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Cherfane M, Boueri M, Issa E, Abdallah R, Hamam A, Sbeity K, Saad A, Abi-Gerges A. Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension. BMC Public Health 2024; 24:628. [PMID: 38413883 PMCID: PMC10900622 DOI: 10.1186/s12889-024-18116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. METHODS An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. RESULTS The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). CONCLUSION Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.
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Affiliation(s)
- Michelle Cherfane
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie- Liban), Beirut, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Elio Issa
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Racha Abdallah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Ali Hamam
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Kassem Sbeity
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Anthony Saad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon.
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Farantos GI, Koutsoukis NS. The influence of SYRIZA-ANEL Greek health policies on hospital efficiency. Health Res Policy Syst 2023; 21:83. [PMID: 37608268 PMCID: PMC10463923 DOI: 10.1186/s12961-023-01032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND We analyse the impact of the three following categories of Health Policies (HP) carried out by the Greek SYRIZA-ANEL governments on the efficiency of Greek public general hospitals. These governments have implemented policies intended to change the rate of contributions to publicly funded healthcare (PCnH), policies to affect the volume and quality of publicly funded health care (PVQH) and those intended to affect the costs of publicly funded healthcare (PCH). A literary review of the PCnH. PVQH and PCH policies of the Greek SYRIZA-ANEL governments was carried out and an efficiency window-DEA study was executed using data from the Ministry of Health (MoH) and the Greek Statistical Authority (ELSTAT). METHODS The study was designed to assess the impact of PCnH. PVQH and PCH policies by the Greek SYRIZA-ANEL governments on the efficiency of Greek general hospitals. The data was collected from HEAL-Link scientific journals. Information on HPs was extracted from the work collected. The values of inputs and outputs used for the efficiency study were obtained from ELSTAT and Greek MoH databases. RESULTS HPs of the Greek SYRIZA-ANEL governments extend to all three HP categories of the sample used. These policies have a dual effect on both the inputs and outputs used in efficiency. Efficiency values exhibit fluctuations with good and bad years. The SYRIZA-ANEL governments seek to ensure more equality in access to health services. Some of the policies reduce costs and have a positive impact on efficiency, while others have the opposite effect. The increase in outputs achieved as a result of health policies is counter balanced by an increase in inputs. CONCLUSIONS The PCnH, PVQH and PCH policies of the SYRIZA-ANEL governance seem to have a dual orientation: some policies reduce the cost of a category and contain the total cost, thus positively contributing to an increase in efficiency. Certain policies are aimed more at fulfilling the criterion of equality in the provision of health services and thus the cost inevitably increases. From the window-DEA study, three relatively "good" years emerge (2015, 2016, 2018) and two "bad years" (2017, 2019). This analysis will be useful for further research on the effect of health policies on hospital efficiency in other countries and periods.
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Wang X, Huang H, Sun Y, Zhu Z, Jiang B, Yang L. Effects of volume-based procurement policy on the usage and expenditure of first-generation targeted drugs for non-small cell lung cancer with EGFR mutation in China: an interrupted time series study. BMJ Open 2023; 13:e064199. [PMID: 37407064 DOI: 10.1136/bmjopen-2022-064199] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES In December 2018, China launched national volume-based procurement (NVBP) to negotiate drug prices with manufacturers. Gefitinib was one of the 25 pilot drugs, which is used for treatment of non-small cell lung cancer. Lung cancer is the most common type of cancer in China and targeted drugs like gefitinib have been proven to provide clinical benefits to patients. This study aims to explore the impact of NVBP policy on the usage and expenditure of anticancer drugs. METHODS Gefitinib and alternative drugs (icotinib and erlotinib) were used as objects of study. Quarterly data from the China Hospital Pharmaceutical Audit database in 9454 hospitals in China were used for analysis. Descriptive analysis was conducted using purchase volume and expenditure as variables. Interrupted time-series (ITS) analysis was applied to further analyse the effect of NVBP policy on the medicines under study. RESULTS During the 12-month period before (2018Q2-2019Q1) and after (2019Q2-2020Q1) the NVBP policy, the total purchase volume of medicines rose from 4.48 million defined daily dose (DDD) to 7.02 million DDD, with an increase of 56.66%. Purchase volume of gefitinib and alternative drugs increased 100.61% and 14.88%, respectively. After the implementation of NVBP policy, procurement volume of alternative drugs decreased by 72 051 DDD (p value=0.044) and trend change decreased by 56 738 DDD (p value<0.01). The overall expenditure reduction was 14.7%, with the expenditure of gefitinib reducing by 38.47% and alternative drugs increasing by 10.70%. ITS analysis indicated statistically significant differences in level and trend changes for expenditure of total drugs and gefitinib. CONCLUSIONS The evidence provided in this study indicated that the implementation of NVBP policy was related to the expenditure reduction of the first generation of anti-EGFR lung cancer drugs. The policy effectively controlled the increase in expenditures for corresponding drugs while ensuring the use of drugs.
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Affiliation(s)
- Xiaoyang Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Huang Huang
- Public Policy Research Center, Peking University, Beijing, China
| | - Yan Sun
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Bin Jiang
- Public Policy Research Center, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Li Yang
- School of Public Health, Peking University Health Science Center, Beijing, China
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Fleming P, Caffrey L, Belle SV, Barry S, Burke S, Conway J, Siersbaek R, Mockler D, Thomas S. How International Health System Austerity Responses to the 2008 Financial Crisis Impacted Health System and Workforce Resilience - A Realist Review. Int J Health Policy Manag 2022; 12:7420. [PMID: 37579453 PMCID: PMC10125082 DOI: 10.34172/ijhpm.2022.7420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. METHODS A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. RESULTS Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. CONCLUSION This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | | | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Jacki Conway
- Everlake, 5 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - David Mockler
- Library Reader Services, Trinity College Dublin, The University of Dublin, St James Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Theodorou M, Kontemeniotis A, Kantaris M, Farmakas A. Disentangling prescribing behaviour of Cypriot physicians, within a complex framework of interacting. Int J Health Plann Manage 2022; 37:2410-2420. [PMID: 35429061 PMCID: PMC9545336 DOI: 10.1002/hpm.3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/23/2021] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of the study is to investigate how physicians' prescribing behaviour in Cyprus adopts to the fragmented healthcare system and to the inadequacies of pharmaceutical market in times of economic crisis. A survey was carried out in using a postal questionnaire administered to a stratified sample of 320 physicians. The questionnaire used was the same with the one used in 2007 survey carried out in Greece and Cyprus, along with complementary questions for prescribing within economic crisis. The comparative analysis and assessment of the findings from the two surveys revealed that the current system and the inadequacies of pharmaceutical market in Cyprus expose physicians to a contrasting environment of public and private sector in terms of incentives, governance principles, financing and market structure. In contrast to public sector prescribers who have behaved in accordance with the governance principles, there is a strong motivation for private sector physicians to favour new branded products, and generally rejecting any ideas that could limit their clinical autonomy. Economic crisis seems to be unilaterally influential, as public sector physicians became more cost conscious while private sector prescribing is still resisting due to strong financial incentives. Prescribing behaviour of physicians in Cyprus amid economic crises. Pressures by patients, policy makers and pharma companies shape prescribing behaviour. Disentangling prescribing behaviour could lead to the revelation of opportunities for improvements. Differential prescribing could justify that decision‐making might be compromised for economic reasons.
