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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
2.
Global Health ; 15(1): 57, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533850

RESUMO

In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middle-income countries rely on the EML, as well as the children's EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum.


Assuntos
Antineoplásicos , Comércio/organização & administração , Medicamentos Essenciais , Propriedade Intelectual , Cooperação Internacional , Políticas , Antineoplásicos/economia , Antineoplásicos/provisão & distribução , Custos e Análise de Custo , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde , Humanos , Neoplasias/tratamento farmacológico , Organização Mundial da Saúde
3.
BMJ ; 366: l4257, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315833

RESUMO

OBJECTIVES: To characterize the trends, drivers, and potential modifiers of increased spending by US Medicare beneficiaries on medicines deemed essential by the World Health Organization. DESIGN: Retrospective cost analysis of Medicare Part D Prescriber Public Use File, detailing annual generic and brand name drug prescribing and spending from 2011 through 2015 by Medicare Part D participants who filled prescriptions for WHO essential medicines. SETTING: US Medicare System. MAIN OUTCOME MEASURES: Total and per beneficiary Medicare spending, total and per beneficiary out-of-pocket patient spending, cumulative beneficiary count, claim count, and per unit drug cost. All spending measures were adjusted for inflation and reported in 2015 US dollars. RESULTS: Medicare Part D expenditures on 265 WHO essential medicines between 2011 and 2015 was $87.2bn (£68.4bn; €76.5bn), with annual spending increasing from $11.9bn in 2011 to $25.8bn in 2015 (116%). Patients' out-of-pocket spending for essential medicines over the same period was $12.1bn. Total annual out-of-pocket spending increased from $2.0bn to $2.9bn (47%), and annual per beneficiary out-of-pocket spending on these drugs increased from $20.42 to $21.17 (4%). Total prescription count increased from 376.1m to 498.9m (33%), and cumulative beneficiary count grew from 95.9m to 135.8m (42%). Of the essential medicines included in the study, the per unit cost of 133 (50%) agents increased faster than the average inflation rate during this period. Overall, approximately 58% of the increase in total spending during this period can be attributed to the introduction of novel agents. CONCLUSIONS: Spending associated with essential medicines grew substantially from 2011 to 2015, driven largely by the increased use of two expensive novel drugs used in treating hepatitis C. Approximately 22% of increased total spending during this period can be attributed to increases in per unit cost of existing drugs. These trends may limit patients' access to essential drugs while also increasing healthcare system costs.


Assuntos
Medicare Part D/economia , Medicare/economia , Organização Mundial da Saúde/economia , Custos de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Medicare/tendências , Medicare Part D/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde) , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
BMC Health Serv Res ; 19(1): 383, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196078

RESUMO

BACKGROUND: Previous studies have shown limited availability of medicines in health facilities in Bangladesh. While medicines are dispensed for free in public facilities, they are paid out-of-pocket in private pharmacies. Availability, price and affordability are key concerns for access to medicines in Bangladesh. METHODS: The World Health Organization/Health Action International survey methodology was used to determine price, availability and affordability of 61 lowest price generic (LPG) and originator branded medicines in public facilities, private retail pharmacies and private clinics across 6 regions of Bangladesh. Medicines for non-communicable and infectious diseases, and both on and off the national Essential Medicines List were included. Prices were compared internationally using Median Price Ratio (MPR). RESULTS: Mean LPG (originator brand) availability in the public sector, private retail pharmacies, and private clinics was 37%, 63 (4) percent, and 54 (2) percent, respectively. Medicines for Non-Communicable Diseases (NCD) and essential medicines were significantly less available than infectious disease medicines and non-essential medicines, respectively. Mean LPG (originator brand) MPR was 0.977 in the public sector, 1.700 (3.698) in private retail pharmacies and 1.740 (3.758) in private clinics. Six medicines were expensive by international standards across all sectors. The least affordable treatments in both private sectors were bisoprolol (hypertension), metformin (diabetes) and atorvastatin (hypercholesterolemia). CONCLUSION: Availability and affordability of NCD medicines are key concerns where the burden of NCD is rising. These findings show improvement from earlier studies, but room for further advances in availability and affordability of NCD medicines in Bangladesh. A small number of medicines are consistently expensive across sectors in Bangladesh, suggesting the need for strategies to address prices for certain medicines.


