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[高成本药品:个人权利与集体权利之间的艰难平衡 高成本药物:个人权利与集体权利之间的艰难平衡]

[High-cost medicines: the difficult balance between individual and collective rightsMedicamentos de alto custo: o difícil equilíbrio entre direitos individuais e coletivos].

作者信息

Marin Gustavo H

机构信息

Centro Universitario de Farmacología Universidad Nacional de La Plata Centro Colaborador OPS-OMS La Plata Argentina Centro Universitario de Farmacología, Universidad Nacional de La Plata, Centro Colaborador OPS-OMS, La Plata, Argentina.

出版信息

Rev Panam Salud Publica. 2024 Aug 13;48:e76. doi: 10.26633/RPSP.2024.76. eCollection 2024.

Abstract

Medicines are special goods that cover the health needs of the population. In recent decades, the pharmaceutical industry has changed its research and development strategy, shifting its focus from the exploration of medicines for chronic diseases affecting a large part of the population to the search for drugs for rare diseases that affect a small number of people.This lack of a mass consumer base is reflected in a selective offer of a few very high-cost products aimed at certain diseases, which hinders both patient access and financial coverage.This article reviews the issue of high-cost medicines, including its cultural, legal, political, economic, and health aspects. It emphasizes the differences between various medicines in terms of their efficacy in changing the natural course of diseases, their market price, the consequences of their cost for healthcare funders, and the cost-opportunity ratio of having to pay for them at the expense of other essential resources.Finally, the article reflects on the legitimate rights of each individual to claim access to high-cost medicines when they are considered essential to recover a person's health, and on how guaranteeing such coverage can affect the collective rights of the population. Concrete examples that illustrate this situation are provided.

摘要

药品是满足民众健康需求的特殊商品。近几十年来,制药行业改变了其研发策略,将重点从研发针对影响大部分人口的慢性病药物,转向寻找针对影响少数人的罕见病药物。这种缺乏大量消费群体的情况反映在针对某些疾病的少数高成本产品的选择性供应上,这既阻碍了患者获得药物,也影响了医保覆盖范围。本文回顾了高成本药品问题,包括其文化、法律、政治、经济和健康等方面。它强调了各种药品在改变疾病自然病程的疗效、市场价格、其成本对医疗保健资助者的影响以及为其支付费用而牺牲其他基本资源的成本效益比方面的差异。最后,本文思考了在高成本药品被认为对恢复个人健康至关重要时,每个人要求获得此类药品的合法权利,以及保障这种医保覆盖会如何影响民众的集体权利。文中提供了说明这种情况的具体例子。

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