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Affiliation(s)
| | | | - Marios Kantaris
- Health and Social Services Research Centre American University of Cyprus Larnaca Cyprus
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Olyaaeemanesh A, Jaafaripooyan E, Abdollahiasl A, Davari M, Mousavi SM, Delpasand M. Pharmaceutical subsidy policy in Iran: a qualitative stakeholder analysis. Health Res Policy Syst 2021; 19:150. [PMID: 34949207 PMCID: PMC8697451 DOI: 10.1186/s12961-021-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Over the past three decades, allocation of foreign currency subsidies has been the primary strategy of various administrations in Iran to improve access to medicines. This strategy has resulted in several challenges, including stakeholder conflicts of interest. OBJECTIVE To identify the power, interest, and role of the stakeholders in allocating foreign currency subsidies to medicines in the Iranian health system. METHODS In this qualitative study, 39 semi-structured interviews were conducted. Key informants were recruited using a purposive sampling technique. The theoretical framework adopted by Varvasovszky and Brugha was employed. The data were analysed using directed content analysis. RESULTS The foreign currency subsidy for medicines included 21 stakeholders in five main categories: governmental organizations, Iranian Parliament, general population, nongovernmental organizations (NGOs), and the pharmaceutical industry. Stakeholders varied in their level of participation and support in the policy-making process. Among them, the Iranian Government, Planning and Budget Organization, the Ministry of Health and Medical Education (MoHME), and Iran Food and Drug Administration (IFDA) were the most important stakeholders, with highly supportive positions, while domestic drug manufacturers were the strongest opponents of this policy. The Government of Iran is the most powerful institution with regard to the ability to allocate foreign currency subsidies to medicines, followed by the MoHME and the IFDA. CONCLUSION This study demonstrated that identifying and analysing the stakeholders involved in allocating foreign currency subsidies to medicines can provide valuable information for policy-makers to enable a more comprehensive understanding and better capacity to determine whether or not to eliminate these subsidies. Moreover, decision-making in this process is a long-term issue that requires consensus among all stakeholders. Because of the political and social consequences of eliminating foreign currency subsidies, the necessary political will is not institutionalized. We recommend a step-by-step approach in eliminating foreign currency subsidies if the requirements are met (i.e., those related to the consequences of such interventions). Therefore, revision of the current policy along with these requirements, in addition to financial transparency and enhanced efficiency, will facilitate progress towards achieving the Sustainable Development Goals by improving access to medicines.
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Affiliation(s)
- Alireza Olyaaeemanesh
- Health Equity Research and National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Abdollahiasl
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Health Foresight and Innovation Research Center, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Delpasand
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Social security organization, Tehran, Iran
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Bonanno L. The Work of Pharmaceuticals in Austerity-Burdened Athens. Modes and Practices of Care in Times of Crisis. ETHNOS 2021. [DOI: 10.1080/00141844.2021.2013282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chen L, Yang Y, Luo M, Hu B, Yin S, Mao Z. The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249415. [PMID: 33334027 PMCID: PMC7765443 DOI: 10.3390/ijerph17249415] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023]
Abstract
In 2019, the Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China, in which 25 drugs were included. We conducted this study to examine the impacts of NCDP policy on drug utilization and expenditures, and to clarify the main factors contributing to drug expenditure changes. This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019. Drugs related to the “4 + 7” policy were selected as study samples, including 23 “4 + 7” policy-related varieties and 15 basic alternative drugs. Driving factors for drug expenditures changes were analyzed using A.M. index system analysis (Addis A. & Magrini N.’ method). After the implementation of the NCDP policy, the volume of “4 + 7” policy-related varieties increased by 73.8%, among which winning products jumped by 1638.2% and non-winning products dropped by 70.8%; the expenditures of “4 + 7” policy-related varieties decreased by 36.9%. Structure effects (0.47) and price effects (0.78) negatively contributed to the increase in drug expenditures of “4 + 7” policy-related varieties, while volume effects (1.73) had positive influence. NCDP policy successfully decreased drug expenditures of “4 + 7” policy-related varieties with structure effects playing a leading role. However, total drug expenditures were not effectively controlled due to the increasing use of alternative drugs.
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Affiliation(s)
- Lei Chen
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Ying Yang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Mi Luo
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Borui Hu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Shicheng Yin
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-6875-9118
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Patsourakos NG, Kouvari M, Kotidis A, Kalantzi KI, Tsoumani ME, Anastasiadis F, Andronikos P, Aslanidou T, Efraimidis P, Georgiopoulos A, Gerakiou K, Grigoriadou-Skouta E, Grigoropoulos P, Hatzopoulos D, Kartalis A, Lyras A, Markatos G, Mikrogeorgiou A, Myroforou I, Orkopoulos A, Pavlidis P, Petras C, Riga M, Skouloudi M, Smyrnioudis N, Thomaidis K, Tsikouri GE, Tsikouris EI, Zisimos K, Vavoulis P, Vitali MG, Vitsas G, Vogiatzidis C, Chantanis S, Fousas S, Panagiotakos DB, Tselepis AD. The incidence of recurrent cardiovascular events among acute coronary syndrome patients treated with generic or original clopidogrel in relation to their sociodemographic and clinical characteristics. The Aegean study. Arch Med Sci 2020; 16:1013-1021. [PMID: 32863989 PMCID: PMC7444691 DOI: 10.5114/aoms.2020.95878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of generic drugs is continuously growing; however, there are limited epidemiological data regarding the therapeutic equivalence of each original drug formulation with its generic counterparts. We evaluated the 12-month composite endpoint of recurrent acute myocardial infarction, ischaemic stroke, cardiac deaths, or hospitalisation due to a major bleeding in acute coronary syndrome (ACS) patients treated with original clopidogrel or a generic clopidogrel formulation, in relation to sociodemographic and clinical characteristics. MATERIAL AND METHODS Consecutive Greek ACS patients (n = 1194) hospitalised in the Aegean islands and the Attica region were enrolled. Clopidogrel treatment was recorded either as original clopidogrel hydrogen sulphate (Plavix®/Iscover®) or as a generic clopidogrel besylate formulation (Clovelen®). The composite endpoint was recorded at 12-month follow-up. RESULTS The 12-month composite endpoint was 3.9% (4.6% in the Aegean islands and 3.5% in the Attica area, p > 0.05). The respective incidence in men was 4.0% and in women 3.8% (p > 0.05). Overall, generic and original clopidogrel use was 87% and 13% of patients, respectively. No significant differences were observed between original and generic clopidogrel use and 12-month composite endpoint incidence. Subgroup analysis with gender, region of residence, and clinical and lifestyle factors as strata did not reveal any significant outcomes. Haemorrhage incidence did not exceed 1% in the total sample. CONCLUSIONS The use of a generic clopidogrel besylate formulation was quite high in both urban and insular areas of Greece and had similar efficacy and safety profile with the original clopidogrel salt, supporting the routine use of this low-cost generic clopidogrel in the management of cardiovascular disease patients.