Assuntos
Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Organização Mundial da Saúde , Bangladesh , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/economia , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Inquéritos e Questionários
5.
Int J Equity Health ; 18(1): 89, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196109

RESUMO

BACKGROUND: Out-of-pocket (OOP) payments can constitute a major barrier for affordable and equitable access to essential medicines. Household surveys in Kyrgyzstan pointed to a perceived growth in OOP payments for outpatient medicines, including those covered by the benefits package scheme (the Additional Drug Package, ADP). The study aimed to explore the extent of co-payments for ADP-listed medicines and to explain the reasons for developments. METHODS: A descriptive statistical analysis was performed on prices and volumes of prescribed ADP-listed medicines dispensed in pharmacies during 2013-2015 (1,041,777 prescriptions claimed, data provided by the Mandatory Health Insurance Fund). Additionally, data on the value and volume of imported medicines in 2013-2015 (obtained from the National Medicines Regulatory Agency) were analysed. RESULTS: In 2013-2015, co-payments for medicines dispensed under the ADP grew, on average, by 22.8%. Co-payments for ADP-listed medicines amounted to around 50% of a reimbursed baseline price, but as pharmacy retail prices were not regulated, co-payments tended to be higher in practice. The increase in co-payments coincided with a reduction in the number of prescriptions dispensed (by 14%) and an increase in average amounts reimbursed per prescription in nearly all therapeutic groups (by 22%) in the study period. While the decrease in prescriptions suggests possible underuse, as patients might forego filling prescriptions due to financial restraints, the growth in average amounts reimbursed could be an indication of inefficiencies in public funding. Variation between the regions suggests regional inequity. Devaluation of the national currency was observed, and the value of imported medicines increased by nearly 20%, whereas volumes of imports remained at around the same level in 2013-2015. Thus, patients and public procurers had to pay more for the same amount of medicines. CONCLUSIONS: The findings suggest an increase in pharmacy retail prices as the major driver for higher co-payments. The national currency devaluation contributed to the price increases, and the absence of medicine price regulation aggravated the effects of the depreciation. It is recommended that Kyrgyzstan should introduce medicine price regulation and exemptions for low-income people from co-payments to ensure a more affordable and equitable access to medicines.


Assuntos
Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/economia , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Humanos , Quirguistão
7.
Rev Saude Publica ; 53: 50, 2019 May 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116239

RESUMO

OBJECTIVE: To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS: Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS: The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS: Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.


Assuntos
Medicamentos Essenciais/provisão & distribução , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Brasil , Orçamentos/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Alocação de Recursos para a Atenção à Saúde/economia , Equidade em Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Valores de Referência , Alocação de Recursos/economia , Fatores Socioeconômicos , Análise Espacial
9.
BMC Res Notes ; 11(1): 925, 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587231

RESUMO

OBJECTIVE: In national drug policies of many countries, ensuring availability and affordability of essential medicines is indicated among the major policy objectives. To achieve the objectives, countries with low and middle income compile such medicines into NEMLs. This study aims to determine availability and affordability of commonly prescribed antibiotics at a tertiary hospital in Ethiopia by assessing (in private and public pharmacies) 13 antibiotics constituting DU90% at the hospital. RESULTS: Availability of the antibiotics in the private and public pharmacies was 92.3% and 98.5%, respectively. Average MPRs for the antibiotics were 4.1 and 2.7, respectively, in the private and public pharmacies. The days' wages (in median prices) ranged from 0.2 for treating acute diarrhea with doxycycline to 415.8 for treating HAP in public pharmacies. Costs of a single day treatment with antibiotics purchased from the public pharmacies ranged from USD 0.1 for acute diarrhea to USD 29.7 for HAP. For the private pharmacies, the range was from USD 0.1 for toxoplasmosis to USD 54.9 for HAP. This study showed that treatments of commonly diagnosed infectious conditions at TASH remain unaffordable according to the WHO/HAI criteria.


