TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Matthew Jowett, PhD Senior Health Financing Specialist Dept. Health Systems Governance & Financing WHO Geneva 29 th October 2013 Health financing policy, medicines and universal health coverage TBS Seminar on Essential Medicines and Health Products

Geneva, 29 October 2013 Universal health coverage goalsThree dimensions interlinkedEvidence from European RegionInstruments in support of UHC

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Universal health coverage goals Equity in service use (reduce gap between need and utilization) Quality of services (sufficient to improve health) Financial protection (no-one becomes poor as a result of paying for care)

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October dimensions of health care coverage Equity in service use Quality

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Moldova 2007 Population enrolment in national health insurance scheme

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 XXXXXXXX

- Formal sector workers (salaried) - Civil servants and private sector - Mandatory contributions (payroll tax) -Informal sector / non-wage -Below the official poverty line -Fully subsidized insurance contributions shared between local and national government -Informal sector / non-salaried -Above the official poverty line -Voluntary contributions with no subsidy

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October Financial coverage dimension

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Insurance effect? Moldova…..

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Georgia - outpatient medicines drives OOPs

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 More (public) money for health Public spending crowds displaces out-of-pocket payments

More health for the money…… Ref: World Health Report 2010, Chapter 4 Medicines: under-use of generics and higher than necessary prices Medicines: use of sub-standard and counterfeit medicines Medicines: in appropriate and ineffective use Services: inappropriate hospital size (low use of infrastructure) Services: medical errors and sub- optimal quality of care Services: inappropriate hospital admissions and length of stay Services & products: oversupply and overuse of equipment, investigations and procedures Health workers: inappropriate or costly staff mix, unmotivated workers Interventions: inefficient mix / inappropriate level of strategies Leakages: waste, corruption, fraud

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Estimated average (median) retail mark-ups: Georgia and selected EU countries EU price source: OBIG/PPRI

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Affordability of standard treatments as % of minimum subsistence allowance

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Portugal - May 2011 Set the maximum price of the first generic introduced in the market to 60% of the branded product with similar active substance; revise reference-pricing system based on international prices Pricing and reimbursement of pharmaceuticals Electronic prescription for medicines & diagnostic covered by public reimbursement compulsory for physicians in public and private sector; improve monitoring system of prescription and set in place a systematic assessment by individual doctor in terms of volume and value; induce physicians at all levels of the system, public & private, to prescribe generic medicines & the less costly available branded product; establish clear rules for the prescription & complementary diagnostic exams (prescription guidelines for physicians); remove entry barriers for generic medicines. Prescription and monitoring prescription Change the calculation of profit margin into a regressive mark-up and a flat fee for wholesale companies and pharmacies; ensures a reduction in public spending and encourage the sales of less expensive pharmaceuticals; lower profits will contribute at least 50M€ to the reduction in public expense with drugs distribution. If this does not produce the expected savings in the distribution profits, introduce a pay-back scheme. Pharmacies sector Set up centralized procurement system for purchase of medical goods, to reduce costs and waste; finalize coding system and common registry for medical supplies; take measures to increase competition among private providers and reduce by at least 10% overall NHS spending with private providers delivering diagnostic and therapeutical services by end 2011 and by an additional 10% by end 2012; introduce regular revision of fee s paid to private providers to reduce cost of more mature diagnostic & therapeutical services; assess compliance with European competition rules. Centralized purchasing and procurement

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013 Some instruments to support UHC Spend on cost- effective public health interventions Better mix, distribution, capacity of HRH Targeted incentives to those using & delivering priority services Ensure health financing as “pooled” as possible

TBS Seminar on Essential Medicines and Health Products Geneva, 29 October 2013