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Affiliation(s)
| | - Matina Kouvari
- School of Health Science and Education, Harokopio University of Athens, Athens, Greece
| | | | | | - Maria E. Tsoumani
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | - Theano Aslanidou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Petros Efraimidis
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | - Kalliopi Gerakiou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | | | - Athanasios Kartalis
- Cardiology Department, ‘Skylitseio’ General Hospital of Chios, Chios, Greece
| | - Anastasios Lyras
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Gerasimos Markatos
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Myroforou
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Anestis Orkopoulos
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Pavlos Pavlidis
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Charalampos Petras
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Maria Riga
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Marina Skouloudi
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | - George Vitsas
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | | | | | - Stefanos Fousas
- Cardiology Department, Tzaneio Hospital of Piraeus, Piraeus, Greece
| | - Demosthenes B. Panagiotakos
- School of Health Science and Education, Harokopio University of Athens, Athens, Greece
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
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Tsakalogiannis C, Karampli E, Athanasakis K, Kyriopoulos J. The role of Health Technology Assessment in pharmaceutical policy decision‐making in Greece. Findings from a qualitative study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Eleftheria Karampli
- Department of Health Economics National School of Public Health Athens Greece
| | - Kostas Athanasakis
- Department of Health Economics National School of Public Health Athens Greece
| | - John Kyriopoulos
- Department of Health Economics National School of Public Health Athens Greece
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Holtorf AP, Gialama F, Wijaya KE, Kaló Z. External Reference Pricing for Pharmaceuticals-A Survey and Literature Review to Describe Best Practices for Countries With Expanding Healthcare Coverage. Value Health Reg Issues 2019; 19:122-131. [PMID: 31416014 DOI: 10.1016/j.vhri.2019.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Countries with expanding healthcare coverage (CEHCs) increasingly use external reference pricing (ERP) for pharmaceuticals. The ERP policies must aim to optimize efficiency, minimize disturbances, and maximize access to effective therapies for all patients. OBJECTIVE This research aims to deduce best practices for prudent ERP regulations from past experiences and currently applied policies and to guide policymakers in CEHCs in implementing robust ERP policies. METHODS The literature was reviewed for methods and effects of ERP for pharmaceuticals. Pharmaceutical pricing experts from Asia, the Middle East, Russia, and South Africa were surveyed for current approaches to ERP in their respective countries. RESULTS Key determinants of ERP relate to scope, number, and choice of reference countries; price definitions; computation rules; frequency; and stringency of applying ERP. The scarce evidence shows that ERP seems to lead to narrower price windows with the risk of reducing prices in high-price countries and raising prices in low-price countries. Moreover, launch delays and indirect price effects are often observed. The ERP policies in CEHCs are often applied in isolation, not always in a consistent and transparent manner, neglecting its indirect effects. CONCLUSION Policymakers should consider a set of requirements when introducing ERP, including clear definitions and decision criteria in full transparency. External reference pricing should inform and serve as a benchmark for pricing decisions, rather than being used as the sole pricing mechanism. External reference pricing is primarily a tool to support decisions regarding on-patent pharmaceuticals, and for off-patent products, competition may prove more effective in reducing prices than ERP.
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Affiliation(s)
| | - Fotini Gialama
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | | | - Zoltán Kaló
- HTA Center at Semmelweis University, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
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Yousefi N, Moradi N, Dinarvand R, Ghiasi G, Inanloo H, Peiravian F. Policies to improve access to pharmaceutical products in shortage: the experience of Iran food and drug administration. Daru 2019; 27:169-177. [PMID: 30903556 PMCID: PMC6593011 DOI: 10.1007/s40199-019-00259-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the past decades, economic sanctions imposed on Iran for its nuclear program. The embargo made difficulty in foreign trade and led to lack of timely access to medicines. As the internationally-led sanctions caused to the shortage of medicine there, healthcare systems need to applied the new policies for maintaining health service quality especially in pharmaceutical sector. OBJECTIVES This paper is about policies applied in Iran health system during the crisis reached its peak in 2012 as a good experience for guarantying access to pharmaceutical products. METHODS Through interviewing experts and managers in pharmaceutical regulatory system, the implemented policies in targeted historical period were extracted, then quantitative data were analyzed to show the impact of the policies on the access and affordability of medicines before and after their implementation in Iran food and drug administration (IFDA). This paper tries to show strategies employed by to tackle the crisis caused by sanctions and to offer practical policies to make medicines more accessible at the time of crisis. RESULTS In order to reduce the harmful effects of this crisis, IFDA proposed some changes at different levels ranging from organizational procedures to parliament legislations. The main achievements of IFDA were making drugs easily available are as follows, significantly reducing prices, decreasing the share of market regarding the imported medicines, facilitating the manufacture of domestic medicines, encouraging foreign investment in manufacturing drugs domestically, controlling the shortage of drugs, and finally giving financial support to all patients in general and to those patients who had problem paying for drugs in particular. CONCLUSION These experiences which made the Iran pharmaceutical sector survive during the international sanctions, can be considered as a good example of resilience strategies in similar situations. Graphical abstract IFDA policies to improve access to pharmaceutical products in sanction.