Assuntos
Antibacterianos , Medicamentos Essenciais , Política de Saúde , Hospitais de Ensino/estatística & dados numéricos , Farmácias , Centros de Atenção Terciária/estatística & dados numéricos , Antibacterianos/economia , Antibacterianos/provisão & distribução , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Etiópia , Humanos , Farmácias/economia , Farmácias/provisão & distribução , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
10.
BMC Health Serv Res ; 18(1): 1013, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594189

RESUMO

BACKGROUND: China ranks first amongst the countries for the abuse of antibacterials. Essential antibacterials could help solve the problem. The aim of the work is to evaluate the availability, price and affordability of essential antibacterials in Hubei province, China. METHOD: The standardized methodology developed by the World Health Organization and Health Action International was used to collect data on the availability and prices of 16 antibacterials in 5 cities of Hubei province, China. RESULTS: First, in total, the median availability of originator brands and lowest-priced generics for the essential antibacterials was low, 3.0% (0.0, 18.2%) and 33.3% (0.0, 87.9%) for each, respectively. Second, the median price ratio of originator brands for the antibacterials was 20.30 (4.71, 35.80), while for generics, it was 0.49 (0.07, 1.18). Third, the affordability of originator brands for the antibacterials was 28.14 (21.70, 41.90) times the daily wages of an unskilled government worker, while for generics, the affordability was 0.35 (0.04, 6.11). Finally, we found that in Hubei province, lowest-priced generics for essential antibacterials with (fairly) high availability and relatively low price included Amoxicillin/Clavulanic Acid, Ceftazidime, Metronidazole, Gentamicin Sulfate and Ceftriaxone. CONCLUSION: The prices of lowest-priced generics for essential antibacterials in Hubei province were reasonable, and in tertiary hospitals the availability was the highest, while in secondary and primary hospitals, it was relatively lower. Originator brands were not only extremely expensive but also difficult to obtain. Measures should be taken to improve the availability of essential antibacterials and the affordability of originator brands.


Assuntos
Antibacterianos/economia , Prescrições de Medicamentos/economia , Medicamentos Essenciais/economia , Padrões de Prática Médica/estatística & dados numéricos , Antibacterianos/provisão & distribução , China , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana , Medicamentos Essenciais/provisão & distribução , Política de Saúde , Humanos , Padrões de Prática Médica/economia , Organização Mundial da Saúde
11.
Artigo em Inglês | MEDLINE | ID: mdl-30136662

RESUMO

The high cancer burden in the World Health Organization (WHO) South-East Asia Region represents not only a significant cause of death, disability and suffering but also a major threat to development. In 2015, the need for equitable access to cancer treatments was underscored by the addition of 16 cancer drugs to the 19th WHO model list of essential medicines, including three high-cost medicines. This paper explores strategies to improve access, including - but not limited to - managing costs through regional cooperation; coordinated procurement mechanisms; price controls; differential pricing; and licensing agreements. The composition of the region, with small and large pharmaceutical markets with a range of manufacturing capacities and supply-chain issues, offers a unique frame of comparison and consideration for access issues. Different approaches are needed that are tailored to specific country situations. However, in the absence of global collaborative funding mechanisms, the region can advocate now, with one voice, for regional action to improve the affordability and availability of essential cancer medicines and align national cancer-control strategies to leverage regional strengths. Delays will lead to more premature cancer deaths and more households in the WHO South-East Asia Region being impoverished through out-of-pocket payments for cancer medicines.


Assuntos
Antineoplásicos/provisão & distribução , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/organização & administração , Neoplasias/tratamento farmacológico , Antineoplásicos/economia , Ásia Sudeste , Custos de Medicamentos , Medicamentos Essenciais/economia , Política de Saúde , Humanos , Organização Mundial da Saúde
12.
Health Hum Rights ; 20(1): 93-105, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30008555

