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Coveney L, Musoke D, Russo G. Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries. Health Policy Plan 2023; 38:1050-1063. [PMID: 37632759 PMCID: PMC10566321 DOI: 10.1093/heapol/czad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Abstract
Universal Health Coverage (UHC) is the dominant paradigm in health systems research, positing that everyone should have access to a range of affordable health services. Although private providers are an integral part of world health systems, their contribution to achieving UHC is unclear, particularly in low-income countries (LICs). We scoped the literature to map out the evidence on private providers' contribution to UHC progress in LICs. Literature searches of PubMed, Scopus and Web of Science were conducted in 2022. A total of 1049 documents published between 2002 and 2022 were screened for eligibility using predefined inclusion criteria, focusing on formal as well as informal private health sectors in 27 LICs. Primary qualitative, quantitative and mixed-methods evidence was included, as well as original analysis of secondary data. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of the studies. Relevant evidence was extracted and analysed using an adapted UHC framework. We identified 34 papers documenting how most basic health care services are already provided through the private sector in countries such as Uganda, Afghanistan and Somalia. A substantial proportion of primary care, mother, child and malaria services are available through non-public providers across all 27 LICs. Evidence exists that while formal private providers mostly operate in well-served urban settings, informal and not-for-profit ones cater for underserved rural and urban areas. Nonetheless, there is evidence that the quality of the services by informal providers is suboptimal. A few studies suggested that the private sector fails to advance financial protection against ill-health, as costs are higher than in public facilities and services are paid out of pocket. We conclude that despite their shortcomings, working with informal private providers to increase quality and financing of their services may be key to realizing UHC in LICs.
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Affiliation(s)
- Laura Coveney
- The Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London E1 2AB, United Kingdom
| | - David Musoke
- School of Public Health, Makerere University, New Mulago Hill Road, Mulango, Kampala, Uganda
| | - Giuliano Russo
- The Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London E1 2AB, United Kingdom
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Kiragga AN, Najjemba L, Galiwango R, Banturaki G, Munyiwra G, Iwumbwe I, Atwine J, Ssendiwala C, Natif A, Nakanjako D. Community purchases of antimicrobials during the COVID-19 pandemic in Uganda: An increased risk for antimicrobial resistance. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001579. [PMID: 36963050 PMCID: PMC10021632 DOI: 10.1371/journal.pgph.0001579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Self-Medication (SM) involves the utilization of medicines to treat self-recognized symptoms or diseases without consultation and the irrational use of over-the-counter drugs. During the COVID-19 pandemic, the lack of definitive treatment led to increased SM. We aimed to estimate the extent of SM for drugs used to treat COVID-19 symptoms by collecting data from pharmacy sale records. The study was conducted in Kampala, Uganda, where we extracted data from community pharmacies with functional Electronic Health Records between January 2018 and October 2021 to enable a comparison of pre-and post-COVID-19. The data included the number of clients purchasing the following drugs used to treat COVID-19 and its symptoms: Antibiotics included Azithromycin, Erythromycin, and Ciprofloxacin; Supplements included Zinc and vitamin C, while Corticosteroids included dexamethasone. A negative binomial model was used to estimate the incident rate ratios for each drug to compare the effect of COVID-19 on SM. In the pre- COVID-19 period (1st January 2018 to 11th March 2020), 19,285 customers purchased antibiotics which included; Azithromycin (n = 6077), Ciprofloxacin (n = 6066) and Erythromycin (n = 997); health supplements including Vitamin C (430) and Zinc (n = 138); and Corticosteroid including Dexamethasone (n = 5577). During the COVID-19 pandemic (from 15th March 2020 to the data extraction date in October 2021), we observed a 99% increase in clients purchasing the same drugs. The number of clients purchasing Azithromycin increased by 19.7% to 279, Ciprofloxacin reduced by 58.8% to 96 clients, and those buying Erythromycin similarly reduced by 35.8% to 492 clients. In comparison, there were increases of 170%, 181%, and 377% for Vitamin C, Zinc, and Dexamethasone, respectively. The COVID-19 pandemic underscored the extent of SM in Uganda. We recommend future studies with a representation of data from pharmacies located in rural and urban areas to further study pandemics' effect on antimicrobials prescriptions, including obtaining pharmacists' perspectives using mixed methods approaches.