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Affiliation(s)
- Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rassoul Dinarvand
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Godman B, Bucsics A, Vella Bonanno P, Oortwijn W, Rothe CC, Ferrario A, Bosselli S, Hill A, Martin AP, Simoens S, Kurdi A, Gad M, Gulbinovič J, Timoney A, Bochenek T, Salem A, Hoxha I, Sauermann R, Massele A, Guerra AA, Petrova G, Mitkova Z, Achniotou G, Laius O, Sermet C, Selke G, Kourafalos V, Yfantopoulos J, Magnusson E, Joppi R, Oluka M, Kwon HY, Jakupi A, Kalemeera F, Fadare JO, Melien O, Pomorski M, Wladysiuk M, Marković-Peković V, Mardare I, Meshkov D, Novakovic T, Fürst J, Tomek D, Zara C, Diogene E, Meyer JC, Malmström R, Wettermark B, Matsebula Z, Campbell S, Haycox A. Barriers for Access to New Medicines: Searching for the Balance Between Rising Costs and Limited Budgets. Front Public Health 2018; 6:328. [PMID: 30568938 PMCID: PMC6290038 DOI: 10.3389/fpubh.2018.00328] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/26/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases, and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growth in both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated to finance new medicines as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA), Brussels, Belgium
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Wija Oortwijn
- Ecorys, Rotterdam, Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Celia C. Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Alessandra Ferrario
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | - Andrew Hill
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Mohamed Gad
- Global Health and Development Group, Imperial College, London, United Kingdom
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Robert Sauermann
- Hauptverband der Österreichischen Sozialversicherungsträger, Vienna, Austria
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Augusto Alfonso Guerra
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health (CCATES/UFMG), College of Pharmacy, Federal University of Minas Gerais. Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Vasileios Kourafalos
- EOPYY-National Organization for the Provision of Healthcare Services, Athens, Greece
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Athens, Greece
| | - Einar Magnusson
- Department of Health Services, Ministry of Health, Reykjavík, Iceland
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona, Verona, Italy
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | | | - Francis Kalemeera
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | | | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila”, University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dmitry Meshkov
- National Research Institution for Public Health, Moscow, Russia
| | | | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Dominik Tomek
- Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Corrine Zara
- Drug Territorial Action Unit, Catalan Health Service, Barcelona, Spain
| | - Eduardo Diogene
- Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Rickard Malmström
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
- Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden
| | | | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
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Trujillo J. Reducing the Hellenic Financial Crisis to Its Root Cause: A Cybernetic Analysis. ANTHROPOLOGY OF CONSCIOUSNESS 2018. [DOI: 10.1111/anoc.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yfantopoulos JN, Chantzaras A. Drug Policy in Greece. Value Health Reg Issues 2018; 16:66-73. [PMID: 30195093 DOI: 10.1016/j.vhri.2018.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To provide a detailed overview of the recent reforms in pharmaceutical pricing and reimbursement processes as well as in other important areas of the pharmaceutical policy in Greece. METHODS Information was collected via a structured questionnaire. The study used publicly available resources, such as publications, relevant legislation, and statistical data, while health experts were also consulted. RESULTS Recent pharmaceutical reforms included significant price cuts, increased co-payments and some provisions for vulnerable groups, rebates/clawbacks, mandatory electronic prescribing and prescription by international nonproprietary name, generics substitution, prescription limits and detailed auditing, centralized procurement, as well as changes in the pricing and reimbursement processes, with the introduction of positive and negative lists and an internal price referencing system. Price lists are compiled by the National Organization for Medicines and are issued by the Ministry of Health (MoH). An advisory pricing committee comprising representatives of stakeholder groups was abolished in early 2018. Nevertheless, under the new provisions, a health technology assessment body for the economic evaluation of reimbursed drugs is to be established for the first time in Greece. The committee is to be staffed by experts appointed by a ministerial decision of the MoH. The specific features of the process are yet to be determined. CONCLUSIONS The pricing and reimbursement decision-making processes are centralized under the competence of the MoH. Despite the good intentions of the reformers, there are still some aspects of transparency, equity, and long-term sustainability that remain under question in Greece.
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Affiliation(s)
- John N Yfantopoulos
- School of Economics and Political Sciences, National and Kapodistrian University of Athens, Athens, Greece.
| | - Athanasios Chantzaras
- School of Economics and Political Sciences, National and Kapodistrian University of Athens, Athens, Greece
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16
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Xanthopoulou SS, Katsaliaki K. Policies and perceptions on generic drugs: The case of Greece. Health Serv Manage Res 2018; 32:49-56. [PMID: 29376411 DOI: 10.1177/0951484817752630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increase in the consumption of generic drugs to reduce pharmaceutical expenditure is a challenge for many countries, especially during the economic crisis. The purpose of the present study is to review the Greek market of generic drugs and the decisions that shape it, to determine the factors that affect Greek patients' and doctors' attitudes about generic substitution and present a set of measures for all stakeholders based on the findings of the secondary and primary analysis. The study includes (a) an analysis of international and national reports and legislation on drugs policies and (b) a questionnaire survey of 242 hospital patients and 85 doctors regarding their perceptions on generics. A small increase in the volume of generics is recorded, yet not followed by sales value, over the recent years that the measures for promoting generics prescription took effect. Distrust from both patients and doctors was observed toward generics' effectiveness and toward the appropriateness of the regulatory authorities' quality controls. The study presents a structured set of viable measures, applicable to many countries, for promoting generic drug consumption that can lead to economic efficiency without degrading the health care quality.
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CURRENT ENVIRONMENT FOR INTRODUCING HEALTH TECHNOLOGY ASSESSMENT IN GREECE. Int J Technol Assess Health Care 2017; 33:396-401. [DOI: 10.1017/s0266462317000629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: The aim of this study was to describe the current regulatory environment in Greece to evaluate the potential introduction of health technology assessment (HTA) for medicinal products for human use.Methods: Data sources consist of national legislation on pricing and reimbursement of health technologies to identify the potential need of establishing HTA and its relevant structure.Results: The pricing procedure regarding medicinal products for human use is based on an external reference pricing mechanism which considers the average of the three lowest Euorpean Union prices. Currently, a formal HTA procedure has not been applied in Greece, and the only prerequisite used for the reimbursement of medicinal products for human use is their inclusion in the Positive Reimbursement List. To restrict pharmaceutical expenditure, a variety of measures—such as clawback mechanisms, rebates, monthly budget caps per physician, generics penetration targeting—have been imposed, aiming mainly to regulate the price level rather than control the introduction of medicinal products for human use in the Greek pharmaceutical market.Conclusions: Greece has the opportunity to rapidly build capacity, implement, and take advantage of the application of HTA mechanisms by clearly defining the goals, scope, systems, context, stakeholders, and methods that will be involved in the local HTA processes, taking into account the country's established e-prescription system and the recently adapted legislative framework.
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Elek P, Takács E, Merész G, Kaló Z. Implication of external price referencing and parallel trade on pharmaceutical expenditure: indirect evidence from lower-income European countries. Health Policy Plan 2017; 32:349-358. [PMID: 27697777 DOI: 10.1093/heapol/czw133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
Abstract
External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that-after controlling for compounding factors such as GDP, the proportion of the old-age population or life expectancy-the annual growth rate of pharmaceutical expenditure was 2.1% points larger in the lower- than in the higher-income members of the European Union between 2000 and 2008. This difference in trends became non-significant (0.6% points) after the onset of the global economic crisis. There was no significant difference between lower- and higher-income countries in the growth rate of non-pharmaceutical health expenditure in either period. Our results indirectly support the presence of price convergence of pharmaceuticals among European countries, and EPR and parallel trade may provide a reasonable explanation to the observed trend difference of pharmaceutical expenditure in the two groups of countries between 2000 and 2008. This higher growth rate of pharmaceutical expenditure put extra burden on public health care budgets in lower-income countries and resulted in disproportionately more cost-containment measures compared to higher-income countries after 2008. It remains to be seen whether the disappearance of the difference in trend growth rates due to special health policy interventions in countries with economic difficulties is temporary or permanent.
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Affiliation(s)
- Péter Elek
- Department of Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
| | | | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
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Cavalieri M, Guccio C, Rizzo I. On the role of environmental corruption in healthcare infrastructures: An empirical assessment for Italy using DEA with truncated regression approach. Health Policy 2017; 121:515-524. [PMID: 28318606 DOI: 10.1016/j.healthpol.2017.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/05/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This paper investigates empirically whether the institutional features of the contracting authority as well as the level of 'environmental' corruption in the area where the work is localised affect the efficient execution of public contracts for healthcare infrastructures. METHODS A two-stage Data Envelopment Analysis (DEA) is carried out based on a sample of Italian public contracts for healthcare infrastructures during the period 2000-2005. First, a smoothed bootstrapped DEA estimator is used to assess the relative efficiency in the implementation of each single infrastructure contract. Second, the determinants of the efficiency scores variability are considered, paying special attention to the effect exerted by 'environmental' corruption on different types of contracting authorities. RESULTS Our results show that the performance of the contracts for healthcare infrastructures is significantly affected by 'environmental' corruption. Furthermore, healthcare contracting authorities are, on average, less efficient and the negative effect of corruption on efficiency is greater for this type of public procurers. CONCLUSIONS The policy recommendation coming out of the study is to rely on 'qualified' contracting authorities since not all the public bodies have the necessary expertise to carry on public contracts for healthcare infrastructures efficiently.
