Objectives: The present study was aimed to investigate the availability and price of essential medicines in both public and private health facilities in Indonesia. Methods: The cross-sectional study was carried out using the World Health Organization (WHO) and Health Action International (HAI) methodology. Availability data for 50 medicines of global, regional, and supplementary list of medicines was collected from six health facilities, consisted of public and private hospitals and retail pharmacies in Yogyakarta region. Medicine price ratios were calculated using international reference prices (IRPs). Results: The mean availability of generic essential medicines in public healthcare facilities and private sectors was 76.6% and 60.58%, respectively. Availability of generic medicines was much higher in the public sector. Four medicines had zero availability were atenolol tablet, enalapril tablet, beclometason inhaler, and clotrimazole topical cream. The procurement price in public sector was 0.98, while in private sector was 2.46 times the IRP. Findings of Median MPR of lowestpriced generic (LPG) in the private sector for ceftriaxone was 5.64, ranitidine was 4.35, and salbutamol was 4.19 times higher than international price. In public health facilities, ceftriaxone injection was 2.19 times compared to international price. Conclusions: This study revealed that availability of essential medicines was inadequate, but procurement prices of surveyed medicines were considered efficient, especially in public sector. However, variation in procurement prices of selected medicines was noted. These evidences impose significant policy implications that could help in formulating policies to optimize the access to essential medicines for patients.
Purpose: The purpose of this study is to confirm how the income level of the family caregivers for recipients in long-term care (LTC) facilities are related to family caregivers’ willingness to pay out-of-pocket payments for better LTC services. Methods: This study used the 2021 survey data on cost sharing in LTC facilities, which surveyed 1,111 family caregivers of recipients. To analyze the effect of the income level of family caregivers on the willingness to pay out-of-pocket payments for better LTC services, a chi-square test, a Cochran-Mantel-Haenszel test, and a logistic regression analysis were performed. Results: We found that 39.0% of respondents were willing to pay out-of-pocket payments if better services were available to recipients. Adjusted for recipient’s and family caregivers’ variables, characteristics of out-of-pocket payment, and LTC service use, the willingness to pay in the monthly household income level of 5 million won and more was 3.28 times higher than those in the monthly household income level of less than 1 million won (95% confidence level=1.93~5.55, p<.001). As monthly household income rises, the odds ratio of willingness to pay tended to increase (p<.001). Conclusion: Family caregivers who bear the out-of-pocket payments of LTC facilities are willing to pay more for better LTC services. In addition, the higher the income level of family caregivers, the higher their willingness to pay. A full-scale review of the system reform is needed to prevent out-of-pocket payments from becoming an economic barrier to service users and to contribute to service quality improvement and financial stability.
A73scheme, prices of brand-name and generic drugs are to be set to the same level after the patent expires. METHODS: The data used for this study were extracted from the National Health Insurance Claims database. We established a monthly panel dataset pertaining to pharmaceutical consumption between January 2011 and June 2013 (30 months). Proxies of market competition were considered as dependent variables such as price dispersion, market share of originators and relative ratio of utilization (originator/generics). Independent variables including policy effect, number of generic drugs, vintages of the first generic drugs, month for new generic entry and market value. RESULTS: The new pricing policy has resulted in no competition mechanism. Rather the policy shows more favorable to originators than generic drugs. Price dispersion has significantly decreased to 0.92 after the new pricing regulations. Market share of the originators has not significantly changed. However, originator-to-generic utilization ratio significantly increased to 6.12 (p< 0.001) after the new policy. This study offers different results to the government's intention. CONCLUSIONS: Price competition cannot be successfully achievable unless demand-side measures are combined. To lower prices, the bigger market share should be delivered through demand-side measures such as the reference pricing or compulsory substitution to lowest drugs applied in some European countries.
(NHIS) introduced the RSA (Risk Sharing Agreement) to ensure patient access to new drugs while holding the pharmaceutical industry responsible for the part of financial burden that could arise from uncertain performance of the drug. Only the prescription drugs indicated for cancer and rare diseases were eligible for the RSA. We aimed to document the outcomes of the RSA to inform the stakeholders of potential changes for cost-effective implementation of RSA. Methods: All the RSAs that the NHIS has finalized until June 1, 2019 were included. They were classified in terms of agreement type, indication, drug class (ATC 5 category), and the origin of the agreement holder. The agreement type was budget cap, fixed amount refund per unit sold and CED (Coverage with Evidence Development). The origin of the agreement holder was either domestic or global. The outcomes of RSA were examined in terms of adoption rates and post-implementation events. Results: As of June 1, 2019, there were 39 RSAs with 4 (10.3%) being expired. Expenditure cap had the highest share (46.2%), followed by refund type (33.3%). The CED (coverage with evidence development) had the lowest share (2.6%). The majority of the drugs had an indication of cancer (71.8%). Most of the RSAs were originated by global companies (82.1%). As for the RSA outcomes, while CED was viewed most desirable, it no longer existed at the end of the study period. As for the expenditure cap RSAs, no RSA exceeded the cap regardless the drug class. Conclusions: The result of this study inform the policy makers of the importance in determining the advantages and disadvantages of RSAs for different types as the pharmaceutical industry demands RSAs for more indications other than cancer and rare conditions.
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