Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova

Ferrario, Alessandra; Chitan, Elena; Seicas, Rita; Sautenkova, Nina; Bezverhni, Zinaida; Kluge, Hans; Habicht, Jarno

doi:10.1093/heapol/czv136

Cited by 7 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar survey in Republic of Moldova found that 1.85 working days for lowest income people are needed to purchase 1 month of cardiovascular disease treatment in 2006 and 0.84 days in 2013. Introduction of mandatory health insurance increased the affordability, as well as the raising household incomes [36]. We can comment that according to our results the affordability is much better in Bulgaria and Ukraine comparison with above studies but if generic alternatives are used.…”

Section: Discussionsupporting

confidence: 50%

Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria

Tkachova

Яковлєва

Mitkova

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThe statins are а developing group of cardiovascular medicines, widely used for dyslipidemia. As a whole statins consumption leads to reduction in cardiovascular events and death, and improves the disease control. The main study issue considers the differences in an affordability to lipid lowering medicines in the countries with the highest morbidity and mortally rate within and outside EU. The affordability has been researched by exploring the price differences and average wages.MethodsOn total 7 international nonproprietary names and 19 dosage forms available on both markets are observed during 2013–2016. An average, minimum, and maximum retail prices per DDD, standard deviation (SD) has been calculated for all marketed dosage forms. A price ratio between the minimal and maximal price per DDD is estimated in order to evaluate their difference. Affordability of the treatment is determined as the number of working hours per month needed for patient to purchase medicines for a monthly therapy.ResultsLarge variations of price per DDD, SD and the average price exist between different dosage forms in both countries. The highest value of a price ratio is observed for 5 mg rosuvastatin in Bulgaria and 10 mg rosuvastatin in Ukraine.The number of working hours needed to cover monthly therapy has increased during 2013–2016 in Ukraine. The most affordable is treatment with a generic atorvastatin in Bulgaria and generic rosuvastatin in Ukraine. The most expensive rosuvastatin in Bulgaria and atorvastatin in Ukraine are found as the least affordable for a monthly therapy.ConclusionsThe decrease of prices for statins is not the only reason influencing patients’ affordability to therapy for statin therapy in Ukraine and Bulgaria. The difference in affordability in Ukraine and Bulgaria is affected mainly by the economic development in the country as well as wages variation.

show abstract

Section: Discussionsupporting

confidence: 50%

Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria

Tkachova

Яковлєва

Mitkova

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Second, costs for medicines and services could be reduced by: i) introducing regulations to prevent informal payments and to regularise formal cost–sharing [28]; ii) increasing, through allocated funding and legal powers, the powers of the Moldovan Medicines and Medical Devices Agency (MMDA) and CNAM, in procuring medicines, negotiating prices, and regulating quality, to reduce costs for those who purchase drugs and the cost burden of medicines in the benefit package [23,29]; iii) strengthening the provision of PHC, where the majority of health needs can be dealt with cost–effectively, in resource allocations for both services and medicines [28]. …”

Section: Discussionmentioning

confidence: 99%

Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments

Hone¹,

Habicht²,

Domente³

et al. 2016

Journal of Global Health

Self Cite

View full text Add to dashboard Cite

BackgroundMoldova is the poorest country in Europe. Economic constraints mean that Moldova faces challenges in protecting individuals from excessive costs, improving population health and securing health system sustainability. The Moldovan government has introduced a state benefit package and expanded health insurance coverage to reduce the burden of health care costs for citizens. This study examines the effects of expanded health insurance by examining factors associated with health insurance coverage, likelihood of incurring out–of–pocket (OOP) payments for medicines or services, and the likelihood of forgoing health care when unwell.MethodsUsing publically available databases and the annual Moldova Household Budgetary Survey, we examine trends in health system financing, health care utilization, health insurance coverage, and costs incurred by individuals for the years 2006–2012. We perform logistic regression to assess the likelihood of having health insurance, incurring a cost for health care, and forgoing health care when ill, controlling for socio–economic and demographic covariates.FindingsPrivate expenditure accounted for 55.5% of total health expenditures in 2012. 83.2% of private health expenditures is OOP payments–especially for medicines. Healthcare utilization is in line with EU averages of 6.93 outpatient visits per person. Being uninsured is associated with groups of those aged 25–49 years, the self–employed, unpaid family workers, and the unemployed, although we find lower likelihood of being uninsured for some of these groups over time. Over time, the likelihood of OOP for medicines increased (odds ratio OR = 1.422 in 2012 compared to 2006), but fell for health care services (OR = 0.873 in 2012 compared to 2006). No insurance and being older and male, was associated with increased likelihood of forgoing health care when sick, but we found the likelihood of forgoing health care to be increasing over time (OR = 1.295 in 2012 compared to 2009).ConclusionsMoldova has achieved improvements in health insurance coverage with reductions in OOP for services, which are modest but are eroded by increasing likelihood of OOP for medicines. Insurance coverage was an important determinant for health care costs incurred by patients and patients forgoing health care. Improvements notwithstanding, there is an unfinished agenda of attaining universal health coverage in Moldova to protect individuals from health care costs.

show abstract

“…Nowadays, there is a special focus on the accessibility and affordability of medicines in different international programs such as Millennium Development Goals (MDGs), Sustainable Development Goals (SDGs), and WHO health system building blocks [14]. On the other hand, the treatment of CVDs is highly dependent on medications [15], and access to good-quality and affordable CVDs drugs was considered in some previous studies [16][17][18][19][20]. In addition, there is an expanded focus on assuring that individuals are secure against financial risks related to the accessing of healthcare, especially in LMICs [21], because households in LMICs bear a significant financial burden, considering that each one of the two government funding and health insurance contributions is inadequate to address the healthcare needs of households.…”

Section: Introductionmentioning

confidence: 99%

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

Zarei

Karimzadeh

Moradi

et al. 2020

IJERPH

View full text Add to dashboard Cite

The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.

show abstract

Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova

Cited by 7 publications

References 16 publications

Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria

Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria

Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

Contact Info

Product

Resources

About