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Affiliation(s)
- Marina Cavalieri
- Department of Economics and Business, University of Catania, Italy
| | - Calogero Guccio
- Department of Economics and Business, University of Catania, Italy.
| | - Ilde Rizzo
- Department of Economics and Business, University of Catania, Italy
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Why do generic drugs fail to achieve an adequate market share in Greece? Empirical findings and policy suggestions. Health Policy 2017; 121:265-272. [PMID: 28109680 DOI: 10.1016/j.healthpol.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Since 2010, the memoranda of understanding were implemented in Greece as a measure of fiscal adjustment. Public pharmaceutical expenditure was one of the main focuses of this implementation. Numerous policies, targeted on pharma spending, reduced the pharmaceutical budget by 60.5%. Yet, generics' penetration in Greece remained among the lowest among OECD countries. This study aims to highlight the factors that affect the perceptions of the population on generic drugs and to suggest effective policy measures. METHODOLOGY The empirical analysis is based on a national cross-sectional survey that was conducted through a sample of 2003 individuals, representative of the general population. Two ordinal logistic regression models were constructed in order to identify the determinants that affect the respondents' beliefs on the safety and the effectiveness of generic drugs. FINDINGS The empirical findings presented a positive and statistically significant correlation with income, bill payment difficulties, safety and effectiveness of drugs, prescription and dispensing preferences and the views toward pharmaceutical companies. Also, age and trust toward medical community have a positive and statistically significant correlation with the perception on the safety of generic drugs. Policy interventions are suggested on the bases of the empirical results on 3 major categories; (a) information campaigns, (b) incentives to doctors and pharmacists and (c) to strengthen the bioequivalence control framework and the dissemination of results.
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Vogler S, Zimmermann N, de Joncheere K. Policy interventions related to medicines: Survey of measures taken in European countries during 2010–2015. Health Policy 2016; 120:1363-1377. [DOI: 10.1016/j.healthpol.2016.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/10/2016] [Accepted: 09/12/2016] [Indexed: 12/16/2022]
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Kastanioti C, Mavridoglou G, Karanikas H, Polyzos N. ABC analysis: a tool of effectively controlling pharmaceutical expenditure in Greek NHS hospitals. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine Kastanioti
- Department of Health and Welfare Unit Management; Technological Educational Institute of Peloponnese; Kalamata Greece
| | - George Mavridoglou
- Department of Health and Welfare Unit Management; Technological Educational Institute of Peloponnese; Kalamata Greece
| | - Haralampos Karanikas
- Department of Informatics and Computer Technology; Technological Educational Institute of Sterea Ellada; Lamia Greece
| | - Nikolaos Polyzos
- Department of Social Management; Democritus University of Thrace; Komotini Greece
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Tsaprantzi AV, Kostagiolas P, Platis C, Aggelidis VP, Niakas D. The Impact of Information on Doctors' Attitudes Toward Generic Drugs. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016637791. [PMID: 27033564 PMCID: PMC5798745 DOI: 10.1177/0046958016637791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
The objective of this study is to assess the impact of information on doctors' attitudes and perceptions toward generics. A cross-sectional survey based on a specially designed 21-item questionnaire was conducted. The survey involved doctors of different specialties working in a public hospital in Greece. The analysis includes descriptive and inferential statistics, reliability and validity tests, as well as structural equation modeling to evaluate the causal model. Statistical analysis was accomplished by using SPSS 20 and Amos 20. A total of 134 questionnaires out of 162 were received, providing a response rate of 82.71%. A number of significant associations were found between information and perceptions about generic medicines with demographic characteristics. It seems that the provision of quality information on generic drugs influences doctors' attitudes and prescription practices toward generic drugs. This is not a static process but a rather dynamic issue involving information provision policies for strengthening the proper doctors' attitudes toward generic drugs.
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Petrou P, Talias MA. Navigating through the maze of pricing and affordability of branded pharmaceuticals in the midst of the financial crisis: a comparative study among five European recession countries, from a Cyprus perspective. J Pharm Policy Pract 2016; 9:8. [PMID: 26981251 PMCID: PMC4792092 DOI: 10.1186/s40545-016-0057-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial recession mandated the introduction of harsh austerity measures. Health, and particularly pharmaceuticals, constitute a significant part of public expenditure and as such they have been subject to significant budget reduction and stringent policies. As a consequence of these measures, an increasing percentage of patients resort to private sector for acquisition of their prescribed pharmaceuticals, due to exclusion of public health care beneficiary status, reduction of breadth of national formularies, delays in reimbursement and excessive waiting times. Affordability for pharmaceuticals in the private sector is of paramount importance since household disposable income plummets and more people are prone to impoverishment. This is critical for branded products, whose active substance and trademark are under patent protection, since no alternative options exist while their monopoly status imply that their prices are high. The impact on affordability regarding access of patient to necessary pharmaceutical care has not been documented in developed countries. METHODS A laspeyer index was constructed to compare prices of branded pharmaceuticals and assess affordability, by adjusting price index with Gross Domestic Product Purchase Power Parity per capita. Laspeyer index compares prices based on weights, which in our study are the corresponding sales of products in Cyprus. Moreover, we define the percentage of population that will face catastrophic pharmaceutical expenditure after acquisition of one product from eight major and common therapeutic categories. We used data from five European recession countries: Italy, Portugal, Spain, Greece and Cyprus, for 48 products which were selected based on sales. RESULTS Cyprus displays the highest prices for pharmaceuticals. By adjusting for Gross Domestic Product Purchase Power Parity per capita, affordability is worst for Cyprus and Portugal. CONCLUSIONS As more patients have to resort to private sector for provision of adequate and timely healthcare, health agencies must reassess affordability of medicines and minimise catastrophic expenditure impact. Health agencies should primarily try to enhance efficiency of the system and reduce waste, instead of resorting to blunt budget reduction, which can demonstrate unpredictable consequences in public health.