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Affiliation(s)
- Agnes N Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Leticia Najjemba
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Galiwango
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- African Center of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Center for Computational Biology, Uganda Christian University, Mukono, Uganda
| | - Grace Banturaki
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Janssen Daalen JM, den Ambtman A, Van Houdenhoven M, van den Bemt BJF. Determinants of drug prices: a systematic review of comparison studies. BMJ Open 2021; 11:e046917. [PMID: 34266841 PMCID: PMC8287090 DOI: 10.1136/bmjopen-2020-046917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE In this systematic review on drug price comparison studies, we report on recent determinants of drug prices in a national and international context to facilitate regulation of drug prices by purchasers and policymakers worldwide. Determinants of drug prices were divided into non-modifiable and modifiable and were categorised as pertaining to a country's income level, pharmaceutical market system and its policies and government. PRIMARY OUTCOME Determinants of drug prices or price variance. DESIGN We systematically searched PubMed, EMBASE, Web of Science and Cochrane Library for peer-reviewed articles published between 2004 and 22 July 2020 that reported an association of the primary outcome with one or more determinants. We performed a best-evidence synthesis of these associations for determinants covered in at least three studies. RESULTS 31 publications were included. Only one publication described net drug prices and 30 described retail drug prices. Five modifiable determinants were associated with lower retail prices: generic market portion, discounts, tendering policies, central (governmental) purchasing and pricing regulation schemes. The originators market portion and a system in which mark-ups are common were associated with higher retail prices. Retail prices were highest in the USA, even compared with other high-income countries. A positive association between national income level and drug retail prices could not be established among middle-income and high-income countries. Retail prices were highest in low-income countries when adjusted for purchasing power parity. CONCLUSIONS Literature on determinants of net drug prices is extremely sparse. Various healthcare system interventions, market-specific and governmental regulations are consistently associated with lower retail prices. Some interventions are easily implementable in developing or middle-income countries, such as tendering, central purchasing and fixed pricing regulation schemes. Net drug price comparison studies are needed to overcome the lack of price transparency and to quantify the effectiveness of policy measures on net drug prices.
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Affiliation(s)
- Jules M Janssen Daalen
- Faculty of Medical Sciences, Radboud University, Nijmegen, The Netherlands
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Anouk den Ambtman
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Mark Van Houdenhoven
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, Netherlands
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Doshmangir L, Rashidian A, Kouhi F, Gordeev VS. Setting health care services tariffs in Iran: half a century quest for a window of opportunity. Int J Equity Health 2020; 19:112. [PMID: 32631344 PMCID: PMC7336437 DOI: 10.1186/s12939-020-01224-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. METHODS We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models. RESULTS Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. CONCLUSION Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.
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Affiliation(s)
- Leila Doshmangir
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Health Policy & Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Arash Rashidian
- Department of Science, Information and Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Kouhi
- Treatment Deputy, Iran Social Security Organization, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Anggriani Y, Ramadaniati HU, Sarnianto P, Pontoan J, Suryawati S. The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia's Social Health Insurance System. Value Health Reg Issues 2019; 21:1-8. [PMID: 31634791 DOI: 10.1016/j.vhri.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/26/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indonesia's social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country. OBJECTIVE To evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices. METHODS This was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals' procurement prices were collected from the data 3 years before and 3 years under Indonesia's social health insurance JKN (2011-2016), and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. RESULTS The results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non-e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. CONCLUSION The pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.
