:329-337.68. 國際骨質疏鬆症基金會International Osteoporosis Foundation http://www.osteofound.org/press_centre/fact_sheet.html69. Berry SD, Samelson EJ, Hannan MT, et al. Second hip fracture in older men and women. Arch Intern Med. 2007;167(18):1971-1976.70. Black DM, Delmas PD, Eastell R, et al. Once-yearly Zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007:356:1809-22.71. 全民健康保險藥事小組第8屆第18次會議紀錄http://www.nhi.gov.tw/Resource/webdata/Attach_15997_2_8-18會議紀錄-final.pdf72. 國民健康局2007年台灣中老年身心社會生活狀況長期追蹤(第六次）調查73. Black DM, Delmas PD, Eastell R, et al. Once-yearly Zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007:356:1809-22.74. 游慧光(2004)，OECD國家與台灣醫療保健支出成長因素之探討，逢甲大學會計與財稅研究所碩士論文。75. 陳昭姿，健保新藥管理趨勢，Dec 14, 201076. Frank R.G.,“Government Commitment and Regulation of Prescription Drugs” Health Affairs 2003;22(3):46-48.77. 行政院衛生署中央健康保險局, 全民健康保險藥品給付規定http://www.nhi.gov.tw/Resource/webdata/15321_1_藥品給付規定條文.doc 描述 碩士
國立政治大學
科技管理研究所
94359030資料來源 http://thesis.lib.nccu.edu.tw/record/#G0094359030 資料類型 thesis dc.contributor.advisor 李仁芳 zh_TW dc.contributor.author (Authors) 王宥人 zh_TW dc.creator (作者) 王宥人 zh_TW dc.date (日期) 2011 en_US dc.date.accessioned 1-Sep-2016 23:40:55 (UTC+8) - dc.date.available 1-Sep-2016 23:40:55 (UTC+8) - dc.date.issued (上傳時間) 1-Sep-2016 23:40:55 (UTC+8) - dc.identifier (Other Identifiers) G0094359030 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/101065 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 科技管理研究所 zh_TW dc.description (描述) 94359030 zh_TW dc.description.abstract (摘要) 由於醫療科技的進步以及人口老化造成各國政府對於健康支出越來越高，導致財務上的壓力；很多創新的藥品因為研發成本高或是病人族群太少所以價格高昂。醫療保險也因為財務衝擊過大而無法給付，最後演變成醫療的需要無法被完全滿足。因此藥品公司採用創新核價模式，透過分擔財務上風險來降低交易成本，近年來更有藥品公司與保險公司或政府簽訂契約，以分擔治療結果上的風險來降低市場進入障礙。本篇論文嘗試以新制度經濟學交易成本理論，初探製藥產業為了降低市場進入障礙採用創新核價模式的可行性。透過文獻整理、外在環境與兩個個案分析發現，創新核價/給付模式提供政府與藥品公司足夠的誘因，讓雙方願意坐下來協商雙方都可接受的可能性。因此，創新核價/給付模式確實能有效降低市場進入障礙，提高新藥的可近性。適合採用創新核價模式的產品通常有以下三個共同特點：交易頻率相對較低，單價高或財務衝擊大，有明確的審查依據並能取得客觀可靠的資訊。台灣目前已有產品部份採用創新核價/給付模式。不確定性是影響交易成本的主要因素，事實上台灣也有越來越多的創新核價/給付模式用來增加市場可近性，除了個案所提的價量協議合約以外，事實上健保局早就將以成效為基礎給付的創新核價/給付模式隱身在給付規定中。未來，創新核價/給付模式除了財務上的風險分攤以外，依實證發展給付（coverage with evidence development, CED）模式或許會成為下一個發展的重點。 zh_TW dc.description.tableofcontents 第一章 緒論 1第一節 研究背景與動機 1第二節 研究目的與問題 4第二章 文獻探討 5第一節 交易成本理論 8壹、 交易的概念 8貳、 何謂交易成本 8參、 交易成本分析 11肆、 小結 13第二節 契約理論 14壹、 契約理論的要素 14貳、 契約理論的類型 15參、 小結 20第三節 創新核價/給付模式 21壹、 創新核價/給付模式的類型 21貳、 以成效為基礎給付的創新核價/給付模式類型 24參、 藥品公司整理的創新核價/給付模式的範疇與型態 32第三章 研究方法 38第一節 研究流程 38第二節 研究架構 39壹、 影響不確定性的因素 39貳、 影響交易頻率的因素 40參、 影響資產專屬性的因素 40第三節 研究設計與資料收集方式 42壹、 研究方法 42貳、 資料收集方法 42參、 研究對象 43第四節 研究限制 45第四章 個案研究 46第一節 Lucentis 46壹、 個案背景介紹 46貳、 各國創新核價/給付模式 49參、 個案分析 62第二節 Aclasta 66壹、 個案背景介紹 66貳、 各國創新核價/給付模型 69參、 個案分析 74第五章 研究發現與討論 78第一節 研究發現 78壹、 創新核價模式能提高新藥的可近性 78貳、 採用創新核價模式的產品共同特點 78參、 台灣部份採用創新核價/給付模式 81第二節 討論 82壹、 創新核價/給付模式是未來的核價給付趨勢 82貳、 不確定性是影響交易成本的主要因素 82參、 台灣也有越來越多的創新核價/給付模式 87附錄一. NICE Guidance for Ranibizumab 92附錄二. 德國合約 93附錄三. NICE Audit Support for Lucentis 101第六章 參考文獻 105 zh_TW dc.format.extent 3628794 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0094359030 en_US dc.subject (關鍵詞) 創新核價模式 zh_TW dc.subject (關鍵詞) 風險分攤 zh_TW dc.subject (關鍵詞) 價量協議 zh_TW dc.subject (關鍵詞) 結果導向給付方案成 zh_TW dc.subject (關鍵詞) 效為基礎給付模式 zh_TW dc.subject (關鍵詞) 製藥產業 zh_TW dc.title (題名) 製藥產業創新核價模式 zh_TW dc.title (題名) Innovative Pricing Model in Pharmaceutical Industry en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 1. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision. http://esa.un.org/unpp, Saturday, September 25, 2010.2. Bill Mitchell, The US should have universal public health care. http://bilbo.economicoutlook.net/blog/?p=8909 Sunday, Oct 3,2010.3. WHO (May 2009). "World Health Statistics 2009" http://www.who.int/whosis/whostat/2009/en/index.html, Sunday, Oct 3, 20104. Institute for research and information in health economics. OECD Health Data 2010 – Frequently Requested Data. http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls, Monday, Oct 4, 2010.5. Claus Moldrup No Cure, No Pay. BMJ 2005;330:1262-4.6. 全民健康保險藥品論質計酬計畫實施要點(草案）. 全民健康保險藥事小組第8屆第16次會議紀錄附件5. http://www.nhi.gov.tw/webdata/AttachFiles/Attach_15849_2_第8屆第16次會議紀錄(990728).pdf, Saturday, Oct 9, 2010.7. 全民健康保險藥價基準(民國99年9月24日修正） http://dohlaw.doh.gov.tw/Chi/FLAW/FLAWDAT0202.asp?lsid=FL037963, Feb 12, 2011.8. Ferris, J. & S. Tang, The New Institutionalism and Public Administration: An Overview. Journal of Public Administration: Research and Theory 1993;3(1):4-10.9. North, D.C. Economic Performance through Time. American Economic Review 1994;84:359-6810. Davis, L. and North, D.C. 1971. Institutional Change and American Economic Growth. 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