Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Ensuring access to essential medicines is a key objective of all health systems, and is an integral component of the progress towards universal health coverage (UHC). Despite global and national efforts to improve access and affordability of medicines, millions of people - particularly in low- and middle-income countries - still remain without access to quality-assured and affordable medicines. This study aims to contribute to existing knowledge on regulatory systems and harmonization efforts in Southeast Asia. Focusing on five member states of the Association of Southeast Asian Nations (ASEAN) - Indonesia, Malaysia, the Philippines, Thailand, an Vietnam - this study gives an overview of pharmaceutical markets and key pharmaceutical policies in the region, provides a cross-country comparison of medicines regulatory systems, and details harmonization efforts, opportunities, and challenges.

Health Policy and Management --- Health Systems Development and Reform --- Health, Nutrition and Population --- Pharmaceuticals and Pharmacoeconomics

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

The case study provides an overview of the main features of the pharmaceuticals pricing andreimbursement policies in Estonia, based on a review of regulations and literature, and data analysis. The first chapter of the report provides background information on the Estonian health system context and overall description of the pharmaceutical sector. The second chapter focuses on the pricing policies used for the retail and hospital sector medicines, while outlining the impact of current policies. The third chapter takes a closer look into the reimbursement policies for outpatient and inpatient medicines. Finally, some conclusions from the case study are provided.

Health Economics and Finance --- Health Insurance --- Health Systems Development and Reform --- Health, Nutrition and Population --- Pharmaceuticals and Pharmacoeconomics

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Croatia operates a mandatory health insurance system with a single public health insurance fund, the Croatian Health Insurance Fund (HZZO), acting as the sole public purchaser of health care services for all insured-the entire population of Croatia. The HZZO holds a monopsony on reimbursement and pricing of publicly funded medicines. This gives it leverage in negotiations with pharmaceutical companies. The HZZO implements two (brand name based) lists of medicines that define: (a) which products are reimbursed, (b) their wholesale prices, and (c) reimbursed prices and co-payments-the 'basic' list with medicines dispensed in community pharmacies and hospitals with no co-payments, and the 'complementary' list with medicines dispensed in community pharmacies covered partially through mandatory insurance and partially by co-payments. These out-of-pocket payments are the result of internal reference pricing procedures, implying that all medicines with co-payments should have comparable1 parallel products listed in the 'basic list' with no co-payments. Community pharmacies are reimbursed monthly for the products they dispense at the listed reimbursed prices. They procure medicines from wholesalers at the regulated wholesale prices (a maximum of 8.5 percent of which accounts for wholesale margins) and are in addition paid by the HZZO linear fees for dispensing. No retail margins are allowed for HZZO reimbursed medicines. Hospitals are paid through Diagnosis Related Groups (DRGs, that account for the cost of medicines used in treatment) but receive additional funds (100 percent of listed price) for use of medicines defined by the HZZO as expensive. Hospitals procure all medicines through public procurement. HZZO's lists define the maximal prices they can pay in the process. Products not reimbursed by the HZZO (over the counter and prescription medicines) can be freely priced. Nevertheless, given the breadth of HZZO's coverage, sales of non-reimbursed prescription medicines are marginal. The value-added tax (VAT) on all medicines (including those reimbursed by the HZZO) is set at 5 percent of the wholesale price.

Health Economics and Finance --- Health Insurance --- Health Systems Development and Reform --- Health, Nutrition and Population --- Pharmaceuticals and Pharmacoeconomics

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

The Three-Gap Model examines the determinants of low-quality health care by examining the patterns and determinants of three gaps. Using four measures of performance-target performance, actual performance, capacity to perform, and knowledge to perform-this paper defines three gaps for each health worker: the gap between target performance and what they have the knowledge to do (the know gap), the gap between their knowledge and their capacity to perform (the know-can gap), and the gap between their capacity and what they actually do (the can-do gap). The paper demonstrates how the patterns of these gaps across health workers in a sample can be used to diagnose failures in the system as well as evaluate the outcomes of policy experiments. Using data on pediatric care from hospitals in Liberia, the paper illustrates how the model can be used to investigate the potential for improvements in the quality of care from several possible policy interventions. The analysis of the relationships between these gaps across health workers in a health system help to paint a better picture of the determinants of performance and can assist policy makers in choosing relevant policies to improve health worker performance.

Health Care Evaluation --- Health Care Services Industry --- Health Service Management and Delivery --- Health, Nutrition and Population --- Industry --- Pay for Performance --- Pay for Quality --- Pediatric Care --- Pharmaceuticals and Pharmacoeconomics --- Pharmaceuticals Industry

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

This study conducted an experiment in Mali to test whether patients pressure doctors to prescribe medical treatment they do not necessarily need. The experiment varied patients' information about a discount for antimalarial tablets and measured demand for both tablets and costlier antimalarial injections. The study finds evidence of patient-driven demand: informing patients about the discount, instead of letting doctors decide to share this information, increased discount use by 35 percent and overall malaria treatment by 10 percent. These marginal patients rarely had malaria, worsening the illness-treatment match. Providers did not use the information advantage to sell injections - their use fell in both information conditions.

Doctor-Patient Interaction --- Health Care Overuse --- Health Care Services Industry --- Health Service Management and Delivery --- Health, Nutrition and Population --- Industry --- Malaria --- Pharmaceuticals and Pharmacoeconomics --- Prescription Drug Demand --- Prescription Drug Use