Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan

The role of insurance policies in the drug pricing landscape

INTRODUCTION

This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria - Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France.

AREAS COVERED

In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care.

EXPERT OPINION

In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed - from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.

Exploring the Efficiency of Primary Health Care Provision in Rural and Sparsely Populated Areas: A Case Study from Mongolia

Mongolia is facing serious challenges in the health sector and the macro-economic sphere that have important implications for health financing and to complete universal health coverage. In this context, improving the efficiency of primary health care facilities appears as a critical issue. We study the efficiency of Soum Health Centres (SHCs), that provide primary care in rural Mongolia. Based on activity and resources data collected for all SHCs of Mongolia in 2017 and 2018 we estimate bias-adjusted efficiency scores. A double bootstrap truncated regression procedure is then used to study the factors associated with SHCs’ efficiency. On average, SHCs could potentially engage in the same activity while reducing overall resource use by around 23%. A comparatively higher population density and dependency ratio in the district where they are located tend to favour SHCs’ efficiency. Conversely, the higher the poverty rate in the soum, the lower the efficiency. We find a positive association between SHCs’ efficiency and the proportion of doctors in the health workforce. The human resources allocation process and the capitation formula currently used to pay SHCs should be adjusted based on the size and socioeconomic/demographic characteristics of the population living in the catchment area of SHCs.