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Plakas S, Mastrogiannis D, Mantzorou M, Adamakidou T, Fouka G, Bouziou A, Tsiou C, Morisky DE. Validation of the 8-Item Morisky Medication Adherence Scale in Chronically Ill Ambulatory Patients in Rural Greece. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.63017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Casagranda I, Costantino G, Falavigna G, Furlan R, Ippoliti R. Artificial Neural Networks and risk stratification models in Emergency Departments: The policy maker's perspective. Health Policy 2015; 120:111-9. [PMID: 26744086 DOI: 10.1016/j.healthpol.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 10/08/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
The primary goal of Emergency Department (ED) physicians is to discriminate between individuals at low risk, who can be safely discharged, and patients at high risk, who require prompt hospitalization. The problem of correctly classifying patients is an issue involving not only clinical but also managerial aspects, since reducing the rate of admission of patients to EDs could dramatically cut costs. Nevertheless, a trade-off might arise due to the need to find a balance between economic interests and the health conditions of patients. This work considers patients in EDs after a syncope event and presents a comparative analysis between two models: a multivariate logistic regression model, as proposed by the scientific community to stratify the expected risk of severe outcomes in the short and long run, and Artificial Neural Networks (ANNs), an innovative model. The analysis highlights differences in correct classification of severe outcomes at 10 days (98.30% vs. 94.07%) and 1 year (97.67% vs. 96.40%), pointing to the superiority of Neural Networks. According to the results, there is also a significant superiority of ANNs in terms of false negatives both at 10 days (3.70% vs. 5.93%) and at 1 year (2.33% vs. 10.07%). However, considering the false positives, the adoption of ANNs would cause an increase in hospital costs, highlighting the potential trade-off which policy makers might face.
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Affiliation(s)
- Ivo Casagranda
- Emergency Department, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Giorgio Costantino
- Internal Medicine Department, "Fondazione IRCCS Ca' Granda" Hospital, Milan, Italy
| | - Greta Falavigna
- CNR-IRCrES (National Research Council of Italy - Research Institute on Sustainable Economic Growth), Moncalieri (Turin), Italy
| | - Raffaello Furlan
- Division of Internal Medicine, Humanitas Research Hospital, Rozzano, Italy; Università degli Studi di Milano, Milan, Italy
| | - Roberto Ippoliti
- Scientific Promotion, "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy; Department of Management, University of Torino, Italy.
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Kheirandish M, Rashidian A, Bigdeli M. A news media analysis of economic sanction effects on access to medicine in Iran. J Res Pharm Pract 2015; 4:199-205. [PMID: 26645026 PMCID: PMC4645132 DOI: 10.4103/2279-042x.167042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In the past decades economic sanctions have been used by different countries or international organizations in order to deprive target countries of some transactions. While the sanctions do not target health care systems or public health structures, they may, in fact, affect the availability of health care in target countries. In this study, we used media analysis to assess the impacts of recent sanctions imposed by the Central Bank of Iran in 2012 on access to medicines in Iran. METHODS We searched different sources of written news media including a database of nonspecialized weeklies and magazines, online news sources, web pages of daily newspapers and healthcare oriented weeklies from 2011 to 2013. We searched the sources using the general term "medicine" to reduce the chances of missing relevant items. The identified news media were read, and categorized under three groups of items announcing "shortage of medicines," "medicines related issues" and "no shortage." We conducted trend analyzes to see whether the news media related to access to medicines were affected by the economic sanctions. FINDINGS A total number of 371 relevant news media were collected. The number of news media related to medicines substantially increased in the study period: 30 (8%), 161 (43%) and 180 (49%) were published in 2011, 2012 and 2013, respectively. While 145 (39%) of media items referred to the shortage of medicines, 97 (26%) reported no shortage or alleviating of concerns. CONCLUSION Media analysis suggests a clear increase in the number of news media reporting a shortage in Iran after the sanctions. In 2013, there were accompanying increases in the number of news media reporting alleviation of the shortages of medicines. Our analysis provides evidence of negative effects of the sanctions on access to medicines in Iran.
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Affiliation(s)
- Mehrnaz Kheirandish
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bigdeli
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries. Health Res Policy Syst 2015; 13:39. [PMID: 26407728 PMCID: PMC4583728 DOI: 10.1186/s12961-015-0028-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 09/07/2015] [Indexed: 01/18/2023] Open
Abstract
Background Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Methods Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. Results The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment. Conclusion Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems. Electronic supplementary material The online version of this article (doi:10.1186/s12961-015-0028-5) contains supplementary material, which is available to authorized users.
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Labiris G, Fanariotis M, Kastanioti C, Alexias G, Protopapas A, Karampitsakos T, Niakas D. Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity. SCIENTIFICA 2015; 2015:251792. [PMID: 26457225 PMCID: PMC4589622 DOI: 10.1155/2015/251792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/24/2015] [Indexed: 05/24/2023]
Abstract
Purpose. To assess the beliefs and preferences of Greek physicians, regarding generic drugs, in the years of financial crisis. Setting. Multicentered, nationwide survey. Material and Methods. A custom questionnaire based on former similar studies was developed and administered to Greek physicians. The variable "perception on generics" was constructed after an exploratory study and the instrument was validated by conventional and Rasch analysis methods. 22 items formed 5 subscales that constructed the variable in question. Results. 908 physicians successfully participated in the study (response rate: 80%). Mean total scores to the instrument were 60.63 ± 12.12 for men and significantly less (58.24 ± 11.73) for women (p = 0.04). Greek physicians were not persuaded on the potential economic gain (45.79 ± 10.53); moreover they identified that Greek authorities cannot address the increased pharmacovigilance mandates. Physicians working in Athens and those working in surgical units demonstrated significantly worse scores than their colleagues from the rest of Greece and those working in Internal Medicine wards (p = 0.03). Conclusion. Our results suggest an overall poor acceptance of the national initiative on generic drugs by Greek physicians. This trial is registered with Clinicaltrials.gov identifier: NCT01855802.