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Affiliation(s)
- Yusi Anggriani
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia.
| | - Hesty Utami Ramadaniati
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Prih Sarnianto
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Jenny Pontoan
- National Institute of Science and Technology, Jakarta, Indonesia
| | - Sri Suryawati
- Division of Clinical Pharmacology and Medicine Policy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Ahmad NS, Hatah E, Makmor-Bakry M. Association between medicine Price declaration by pharmaceutical industries and retail prices in Malaysia's private healthcare sector. J Pharm Policy Pract 2019; 12:15. [PMID: 31304021 PMCID: PMC6607540 DOI: 10.1186/s40545-019-0176-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/08/2019] [Indexed: 11/11/2022] Open
Abstract
Background As part of the initiatives to increase price transparency for consumers, pharmaceutical industry in Malaysia have been encouraged to declare the wholesale and recommended retail prices (RRP) of medicines to the Pharmaceutical Service Department (PSD) yearly. However, the relationship between the voluntary price reporting practices and consumers’ retail medicine price is unknown. Therefore, this study aims to evaluate the effect of the voluntary price reporting practice of pharmaceutical industry on retail medicine prices, factors that may affect consumer medicine prices in Malaysia’s private healthcare sector, and the retail medicine pricing trend over 2011–2015. Methods A yearly correlation test for a 5-year period was performed to investigate the association between the wholesale and RRP medicine prices declared by the pharmaceutical industry from 2011 to 2015 on the one hand and the consumer wholesale and retail medicine price database on the other hand. The median price ratio (MPR) was calculated by comparing the consumer retail medicine price to its international reference price. The Krukal Wallis test was used to analyse the pricing trend throughout the 5-year period, and factors that might elevate the MPR above 2.5 were modelled using binary logistic regression. Results A total of 2527 medicine price data were analysed. There was a strong significant association between medicine prices declared to the PSD and the retail medicine prices in every year of the 5-year period. Moreover, there was no significant increase in retail medicine prices throughout the 5-year period. The medicine types, retail location, type of manufacturer, medicinal indications, declared wholesale and RRPs significantly influenced the consumer MPRs that where > 2.5. Conclusion The declared medicine price was found to have a significant association with the consumer retail medicine price. Thus, it may be a useful reference for consumers purchasing medicines in private healthcare settings. However, the government of Malaysia must develop strategies to increase medicine price transparency for price-control mechanisms in the private healthcare sector. Electronic supplementary material The online version of this article (10.1186/s40545-019-0176-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nur Sufiza Ahmad
- 1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.,2Pharmaceutical Services Division, Ministry of Health Malaysia, 46350 Petaling Jaya, Selangor Malaysia
| | - Ernieda Hatah
- 1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- 1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Nguyen TA, Knight R, Mant A, Razee H, Brooks G, Dang TH, Roughead EE. Corruption practices in drug prescribing in Vietnam - an analysis based on qualitative interviews. BMC Health Serv Res 2018; 18:587. [PMID: 30055601 PMCID: PMC6064099 DOI: 10.1186/s12913-018-3384-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Results from a previous study showed that 40 to 60% of the price of off-patent medicines in Vietnam was typically spent to induce prescribers to use the medicines, and to persuade procurement officers within hospitals to buy them. In this article we examine how and why inducements were paid by the pharmaceutical industry to health care providers in Vietnam. METHODS We use a theoretically informed analysis to understand pharmaceutical companies' account of giving inducements and prescribers' account of taking them, elicited through in-depth interviews. RESULTS Analysis of the emergent concepts derived from our qualitative data led to viewing the constructs from the theoretical framework of opportunities; pressures; and rationalization within a hierarchy of systemic factors and individual factors. Economic survival pressures in an imperfectly competitive market reportedly encouraged pharmaceutical companies and prescribers to be linked financially. Although individual factors such as professional ethics and personal values influenced doctors' responses to corrupt practices, entrenched systemic issues, including lack of transparency, accountability, poor enforcement of legislation and prevalence of corruption emerged as important factors supporting corrupt practice or even making it very difficult for individuals to opt out of corrupt practices. CONCLUSIONS Our theoretically informed analysis of inducements provides an in-depth understanding of an angle of corruption in Vietnam's health sector, showing the need for multifaceted strategies in the fight against corruption in the health sector. Remedial strategies need to address both systemic and individual factors including interventions to relieve dependencies for survival of health care services on the corrupt system.