RESUMO

Uruguay has witnessed an ever-increasing number of domestic court claims for high-priced medicines despite its comprehensive universal coverage of pharmaceuticals. In response to the current national debate and development of domestic legislation concerning high-priced medicines, we review whether Uruguayan courts adequately interpret the state's core obligations to provide essential medicines and ensure non-discriminatory access in line with the right to health in the International Covenant on Economic, Social and Cultural Rights. Using a sample of 42 amparo claims for the reimbursement of medicines in 2015, we found that the circuits of appeal fail to offer predictable legal argumentation, including for nearly identical cases. Moreover, the judiciary does not provide an interpretation of state obligations that is consistently aligned with the right to health in the International Covenant on Economic, Social and Cultural Rights. These findings illustrate that medicines litigation in Uruguay offers relief for some individual claims but may exacerbate systemic inequalities by failing to address the structural problems behind high medicines prices. We recommend that the judiciary adopt a consistent standard for assessing state action to realize the right to health within its available resources. Moreover, the legislature should address the need for medicines price control and offer a harmonized interpretation of the right to health. These transformations can increase the transparency and predictability of Uruguay's health and legal systems for patients and communities.


Assuntos
Medicamentos Essenciais/provisão & distribução , Medicamentos Essenciais/normas , Acesso aos Serviços de Saúde/normas , Direitos Humanos/legislação & jurisprudência , Direitos do Paciente/normas , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Direitos do Paciente/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/normas , Uruguai
13.
Int J Pharm Pract ; 26(4): 364-368, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29732641

RESUMO

OBJECTIVE: In many low- and middle-income countries (LMICs), limited availability, substandard quality and high prices of pharmaceutical products lead to lack of access to essential medicines and poor health outcomes. Manufacturing pharmaceuticals in LMICs may improve access for patients while increasing the market size for manufacturers. METHODS: We present a tool for assessment of local manufacturing feasibility of pharmaceuticals, intended for use among key stakeholders during the business development process. The tool consists of five domains: product selection and capacity, market sizing, market entry, funding and quality assurance. KEY FINDINGS: The tool is intended to identify barriers and facilitators for local manufacturing and provide a roadmap for decision-making across multiple stakeholders. A case study in Namibia identified key barriers and facilitators to successful manufacturing in that county. CONCLUSIONS: Careful consideration of feasibility and potential for success may lead to improved health for the populations of LMIC as well as significant market potential for pharmaceutical manufacturers.


Assuntos
Tomada de Decisões Gerenciais , Países em Desenvolvimento , Custos de Medicamentos , Medicamentos Essenciais/economia , Tecnologia Farmacêutica/organização & administração , Técnicas de Apoio para a Decisão , Estudos de Viabilidade , Setor de Assistência à Saúde/organização & administração , Humanos , Tecnologia Farmacêutica/economia
14.
PLoS One ; 13(4): e0193513, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29621245

RESUMO

BACKGROUND AND PURPOSE: Drug costs is one of the main components of hospitalization expenditure for cerebral infarction inpatients. In China, the National Essential Medicine System (NEMS) was created to relieve the heavy drug-cost burden for patients. The objective of this study was to investigate essential drug-use status and its influencing factors among cerebral infarction inpatients in county-level hospitals of Anhui province, China. METHODS: Three county-level hospitals were selected through a multi-stage cluster random sampling method. The hospitalization cost data of cerebral infarction inpatients in the three hospitals were extracted from the Anhui provincial information platform of the New Rural Cooperative Insurance System (NCMS), and whether the proportion of essential drug cost in the total drug cost reached the median value of 33.05% which was set as the evaluation index for essential drug-use status. Questionnaires for hospitals and physicians were designed and given to them to assess influencing factors. RESULTS: We retrieved the cost data of 2,189 inpatients from the NCMS platform and investigated 51 corresponding physicians in total. The drug costs accounted for 52.6% of the total hospitalization cost, and essential drug costs alone accounted for 37.0% of the total drug costs. The essential drug-cost proportion was high among physicians with a higher recognition degree on NEMS, older age, lower final academic degree, longer work experience and lower professional title. Married physicians and those with tight organizational affiliation also prescribed more essential drugs. CONCLUSIONS: Increasing the proportion of essential drugs was an effective way to reduce the disease burden for cerebral infarction patients. Perfecting the NEMS, increasing government investment, reinforcing education and propaganda, and formulating relevant incentive and restrictive mechanisms were all effective ways to promote and increase the number of essential drug prescriptions written by physicians.