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Affiliation(s)
- Georgios Labiris
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Michael Fanariotis
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | | | - Georgios Alexias
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Adonis Protopapas
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Theodoros Karampitsakos
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
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Souliotis K, Papageorgiou M, Politi A, Frangos N, Tountas Y. Estimating the Fiscal Effects of Public Pharmaceutical Expenditure Reduction in Greece. Front Public Health 2015; 3:203. [PMID: 26380249 PMCID: PMC4553366 DOI: 10.3389/fpubh.2015.00203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/07/2015] [Indexed: 12/23/2022] Open
Abstract
The purpose of the present study is to estimate the impact of pharmaceutical spending reduction on public revenue, based on data from the national health accounts as well as on reports of Greece’s organizations. The methodology of the analysis is structured in two basic parts. The first part presents the urgency for rapid cutbacks on public pharmaceutical costs due to the financial crisis and provides a conceptual framework for the contribution of the Greek pharmaceutical branch to the country’s economy. In the second part, we perform a quantitative analysis for the estimation of multiplier effects of public pharmaceutical expenditure reduction on main revenue sources, such as taxes and social contributions. We also fit projection models with multipliers as regressands for the evaluation of the efficiency of the particular fiscal measure in the short run. According to the results, nearly half of the gains from the measure’s application is offset by financially equivalent decreases in the government’s revenue, i.e., losses in tax revenues and social security contributions alone, not considering any other direct or indirect costs. The findings of multipliers’ high value and increasing short-term trend imply the measure’s inefficiency henceforward and signal the risk of vicious circles that will provoke the economy’s deprivation of useful resources.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Manto Papageorgiou
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Anastasia Politi
- Department of Statistics, Athens University of Economics and Business , Athens , Greece
| | - Nikolaos Frangos
- Department of Statistics, Athens University of Economics and Business , Athens , Greece
| | - Yiannis Tountas
- Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Kheirandish M, Rashidian A, Kebriaeezade A, Cheraghali AM, Soleymani F. A review of pharmaceutical policies in response to economic crises and sanctions. J Res Pharm Pract 2015; 4:115-22. [PMID: 26312250 PMCID: PMC4548429 DOI: 10.4103/2279-042x.162361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An economic crisis has been defined as a situation in which the scale of a country's economy becomes smaller in a period of time. Economic crises happen for various reasons, including economic sanctions. Economic crises in a country may affect national priorities for investment and expenditure and reduce available resources, and hence may affect the health care sector including access to medicines. We reviewed the pharmaceutical policies that the countries adopted in order to mitigate the potential negative effects on access to medicines. We reviewed published reports and articles after conducting a comprehensive search of the PubMed and the Google Scholar. After extracting relevant data from the identified articles, we used the World Health Organization (WHO) access to medicines framework as a guide for the categorization of the policies. We identified a total of 40 studies, of which 10 reported the national pharmaceutical policies adopted to reduce the negative impacts of economic crises on access to medicines in high-income and middle-income countries. We identified 89 policies adopted in the 11 countries and categorized them into 12 distinct policy directions. Most of the policies focused on financial aspects of the pharmaceutical sector. In some cases, countries adopted policies that potentially had negative effects on access to medicines. Only Italy had adopted policies encompassing all four accesses to medicine factors recommended by the WHO. While the countries have adopted many seemingly effective policies, little evidence exists on the effectiveness of these policies to improve access to medicines at a time of an economic crisis.
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Affiliation(s)
- Mehrnaz Kheirandish
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran ; Department of Global Health and Public Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezade
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran ; Research Center for Pharmaceutical Management and Pharmacoeconomics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Soleymani
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran ; Research Center for Pharmaceutical Management and Pharmacoeconomics, Tehran University of Medical Sciences, Tehran, Iran
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Tapia Granados JA, Rodriguez JM. Health, economic crisis, and austerity: A comparison of Greece, Finland and Iceland. Health Policy 2015; 119:941-53. [PMID: 25979416 DOI: 10.1016/j.healthpol.2015.04.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
Reports have attributed a public health tragedy in Greece to the Great Recession and the subsequent application of austerity programs. It is also claimed that the comparison of Greece with Iceland and Finland-where austerity policies were not applied-reveals the harmful effect of austerity on health and that by protecting spending in health and social budgets, governments can offset the harmful effects of economic crises on health. We use data on life expectancy, mortality rates, incidence of infectious diseases, rates of vaccination, self-reported health and other measures to examine the evolution of population health and health services performance in Greece, Finland and Iceland since 1990-2011 or 2012-the most recent years for which data are available. We find that in the three countries most indicators of population health continued improving after the Great Recession started. In terms of population health and performance of the health care system, in the period after 2007 for which data are available, Greece did as good as Iceland and Finland. The evidence does not support the claim that there is a health crisis in Greece. On the basis of the extant evidence, claims of a public health tragedy in Greece seem overly exaggerated.
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Affiliation(s)
- José A Tapia Granados
- Department of History and Political Science, Drexel University, Philadelphia, PA, United States.
| | - Javier M Rodriguez
- Mathematica Policy Research and Population Studies Center, Institute for Social Research, University of Michigan,, Ann Arbor, MI, USA
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Nikolentzos A, Kontodimopoulos N, Polyzos N, Thireos E, Tountas Y. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers. Glob J Health Sci 2015; 7:272-87. [PMID: 26156925 PMCID: PMC4803861 DOI: 10.5539/gjhs.v7n5p272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/24/2014] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.
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Affiliation(s)
- Athanasios Nikolentzos
- School of Social Science, Hellenic Open University & Institute for Social and Preventative Medicine.
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Petrou P, Vandoros S. Cyprus in crisis: Recent changes in the pharmaceutical market and options for further reforms without sacrificing access to or quality of treatment. Health Policy 2015; 119:563-8. [PMID: 25837234 DOI: 10.1016/j.healthpol.2015.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/26/2015] [Accepted: 03/06/2015] [Indexed: 02/06/2023]
Abstract
The pharmaceutical market in Cyprus has been characterised by high volume and a steep increase in per-capita expenditure over the past decade. Most importantly, the market is fragmented due to the absence of universal health insurance, and the uninsured have to rely exclusively on the private market. The objective of this study is to examine the weaknesses of the Cypriot pharmaceutical market before the financial crisis; to discuss the measures recently introduced after recommendations by the Troika; and to propose interventions that can improve access to pharmaceuticals and efficiency without compromising health outcomes. Apart from the introduction of new pharmaceutical policies, we also recommend the swift implementation of universal health insurance.
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Affiliation(s)
- Panagiotis Petrou
- Open University of Cyprus, HealthCare Management Programme, PO Box 12794, 2252, Latsia, Cyprus; Health Insurance Organization, 17-19 Klimentos Street, 1061 Nicosia, Cyprus.
| | - Sotiris Vandoros
- King's College London, Department of Management, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom
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Paris V. [The impact of the economic crisis on health systems of OECD countries]. Med Sci (Paris) 2014; 30:910-5. [PMID: 25311027 DOI: 10.1051/medsci/20143010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper describes measures adopted by OECD countries in the health sector in response to the economic crisis which began in 2008: increase and diversification of revenues collected for health, increases in user charges, reductions in staff, salaries and prices of health goods and services; and policies aiming to increase health systems efficiency. It then reviews the impact of these policies on health spending trends.
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Affiliation(s)
- Valérie Paris
- OCDE (Organisation de coopération et de développement économiques), 2, rue André-Pascal, 75775 Paris, France
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Olga SC, Daphne KC, Panagiota LS, Georgia GS, Helen AA, Panagiotis PG, Sotiria AP, Lycourgos LL. Investigating the Economic Impacts of New Public Pharmaceutical Policies in Greece: Focusing on Price Reductions and Cost-Sharing Rates. Value Health Reg Issues 2014; 4:107-114. [PMID: 29702797 DOI: 10.1016/j.vhri.2014.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Since 2010, cost-containment efforts in Greece focused on the reduction of public pharmaceutical expenditure. Changes in cost-sharing levels, reductions in prices, and generic substitution are some of the measures implemented after the second quarter of 2012. The objective of this study was to investigate the economic impact of the measures on public funds and households. METHODS Data on volume and value for prescribed drugs for each therapeutic category and cost-sharing levels were obtained from the National Organization for Health Care Services Provision (EOPYY), the main reimbursement agency covering 95% of the population. Four different periods were compared, taking into consideration the implementation of different regulation, data availability, and disease seasonality. The periods compared were January-March 2012 versus January-March 2013 and April-August 2012 versus April-August 2013. RESULTS In 2013, only 8% of prescribed drug boxes were provided with 0% cosharing arrangement versus 13% in 2012. Α 25% cost-sharing level was imposed on 77% of the prescribed medicines in 2013 compared with 53% in 2012. Consequently, the mean cost-sharing burden for pharmaceuticals in 2013 was estimated at 18% versus 13.3% in 2012. The average price per package declined in 2013 by 28%, from €17.8 in 2012 to €12.8 in 2013. Major (>50%) savings were achieved in cardiovascular and nervous system drugs, accounting in volume for almost 60% of total pharmaceutical consumption. CONCLUSIONS The economic results of the measures for third-party payers were positive. The measures, however, should be reconsidered and examined more closely considering social effects, such as accessibility, especially for vulnerable groups in need of essential pharmaceutical care.