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Affiliation(s)
- Tuan A Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Rosemary Knight
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Andrea Mant
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Husna Razee
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Thu H Dang
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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Alonso S, Munguambe K, Sicuri E. Market for Artemether-Lumefantrine to treat childhood malaria in a district of southern Mozambique. HEALTH ECONOMICS 2017; 26:e345-e360. [PMID: 28548247 DOI: 10.1002/hec.3514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/24/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Malaria is one of the leading causes of death in sub-Saharan Africa. Artemisinin-based combination therapies are used as first-line treatment drugs, but their market is far from competitive. Market failures include limited availability, low quality, lack of information, and high costs of access. We estimated the theoretical demand for one of the most common artemisinin-based combination therapies, artemether-lumefantrine (AL), and its determinants among caregivers of children with malaria seeking care at public health facilities, thus, entitled to receive drugs for free, in southern Mozambique (year 2012). The predicted theoretical demand was contrasted with international and local private market AL prices. Respondents stated high willingness to pay but lower ability to pay (ATP), which was defined as the theoretical demand. The ATP was on average of 0.94 USD for the treatment of a malaria episode. This implied an average gap of 1.04 USD between average local private prices and theoretical demand. Predicted ATP decreased by 14% for every additional malaria episode that the child had suffered during the malaria season. The market price was unaffordable for a large share of our sample, highlighting an unequal welfare distribution between suppliers and potential consumers, as well as issues of inequity in the private delivery of AL.
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Affiliation(s)
- Sergi Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Elisa Sicuri
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Health Economics group, School of Public Health, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Abdel Rida N, Mohamed Ibrahim MI, Babar ZUD, Owusu Y. A systematic review of pharmaceutical pricing policies in developing countries. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Yaw Owusu
- College of Pharmacy; Qatar University; Doha Qatar
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Rodrigues CF. Medicines and therapeutic pluralism in Maputo: exploring modalities of trust and the (un)certainties of everyday users. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1271403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Carla F. Rodrigues
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Eduardo Mondlane University, Maputo, Mozambique
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Abstract
Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.
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Affiliation(s)
- Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tim Ensor
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hugh Waters
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Patouillard E, Hanson K, Kleinschmidt I, Palafox B, Tougher S, Pok S, O'Connell K, Goodman C. Determinants of price setting decisions on anti-malarial drugs at retail shops in Cambodia. Malar J 2015; 14:224. [PMID: 26024880 PMCID: PMC4462075 DOI: 10.1186/s12936-015-0737-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background In many low-income countries, the private commercial sector plays an important role in the provision of malaria treatment. However, the quality of care it provides is often poor, with artemisinin combination therapy (ACT) generally being too costly for consumers. Decreasing ACT prices is critical for improving private sector treatment outcomes and reducing the spread of artemisinin resistance. Yet limited evidence exists on the factors influencing retailers’ pricing decisions. This study investigates the determinants of price mark-ups on anti-malarial drugs in retail outlets in Cambodia. Methods Taking an economics perspective, the study tests the hypothesis that the structure of the anti-malarial market determines the way providers set their prices. Providers facing weak competition are hypothesized to apply high mark-ups and set prices above the competitive level. To analyse the relationship between market competition and provider pricing, the study used cross-sectional data from retail outlets selling anti-malarial drugs, including outlet characteristics data (e.g. outlet type, anti-malarial sales volumes), range of anti-malarial drugs stocked (e.g. dosage form, brand status) and purchase and selling prices. Market concentration, a measure of the level of market competition, was estimated using sales volume data. Market accessibility was defined based on travel time to the closest main commercial area. Percent mark-ups were calculated using price data. The relationship between mark-ups and market concentration was explored using regression analysis. Results The anti-malarial market was on average highly concentrated, suggesting weak competition. Higher concentration was positively associated with higher mark-ups in moderately accessible markets only, with no significant relationship or a negative relationship in other markets. Other determinants of pricing included anti-malarial brand status and generic type, with higher mark-ups on cheaper products. Conclusions The results indicate that provider pricing as well as other key elements of anti-malarial supply and demand may have played an important role in the limited access to appropriate malaria treatment in Cambodia. The potential for an ACT price subsidy at manufacturer level combined with effective communications directed at consumers and supportive private sector regulation should be explored to improve access to quality malaria treatment in Cambodia. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0737-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edith Patouillard
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Immo Kleinschmidt
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Benjamin Palafox
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Sarah Tougher
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Sochea Pok
- Population Services International Cambodia, No. 29 Street 334, P.O. Box 153, BKK1 Chamcar Mon, Phnom Penh, Kingdom of Cambodia.