Assuntos
Infarto Cerebral/tratamento farmacológico , Medicamentos Essenciais/uso terapêutico , Idoso , Infarto Cerebral/economia , China/epidemiologia , Custos de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/economia , Feminino , Custos Hospitalares/estatística & dados numéricos , Hospitais de Condado/economia , Hospitais de Condado/estatística & dados numéricos , Humanos , Masculino , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Amostragem
15.
Health Policy Plan ; 33(4): 602-610, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29562286

RESUMO

The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013-15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a 'local health' policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health-industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with 'global health' frameworks but poses a challenge to some of its underlying assumptions.


Assuntos
Custos e Análise de Custo , Assistência à Saúde/economia , Indústria Farmacêutica/organização & administração , Medicamentos Essenciais/provisão & distribução , Programas Governamentais , Política de Saúde/economia , África Oriental , Comércio , Indústria Farmacêutica/economia , Medicamentos Essenciais/economia , Saúde Global , Acesso aos Serviços de Saúde , Humanos , Pobreza
16.
BMC Health Serv Res ; 18(1): 218, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587742

RESUMO

BACKGROUND: This study aimed to examine the availability, use, and affordability of medicines in urban China following the 2009 Health Care System Reform that included implementation of universal health coverage (UHC). METHODS: This longitudinal study was performed in Hangzhou (high income, eastern China) and Baoji (lower income, western China). Five yearly household surveys were conducted (one each year from 2009 to 2013) to evaluate the impact of UHC on medicines use and expenditure, and a health facility survey was conducted in 2013 to evaluate availability of medicines. A cohort of over 800 households in Hangzhou and Baoji was established in 2009, and 20 hospitals were included in the health facility survey. Medicines use was determined using data from health facility and household surveys. An average, two-week out-of-pocket medicines expenditure was calculated to assess the affordability of medicines. RESULTS: The number of medicines stocked in primary health facilities in Hangzhou decreased, while the number in Baoji increased. In Baoji, patients usually chose a pharmacy to buy medicines directly, despite the 48.2% increased availability of essential medicines in primary health care centers. The majority of survey respondents stated that their medicines need was basically met; however, medicines cost still accounted for a major part of their health expenditure. Medicines expenditure showed an increasing trend from 2009 to 2013. The average annual growth rate of household overall medical expenditure was significantly higher than that for household non-food consumption expenditure. CONCLUSIONS: Following China's Health Care System Reform and implementation of UHC, availability and use of medicines has improved in urban areas. However, the affordability of medicines is still a concern.


Assuntos
Tratamento Farmacológico/estatística & dados numéricos , Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Cobertura Universal do Seguro de Saúde , População Urbana , China , Medicamentos de Ervas Chinesas , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Pesquisa Empírica , Reforma dos Serviços de Saúde , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Farmácias , Atenção Primária à Saúde
17.
PLoS One ; 13(1): e0190855, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29338028

RESUMO

OBJECTIVE: To understand whether the increased outpatient service provision (OSP) brings in enough additional income (excluding income from essential medicine) for primary hospitals (INCOME) to compensate for reduced costs of medicine. METHODS: The two outcomes, annual OSP and INCOME for the period of 2008-2012, were collected from 34,506 primary hospitals in 2,675 counties in 31 provinces in China by the national surveillance system. The data had a four-level hierarchical structure; time points were nested within primary hospital, hospitals within county, and counties within province. We fitted bivariate five-level random effects regression models to examine correlations between OSP and INCOME in terms of their mean values and dose-response effects of the essential medicine policy (EMP). We adjusted for the effects of time period and selected hospital resources. FINDINGS: The estimated correlation coefficients between the two outcomes' mean values were strongly positive among provinces (r = 0.910), moderately positive among counties (r = 0.380), and none among hospitals (r = 0.002) and time (r = 0.007). The correlation between their policy effects was weakly positive among provinces (r = 0.234), but none at the county and hospital levels. However, there were markedly negative correlation coefficients between the mean and policy effects at -0.328 for OSP and -0.541 for INCOME at the hospital level. CONCLUSION: There was no evidence to suggest an association between the two outcomes in terms of their mean values and dose-response effects of EMP at the hospital level. This indicated that increased OSP did not bring enough additional INCOME. Sustainable mechanisms to compensate primary hospitals are needed.