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Affiliation(s)
- Siskou Ch Olga
- Center for Health Services Management and Evaluation, National and Kapodistian Univerisity of Athens, Athens Greece.
| | - Kaitelidou Ch Daphne
- Center for Health Services Management and Evaluation, National and Kapodistian Univerisity of Athens, Athens Greece
| | - Litsa S Panagiota
- National Organization for Health Care Services Provision (EOPYY), Athens Greece
| | | | - Alexopoulou A Helen
- National Organization for Health Care Services Provision (EOPYY), Athens Greece
| | | | | | - Liaropoulos L Lycourgos
- Center for Health Services Management and Evaluation, National and Kapodistian Univerisity of Athens, Athens Greece
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Fanourgiakis J, Kanoupakis E. Greek’s health, waiting for the ‘deus ex machina’. Expert Rev Pharmacoecon Outcomes Res 2014; 14:637-42. [DOI: 10.1586/14737167.2014.927316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Petrou P, Talias MA. Tendering for pharmaceuticals as a reimbursement tool in the Cyprus Public Health Sector. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Goranitis I, Siskou O, Liaropoulos L. Health policy making under information constraints: an evaluation of the policy responses to the economic crisis in Greece. Health Policy 2014; 117:279-84. [PMID: 25150026 DOI: 10.1016/j.healthpol.2014.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/03/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities. METHODS Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections. RESULTS Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed. CONCLUSION Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals' right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.
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Affiliation(s)
- Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom.
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Greece
| | - Lycourgos Liaropoulos
- Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Greece
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Petrou P. Pharmacoeconomics in the years of crisis: a solution or just a resolution? A Cyprus perspective. Expert Rev Pharmacoecon Outcomes Res 2014; 14:627-36. [PMID: 24953125 DOI: 10.1586/14737167.2014.917969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cyprus is one of the latest countries to apply for a bailout with Troika. Major reforms applied and health sector was massively restructured. Cyprus is currently the single EU country without a Health System and health care spending is primarily driven by out-of-pocket payment. Pharmaceutical sector is divided into private and public sector, which are fragmented and are highly heterogeneously regulated. Although there is a need to introduce economic evaluations for pharmaceuticals, current adverse and unstable economic environment, along with some attributes of the country are not good prognostic factors. We suggest that some forms of economic evaluations could be introduced selectively during recession. Unification of health sector in the form of a National System would enable full scale introduction of economic evaluations.
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Affiliation(s)
- Panagiotis Petrou
- Healthcare Management Programme, Open University of Cyprus, P.O. Box 12794, Nicosia, Cyprus
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Puig-Junoy J, Rodríguez-Feijoó S, Lopez-Valcarcel BG. Paying for formerly free medicines in Spain after 1 year of co-payment: changes in the number of dispensed prescriptions. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:279-287. [PMID: 24696429 DOI: 10.1007/s40258-014-0097-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND After more than three decades of free medicines for the elderly in Spain, in the context of heavy austerity reforms of public financing, a set of cost-sharing reforms on pharmaceutical prescriptions with regional variants have been established in Spain since July 2012. OBJECTIVE The purpose of this analysis is to present the first attempt to provide accurate estimates of the overall impact at the regional level of these cost-sharing reforms. METHODS We estimated the impact of the reforms on the quantity of dispensed medicines during the first 14 months. We estimated 17 autoregressive integrated moving average (ARIMA) time series models of the monthly number of prescriptions dispensed in pharmacies for the period January 2003-May 2012 in each one of the 17 regions (Autonomous Communities) of Spain. We calculated dynamic forecasts for the horizon June 2012-July 2013 in order to estimate the counterfactual (number of prescriptions that would had been observed without the intervention), and we estimated the impact of cost-sharing changes as the difference between the observed number of accumulated prescriptions at 3, 6, 12, and 14 months and the number predicted by our time-series models (in percentages). RESULTS During the last decade the number of dispensed prescriptions has experienced rapid and continuous increases. In the first 14 months after the co-payment reform, the total number of prescriptions decreased dramatically, by more than 20% in Catalunya, Valencia, and Galicia, by more than 15% in nine other regions, and by more than 10% in 15 of the 17 Spanish regions. The results of our model suggest that the new co-payment caused an abrupt shift in the mean level of the time series. No shift in trend has been detected; the previous positive trend remains unchanged in most of the Autonomous Communities. CONCLUSION After decades of unsuccessfully trying to reduce drug spending in the Spanish National Health System through actions on prices and on prescribers, the co-payment established in mid-2012 led to a dramatic reduction in the use of drugs. The health effects of this reduction are not known.
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Affiliation(s)
- Jaume Puig-Junoy
- Department of Economics and Business, Pompeu Fabra University, Ramon Trias Fargas 25-27, 34-08005, Barcelona, Catalunya, Spain,
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Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review. Health Policy 2014; 115:111-9. [DOI: 10.1016/j.healthpol.2014.02.002] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 01/23/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022]
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Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care. Health Policy 2013; 113:8-12. [DOI: 10.1016/j.healthpol.2013.05.017] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/09/2013] [Accepted: 05/24/2013] [Indexed: 11/24/2022]
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Quaglio G, Karapiperis T, Van Woensel L, Arnold E, McDaid D. Austerity and health in Europe. Health Policy 2013; 113:13-9. [DOI: 10.1016/j.healthpol.2013.09.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 11/25/2022]
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Kontodimopoulos N, Kastanioti C, Thireos E, Karanikas H, Polyzos N. The contribution of generic substitution to rationalizing pharmaceutical expenditure in Greek public hospitals under recent economic crisis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Catherine Kastanioti
- Health Procurement Committee; Ministry of Health; Athens Greece
- Department of Health and Welfare Unit Management; TEI of Kalamata; Antikalamos Kalamata Greece
| | | | - Haralampos Karanikas
- Health Procurement Committee; Ministry of Health; Athens Greece
- Department of Informatics and Computer Technology; TEI of Lamia; Lamia Greece
| | - Nikolaos Polyzos
- Department of Social Management; Democritus University of Thrace; Komotini Greece
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Vandoros S, Stargardt T. Authors’ response to “Health service expenditures and efficiencies in Greece” (I). Health Policy 2013; 111:208-9. [DOI: 10.1016/j.healthpol.2013.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Health service expenditure and efficiencies in Greece. Health Policy 2013; 111:206-7. [DOI: 10.1016/j.healthpol.2013.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/23/2013] [Indexed: 11/20/2022]
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