| | - Kate O'Connell
- Malaria and Child Survival Department, Population Services International (PSI), PO Box 14355-00800, Nairobi, Kenya.
| | - Catherine Goodman
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Yadav P. Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform. Health Syst Reform 2015; 1:142-154. [PMID: 31546312 DOI: 10.4161/23288604.2014.968005] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract-Well-functioning supply chains to deliver medicines, vaccines, and other health products form the backbone of the health system. Health product supply chains in developing countries are fraught with many problems. Ineffective supply chains weaken the overall health system's ability to respond to the healthcare needs of the population and put treatment programs at risk. This article provides an overview of the structure of health product supply chains in developing countries and outlines the main challenges and their root causes. It aims to identify key areas of reform to ensure that supply chains enable-or at least do not impede-achieving the targeted health outcomes from the increased investments in global health.
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Affiliation(s)
- Prashant Yadav
- William Davidson Institute; Ross School of Business and School of Public Health; University of Michigan ; Ann Arbor , MI , USA
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Hoehn RS, Abbott DE. Beyond the bedside: A review of translational medicine in global health. World J Transl Med 2015; 4:1-10. [DOI: 10.5528/wjtm.v4.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 11/14/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside, followed by evidence-based practice and population-level policy and programming. Understanding these phases is crucial when it comes to preventing and treating illness, especially in global health. Communities around the world struggle with a variety of health problems that are at some times similar and at others quite different. Three major world health issues help to outline the phases of translational research: vaccines, human immunodeficiency virus and acquired immunodeficiency syndrome, and non-communicable diseases. Laboratory research has excelled in many of these areas and is struggling in a few. Where successful therapies have been discovered there are often problems with appropriate use or dissemination to groups in need. Also, many diseases would be better prevented from a population health approach. This review highlights successes and struggles in the arena of global health, from smallpox eradication to the impending epidemic of cardiovascular disease, in an attempt to illustrate of the various phases of translational research.
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Abstract
This study explores the issue of demand for health care and medicines in low-income country settings. Using the World Health Survey, multivariate analysis of cross-sectional household data from 35 low-income countries found that when ill, patient demand for health care to visit a clinic or hospital is inelastic ranging from -0.19 to 0.11. The main determinants of health seeking behaviour include having insurance, having a chronic condition, high household expenditure, and marital status. Women, the educated and those living in urban settings are more likely to seek care in a clinic. These findings suggest low-income patients will experience access problems, raising important policy implications to improve access to health care and medicines in these settings.
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Affiliation(s)
- Divya Srivastava
- OECD, Health Division, 2 Rue André Pascal, Paris, 75016, France; LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Alistair McGuire
- LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom
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Srivastava D, McGuire A. Analysis of prices paid by low-income countries - how price sensitive is government demand for medicines? BMC Public Health 2014; 14:767. [PMID: 25073407 PMCID: PMC4287477 DOI: 10.1186/1471-2458-14-767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to medicines is an important health policy issue. This paper considers demand structures in a selection of low-income countries from the perspective of public authorities as the evidence base is limited. Analysis of the demand for medicines in low-income countries is critical for effective pharmaceutical policy where regulation is less developed, health systems are cash constrained and medicines are not typically subsidised by a public health insurance system METHODS This study analyses the demand for medicines in low-income countries from the perspective of the prices paid by public authorities. The analysis draws on a unique dataset from World Health Organization (WHO) and Health Action International (HAI) using 2003 data on procurement prices of medicines across 16 low-income countries covering 48 branded drugs and 18 therapeutic categories. Variation in prices, the mark-ups over marginal costs and estimation of price elasticities allows assessment of whether these elasticities are correlated with a country's national income. RESULTS Using the Ramsey pricing rule, the study's findings suggest that substantial cross-country variation in prices and mark-ups exist, with price elasticities ranging from -1 to -2, which are weakly correlated with national income. CONCLUSIONS Government demand for medicines thus appears to be price elastic, raising important policy implications aimed at improving access to medicines for patients in low-income countries.