Assuntos
Medicamentos Essenciais/economia , Economia Hospitalar , Política de Saúde/economia , China , Reforma dos Serviços de Saúde/economia , Pesquisas sobre Serviços de Saúde/economia , Recursos em Saúde/economia , Hospitais , Humanos , Modelos Econômicos , Avaliação de Resultados (Cuidados de Saúde)
18.
Eur J Clin Pharmacol ; 74(1): 131-138, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29063149

RESUMO

PURPOSE: Inappropriate use of medicines causes increased morbidity, mortality, adverse drug reactions, therapeutic failures and drug resistance as well as wastes valuable resources. Evidence-based cost-effective treatment recommendations of essential medicines are a way of avoiding these. We assessed primary care prescribers' knowledge about and perceptions of an essential medicines formulary, as well as the reasons for adhering to the recommendations. METHODS: We conducted a web based questionnaire survey targeting all physicians working in the primary healthcare of the Stockholm healthcare region (2.3 million inhabitants), regarding the knowledge of, attitudes to and usefulness of the essential medicines formulary of the Stockholm Drug and Therapeutics Committee, the so-called Wise List. RESULTS: Of the 1862 physicians reached by our e-mail invitations, 526 (28%) participated in the survey. All but one respondent knew of the formulary, and 72% used it at least once a week when prescribing. The main reason for using the formulary was evidence-based prescribing; 97% trusted the guidelines, and almost all (98%) found the content easy to understand. At the same time, many prescribers thought that the annual changes of some recommendations were too frequent, and some felt that a national formulary would increase its trustworthiness. CONCLUSIONS: We found that the essential medicines formulary was widely used and trusted by the prescribers. The high uptake of the treatment recommendations could be due to the Stockholm Drug and Therapeutics Committee's transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interest, feedback to prescribers, continuous medical education and minor financial incentives.


Assuntos
Prescrições de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/uso terapêutico , Comitê de Farmácia e Terapêutica , Médicos de Atenção Primária/normas , Guias de Prática Clínica como Assunto/normas , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Medicamentos Essenciais/economia , Alocação de Recursos para a Atenção à Saúde/economia , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e Questionários , Suécia
19.
Med Sante Trop ; 28(4): 351-354, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30799816

RESUMO

Access to drugs is a key element in the treatment of diabetes. Access remains an issue because of their price, availability, and especially affordability. Two elements included in the sustainable development goals - universal health coverage and partnerships - offer an opportunity to improve access.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde , Hipoglicemiantes/uso terapêutico , África , Humanos , Hipoglicemiantes/economia , Parcerias Público-Privadas , Cobertura Universal do Seguro de Saúde
20.
Pan Afr Med J ; 31: 174, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31086626

RESUMO

Introduction: Medicines are the most frequently used intervention in healthcare. Rational and cost-effective prescribing is especially important in countries where access to effective medicines may be challenged by affordability issues. This study describes the prescribing patterns of doctors in government hospitals in Freetown, Sierra Leone, considering the scope for rationalising prescribing and reducing cost to the patient. Methods: A descriptive, retrospective, cross-sectional study was conducted at four hospitals, using selected World Health Organisation (WHO) indicators applied to 600 prescriptions, after systematic random sampling. The data was analysed using SPSS.16 and the Index of Rational Drug Prescrib-ing (IRDP) calculated. The Spearman's rank coefficient was used to examine possible associations between the number of medicines prescribed as generics and from the National Essential Medicines List (NEML) and cost of the prescription respectively. Affordability was determined from the average number of days of work required to purchase a prescription, based on the minimum wage of the lowest paid government worker in Sierra Leone. Results: The mean number of medicines per prescription from the four hospitals was 4.37(range 4.18-4.56) with 57% prescribed generically and 64% from the NEML. An antibiotic and injection were found on 72% and 26% of prescriptions respectively. The overall IRDP was 2.65/5. The aver-age cost per prescription was Le. 29,376.30 ($6.78), equivalent to 43 days of work of the lowest paid government worker. Conclusion: In this study, opportunities were identified for significant rationalisation and improvement in cost-effective prescribing.


Assuntos
Medicamentos Essenciais/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Criança , Análise Custo-Benefício , Estudos Transversais , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Padrões de Prática Médica/normas , Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Serra Leoa , Adulto Jovem
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