来源：中国药促会    2013-07-05

经合组织发表报告称，继2010年大幅下调后，2011年经济合作与发展组织（OECD经合组织）国家卫生支出回稳，但药品支出作为削减医疗成本的“首要目标”，2011年被大幅度地削减。

根据经合组织健康数据2013，虽然2000年-2009年经合组织成员国卫生支出年平均增长接近5％，其后由于经济危机的持续影响，尤其是那些受金融危机重创的欧洲国家，2010年和2011年增长放缓至约0.5％。

一些国家的初步数据表明2012年这一趋势仍将延续，报告补充道。

自2009年以来，卫生支出的急剧下降主要是由于政府卫生支出增长的坍塌，记录显示两年平均增长接近于零。在许多国家，随着家庭收入持平或下降，2010年和2011年私人卫生支出也在放缓，尽管此种减少较为有限。

希腊在2000年至2009年年均增长速度超过5％之后，2010年和2011年医疗总开支下降了11％，此减少主要是由于政府大幅削减支出，经合组织表示。

爱尔兰、冰岛和西班牙卫生支出也经历了连续两年的负增长，而其他一些国家如爱沙尼亚和捷克共和国，卫生支出在2010年经历急剧下降后，2011年温和反弹。其他国家包括葡萄牙和意大利，2010年削减计划可能被推迟，但在随后的2011年削减了公共卫生支出；葡萄牙2009年和2010年间公共卫生支出保持平稳，之后2011年公共支出下降了8％。

报告指出，只有两个经合组织国家 - 以色列和日本 - 自2009年以来卫生支出比之前加速。

欧洲以外地区，2010年和2011年卫生支出增幅也放缓，尤其是在加拿大（2010年增长3％，2011年实际增长0.8％）和美国（2010年增长2.5％，2011年实际增长1.8％）。

美国经过多年的稳步增长，2009至2011年间卫生支出占国内生产总值（GDP）比值保持在17.7％。

然而，该报告补充道：“目前尚不清楚近期的放缓是否主要反映的是周期性因素，当经济增长回升时，它可能不会产生持久影响，或者它是否反映了更多的结构变化，例如新技术和新药物的陆续应用以及供应商付款方式的变更导致资金使用效率的提高。”

经合组织还报告了许多成员国公共卫生支出裁减通常采用一刀切的方式，并且药品支出一直是裁减的首要目标，继2010年支出小幅下降后2011年进行了更大幅度的削减。

许多国家都采取加大了药品费用分摊、降低药价、减小覆盖范围以及促进仿制药应用的措施。例如葡萄牙、希腊和西班牙，2011年处方药支出分别减少了20％、13％和8％，而在西班牙，仿制药（在药品消费总值）所占比例在2006年至2011年间增加了一倍以上。

经合组织的数据显示，2011年英国的卫生支出占国内生产总值的9.4％，略高于经合组织平均水平9.3％，但是英国的卫生支出占GDP的比重远低于美国，根据2011年的健康数据，美国卫生支出占GDP比重为17.7％。 英国的数字也略低于一些欧洲国家，如荷兰（11.9％）、法国（11.6％）和德国（11.3％）。

2011年英国人均卫生支出保持在3405美元，略高于经合组织平均3339美元（按购买力平价调整）。英国的人均卫生支出维持在美国人均卫生支出40％的水平，2011年美国人均花费8508美元，经合组织报告。

原文链接：

http://www.pharmatimes.com/Article/13-07-03/Pharma_a_prime_target_of_govt_health_cuts_in_2011_says_OECD.aspx

Pharma "a prime target" of govt health cuts in 2011, says OECD

After falling sharply in 2010, health spending remained flat across Organisation for Economic Cooperation and Development (OECD) countries in 2011, but pharmaceutical spending, as a "prime target" for health cost cuts, experienced deeper cuts during the year, the Organisation reports.

While health spending grew close to 5% on average year-on-year from 2000 to 2009 in OECD member-nations, then followed sluggish growth of around 0.5% in 2010 and 2011 as the economic crisis continued to have an impact, particularly in those European countries hardest-hit by the crisis, according to OECD Health Data 2013.

Preliminary figures for some countries suggest a continuation of this trend in 2012, it adds.

The decline has been driven primarily by a collapse in the growth of government health spending since 2009, recording close to zero growth in both years on average.

Private health spending also slowed down in many countries in 2010 and 2011, as household incomes remained flat or decreased, although this reduction was more limited.

In Greece, overall health spending dropped 11% in both 2010 and 2011 after yearly growth rate of more than 5% on average between 2000 and 2009, and these reductions were mainly driven by deep cuts in government expenditures, says OECD.

Ireland, Iceland and Spain also experienced two consecutive years of negative growth in health spending, while some other nations, such as Estonia and the Czech Republic, saw severe falls in expenditure in 2010 followed by a modest rebound in 2011. Other countries, including Portugal and Italy, may have delayed cuts in 2010 but then reduced public health spending in 2011; in Portugal, public spending dropped 8% in 2011 after remaining stable between 2009 and 2010.

Only two OECD countries - Israel and Japan - have seen an acceleration in health spending since 2009 compared with the period before, the report notes.

Away from Europe, it finds that health spending growth also slowed in 2010 and 2011, notably in Canada (3% in 2010 and 0.8% in 2011 in real terms), and the US (2.5% in 2010 and 1.8% in 2011, also in real terms).

In the US, the share of health spending to Gross Domestic Product (GDP) remained at 17.7% between 2009 and 1011, after years of steady increases.

However, the report adds: "it is not clear yet whether the recent slowdown reflects mainly cyclical factors and may therefore not have lasting effect when economy growth picks up, or whether it reflects more structural changes such as a slow diffusion of new technologies and pharmaceuticals, and changes in provider payments resulting in greater efficiency."

OECD also reports that reductions in public spending on health in many of its member-nations have typically been made across the board, and that pharmaceutical spending has been a prime target, with expenditures here falling slightly in 2010 followed by deeper cuts in 2011.

For example, in 2011 Portugal, Greece and Spain reduced spending on prescription drugs by 20%, 13% and 8% respectively, while in Spain, the share of generic drugs (in the total value of consumption) more than doubled between 2006 and 2011.

The OECD's data shows that health expenditures in the UK accounted for 9.4% of GDP in 2011.

This is slightly above the OECD average of 9.3%, but the UK's spending as a share of GDP is much lower than in the US, which spent 17.7% of its GDP on health in 2011.

he UK figure is also slightly lower than some European countries such as the Netherlands (11.9%), France (11.6%) and Germany (11.3%).

In terms of per capita spending on health, the UK continued to spend slightly more in 2011, at US$3,405, than the OECD average of US$3,339 (adjusted for purchasing power parity).

Health spending per capita in the UK remains at 40% of the level in the US, which spent $8,508 per capita in 2011, OECD reports.