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Narayana SA, Kumar Pati R, Vrat P. Managerial research on the pharmaceutical supply chain – A critical review and some insights for future directions. JOURNAL OF PURCHASING AND SUPPLY MANAGEMENT 2014. [DOI: 10.1016/j.pursup.2013.09.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Russo G, McPake B, Fronteira I, Ferrinho P. Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities. Health Policy Plan 2013; 29:774-83. [PMID: 24077880 PMCID: PMC4153303 DOI: 10.1093/heapol/czt071] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Scarce evidence exists on the features, determinants and implications of physicians’ dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians’ engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% ‘outside’ public facilities, 8% ‘inside’ and 16% both ‘outside’ and ‘inside’. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians’ decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians’ engagement in professional activities, and contributes to an evidence base for its regulation.
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Affiliation(s)
- Giuliano Russo
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal and Institute for International Health Development, Queen Margaret University, Edinburgh, UK
| | - Barbara McPake
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal and Institute for International Health Development, Queen Margaret University, Edinburgh, UK
| | - Inês Fronteira
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal and Institute for International Health Development, Queen Margaret University, Edinburgh, UK
| | - Paulo Ferrinho
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal and Institute for International Health Development, Queen Margaret University, Edinburgh, UK
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Angeli F. With the help of a foreign ally: biopharmaceutical innovation in India after TRIPS. Health Policy Plan 2013; 29:280-91. [PMID: 23558959 DOI: 10.1093/heapol/czt015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article investigates the implications of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which reached full-fledged implementation in 2005, for the patenting activity of Indian biopharmaceutical companies. The Indian biopharmaceutical industry is well-known for its generic producers, whose business models capitalize on the opportunity to reverse-engineer patented compounds and produce them at low costs through process innovation. By strengthening intellectual property rights, TRIPS determined a major regulative change, which presents the characteristics of an institutional shock. The examination of the patenting and alliance activity of 123 Indian biopharmaceutical firms between 1999 and 2009 reveals two important insights. First, the innovation outcome of Indian biopharmaceuticals has sharply increased during the transition to TRIPS-compliant regulation, suggesting that Indian companies have been capable and willing to transit from an imitation-based to an innovation-based business model. Second, those biopharmaceutical firms holding cross-border alliances to foreign partners have proved significantly more successful at enhancing their innovative capability. This research delivers a multifold contribution to the policy debate surrounding the enforcement of TRIPS in emerging economies. First, it suggests that such regulatory change may have encouraged biopharmaceutical innovation in India, despite the sceptical voices who did not foresee any benefits because of inherent inertia of the industry. Second, by arguing and testing the advantages of foreign partnerships, this research highlights that the much feared return of pharmaceutical foreign companies to India could instead favour adaptation to institutional change. Implications for Indian public health are particularly critical. The impact of TRIPS on drug pricing and on the capability--and willingness--of Indian biopharmaceuticals to invest in local health conditions are two crucial points of discussion.
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Affiliation(s)
- Federica Angeli
- Department of Health Services Research, Maastricht University, Duboisdomein 30, Postbox 6200 MD, Maastricht, The Netherlands. E-mail:
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Wafula FN, Miriti EM, Goodman CA. Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature. BMC Health Serv Res 2012; 12:223. [PMID: 22838649 PMCID: PMC3520114 DOI: 10.1186/1472-6963-12-223] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. METHODS We searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually through references of retrieved articles. Our search included studies of all designs that described characteristics, knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist. Finally, we conducted a structured narrative synthesis of the main findings. RESULTS We obtained 61 studies, mostly from Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested, with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is known on the link between regulatory enforcement and practices of specialized drug shops. CONCLUSIONS Evidence suggests that characteristics and practices of specialized drug shops differ across rural and urban locations, and that these providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the governance of the retail pharmaceutical sector.
