In this paper, we propose a new approach to address the problem of designing pharmaceutical copayments. The rationale for positive copayments in our setting lies in the presence of budgetary constraints and, hence, in the need to raise funds in order to finance the costs of the treatments. We use results from the literature on axiomatic bargaining with claims to incorporate criteria of distributive justice into the design of copayments. We find that if the government constrains patient rights to what is medically feasible, equity-based copayments vary from a percentage of the cost of the treatment, to a flat rate per prescription. If the government also takes into account the burden of disease experienced by patients, then copayments based on equity lead to a relation between copayments and clinical status that diverges from those proposals based on efficiency arguments. In particular, we show that equity-based copayments might be increasing in the health gains that the treatments provide to the patients. The reason is that these copayments try to avoid a “double jeopardy” problem, by ensuring that those patients with a large burden of disease do not face also an important monetary cost.

中文翻译：

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论股权导向医药共付款的设计

在本文中，我们提出了一种新的方法来解决设计药品共付额的问题。在我们的情况下，实现正共付额的理由在于预算限制，因此需要筹集资金以支付治疗费用。我们使用公理讨价还价的文献结果和主张，将分配正义的标准纳入共付额的设计中。我们发现，如果政府将患者权利限制在医学上可行的范围内，那么基于权益的共付额会从治疗费用的百分比到每张处方的统一费率不等。如果政府还考虑到患者所承受的疾病负担，然后，基于权益的共付额会导致共付额与临床状况之间的关系与基于效率论证的那些提议有所不同。特别是，我们表明，基于权益的共付额可能会增加治疗为患者带来的健康收益。原因是，这些共付额旨在通过确保那些负担较大疾病的患者不会面临重大的金钱成本，从而避免“双重危险”的问题。