TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Matthew Jowett, PhD Senior Health Financing Specialist Dept. Health Systems Governance & Financing WHO Geneva 29 th October 2013 Health financing policy, medicines and universal health coverage TBS Seminar on Essential Medicines and Health Products
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Health financing policy, medicines and universal health coverage
TBS Seminar on Essential Medicines and Health Products. Health financing policy, medicines and universal health coverage. Matthew Jowett, PhD Senior Health Financing Specialist Dept. Health Systems Governance & Financing WHO Geneva 29 th October 2013. Financial protection - PowerPoint PPT Presentation
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TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Matthew Jowett, PhDSenior Health Financing Specialist
Dept. Health Systems Governance & Financing WHO Geneva
29th October 2013
Health financing policy, medicines and universal health coverage
TBS Seminar on Essential Medicines and Health Products
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Universal health coverage goals
Three dimensions interlinked
Evidence from European Region
Instruments in support of UHC
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Universal health coverage goalsEquity in service
use(reduce gap between need and utilization)
Quality of services(sufficient to improve
health)
Financial protection(no-one becomes poor as a result of paying
for care)
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
3 dimensions of health care coverage
Equity in service useQuality
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Moldova 2007Population enrolment in national health insurance scheme
- Informal sector / non-wage- Below the official poverty line- Fully subsidized insurance contributions shared between
local and national government
- Informal sector / non-salaried- Above the official poverty line- Voluntary contributions with no subsidy
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
.
<0.51
23
45
67
89
1011
Per
cent
age
of h
ouse
hold
s w
ith c
atas
troph
ic h
ealth
exp
endi
ture
0 10 20 30 40 50 60 70 80 90Out-of-pocket payments as a percentage of total health expenditure
Low Low-middle Upper-middle High
Catastrophic health expenditure and out-of-pocket payments by country income
Financial coverage dimension
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Insurance effect? Moldova…..
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Georgia - outpatient medicines drives OOPs
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
More (public) money for healthPublic spending crowds displaces out-of-pocket payments
More health for the money……Ref: World Health Report 2010, Chapter 4
Medicines: under-use of generics and higher than necessary prices
Medicines: use of sub-standard and counterfeit medicines
Medicines: in appropriate and ineffective use
Services: inappropriate hospital size (low use of infrastructure)
Services: medical errors and sub-optimal quality of care
Services: inappropriate hospital admissions and length of stay
Services & products: oversupply and overuse of equipment, investigations and procedures
Health workers: inappropriate or costly staff mix, unmotivated workers
Interventions: inefficient mix / inappropriate level of strategies
Leakages: waste, corruption, fraud
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Estimated average (median) retail mark-ups: Georgia and selected EU countries
102%
35%
46%
27%
49%
32%
0%
20%
40%
60%
80%
100%
120%
Georgia Czech Rep. Greece Hungary Italy Poland
% m
argi
n
CountrySource: CIF/WB survey and OBIG
EU price source: OBIG/PPRI
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Affordability of standard treatments as % of minimum subsistence allowance
24% 22%
4%
61%
12%7%
2%
13%
0%
10%
20%
30%
40%
50%
60%
70%
Peptic ulcer ARI Hypertension Arthritis
Brand
Generic
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Portugal - May 2011
• Set the maximum price of the first generic introduced in the market to 60% of the branded product with similar active substance; revise reference-pricing system based on international prices
Pricing and reimbursement of pharmaceuticals
• Electronic prescription for medicines & diagnostic covered by public reimbursement compulsory for physicians in public and private sector; improve monitoring system of prescription and set in place a systematic assessment by individual doctor in terms of volume and value; induce physicians at all levels of the system, public & private, to prescribe generic medicines & the less costly available branded product; establish clear rules for the prescription & complementary diagnostic exams (prescription guidelines for physicians); remove entry barriers for generic medicines.
Prescription and monitoring
prescription• Change the calculation of profit margin into a regressive mark-up and a
flat fee for wholesale companies and pharmacies; ensures a reduction in public spending and encourage the sales of less expensive pharmaceuticals; lower profits will contribute at least 50M€ to the reduction in public expense with drugs distribution. If this does not produce the expected savings in the distribution profits, introduce a pay-back scheme.
Pharmacies sector
• Set up centralized procurement system for purchase of medical goods, to reduce costs and waste; finalize coding system and common registry for medical supplies; take measures to increase competition among private providers and reduce by at least 10% overall NHS spending with private providers delivering diagnostic and therapeutical services by end 2011 and by an additional 10% by end 2012; introduce regular revision of fee s paid to private providers to reduce cost of more mature diagnostic & therapeutical services; assess compliance with European competition rules.
Centralized purchasing and
procurement
TBS Seminar on Essential Medicines and
Health ProductsGeneva, 29 October 2013
Some instruments to support UHC
Spend on cost-effective public health interventions