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Affiliation(s)
- Francis N Wafula
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
| | - Eric M Miriti
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
| | - Catherine A Goodman
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Kaplan WA, Ritz LS, Vitello M, Wirtz VJ. Policies to promote use of generic medicines in low and middle income countries: a review of published literature, 2000-2010. Health Policy 2012; 106:211-24. [PMID: 22694970 DOI: 10.1016/j.healthpol.2012.04.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/29/2012] [Accepted: 04/30/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Review the literature on the impact of policies designed to enhance uptake of generic medicines in low and middle income countries (LMICs). METHODS We searched for publications related to generic medicines policies (January 2000-March 2010) and did a bibliometric, descriptive analysis of the dataset in addition to an analysis of studies evaluating the impact of pro-generic policies. We repeated a subset of this larger search in January 2012. RESULTS Of the 4994 articles screened, 315 (6.3%) full-text publications were related to generic medicines policies. Of these 315, 236 (75%) dealt with generic medicine policies in high-income countries, and 79 (25%) with policies in LMICs. In total, we found only 10 evaluation studies looking at the impact of competition, trade, pricing and prescribing policies on generic medicine price and/or volume. Key barriers to implementing generic medicine policies in LMICs are negative perceptions of stakeholders (e.g., generics are of lower quality) plus perverse private sector financial incentives to sell products with the highest profit margin. Other relevant barriers are legal/regulatory, such as the absence of generic substitution regulations. There also exists a general difficulty in promoting generics due to a lack of transparency in the pharmaceutical supply and distribution system, for example, a lack of price information provided by health care provider organizations to physicians. CONCLUSION There is little policy evaluation to determine which pro-generic policies increase generic medicines utilization in LMICs. Ensuring a functioning medicines regulation authority, creating a reasonably robust market of generic medicines and aligning incentives for physicians, consumers and drug sellers are necessary prerequisites for increasing the uptake and use of generic medicines.
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Affiliation(s)
- Warren A Kaplan
- Center for Global Health & Development/Department of International Health, Boston University School of Public Health, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW In developing countries, most people who need medicines have to pay for them out of their own pockets. This review focuses on publications to explore the affordability gap of medicines and ways to close it. RECENT FINDINGS Cardiovascular medicines were unaffordable in low-income to middle-income countries, whereas dementia medicines were only affordable in regions of wealth. In urban Mozambique, local mark-ups are up to two-thirds of final price in private pharmacies, whereas some governments consistently paid higher prices above the international reference prices to procure a number of medicines. Generics competition from India made an originator brand manufacturer of a AIDS drug willing to supply the drug at a cheaper rate to poorer countries, whereas a Brazilian national program to produce nonprofit generics against protected patent of originator brand products to provide free AIDS drugs had cut the number of people dying by half and hospitalization by 80%, which saved about half a billion US dollars, making the program almost fund itself. SUMMARY Although lowering the manufacturer's price has a greater effect on the cost, policies to eliminate duties and taxes on medicines and regulate mark-ups are practical strategies to avoid excessive add-on costs.
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Waning B, Maddix J, Soucy L. Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan. BMC Health Serv Res 2010; 10:205. [PMID: 20626904 PMCID: PMC2914726 DOI: 10.1186/1472-6963-10-205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 07/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. METHODS We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). RESULTS Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with < US $25,000 due to governmental resource-sharing. The network operated at break-even profit, leaving little room to lower medicine prices and mark-ups. Medicine mark-ups needed for sustainability were greater than originally envisioned by network administration. In 2005, 55%, 35%, and 10% of the network's top 50 products revealed mark-ups of < 50%, 50-99% and > 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of < 50% and 50-99%, respectively; while 35% of products revealed mark-ups > 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. CONCLUSION Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals. Health systems researchers must document the positive and negative financial experiences of pharmacy initiatives to inform future projects and advance access to medicines goals.
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Affiliation(s)
- Brenda Waning
- Department of Family Medicine, Boston University School of Medicine, One Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA.
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