医生们无论是处方抗肿瘤药物还是治疗糖尿病的药物，都需要考虑性价比。在生活中，医生也是一个普通公民，也会衡量花掉的钱值不值得，所以医疗领域也不能例外。因此需要更广泛定义医疗的“价值”。

　　英国如何决定医保承担份额

　　英国国家临床规范研究院的机制透明，能根据新疗法给患者带来的生存获益及生活质量获益，来判断其是否“物有所值”。英国的医疗体系是由纳税人支撑，可以民主决定医保覆盖药物和承担的金额。如果某种药物效果很好，就覆盖到医保里。但是许多现代癌症药物，充其量勉强有效。因此，医保药物增量计划让人纠结：花10万美元多购买六个星期的无进展生存值得吗？

　　目前英国的医保承担范围是50000 ~60000美元，这个区间似乎很合理。不同国家或地区有其自己的医保标准。卡塔尔最富有，医保计划覆盖了所有医疗项目。

　　昂贵的肿瘤药物到底值不值

　　衡量医疗服务的“价值”不是根据市场规律。Kerr博士“价值”的定义清晰且简单，但是每个人都有自己的价值定义，他们认为价值与品质相关，他们把价值理解为日常购物，是否“物有所值” ，这显示了语言解释复杂问题的有限性。

　　哈佛大学的迈克尔·波特是一位很优秀的卫生系统专家。他对价值定义很好地表达了Kerr博士的想法。他认为价值是基于治疗患者的“量”，而不是治疗效果，关键是要同时考虑到功效和成本。

访谈原文

　　Oncology Frontier: Where is the balance point in healthcare decisions where economics demand that you don’t use a particular treatment?

　　《肿瘤瞭望》：你们如何决定医保覆盖的治疗选项？

　　Dr Kerr: I think all of us， whether we are practicing cancer medicine or diabetic medicine and so on， need to take account of value for money. In our ordinary lives as citizens we demand value for whatever we are paying for and that shouldn’t be different with healthcare. We probably need to promote the concept of value more widely. In our taxation-based healthcare system in the United Kingdom， we have the National Institute of Clinical Excellence which has a transparent means of allowing us to judge the value of a new treatment. The way we do that is to look at the benefits in terms of improved survival and improved quality of life against cost. Because we are part of a democracy in a taxation-based healthcare system， we can work with politicians to decide how much we as a country can afford for drugs that are often fairly marginal. If the drug is wonderful and works well， we will use it. We are having this argument because many of the modern cancer drugs are， at best， marginally effective. This is why it becomes very tangled in terms of these increment schemes. Is it really value for money to spend