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Introduction

This longitudinal study assesses the impact of the Positive List system on prescribing patterns and medication costs for adult pneumonia patients in PHIC-accredited hospitals. The study reveals insights into physician choices, drug costs, and antibiotic types pre and post-implementation of the Positive List.

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Introduction

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  1. IMPACT ON THE USE AND COST OF MEDICINES OF EXPANDED DRUG COVERAGE VIA A POSITIVE LIST IN THE PHILIPPINES: A LONGITUDINAL STUDY Acuin J for the QARPDG Group (Valera M, Acuin J, Soria F, Lavina S, Barbosa J, Bacting M, Palafox B)

  2. Introduction • The National Health Insurance program covers mainly inpatient care up to pre-set limits for each of the following components: • drugs, supplies, surgical procedures, room and board • Drug prescriptionsconstitute the largest proportion (32% of the total benefit payments) • The expansion of the list of reimbursable drugs through the implementation of the Positive List was aimed at increasing choice and improving adherence to practice guidelines

  3. General Objective To determine the impact of expanded drug coverage (Positive List) implemented by the Philippine Health Insurance Corporation on prescribing patterns of physicians and medication costs among adult patients diagnosed with pneumonia admitted in PHIC accredited hospitals before and after its implementation in October 2000.

  4. Methods • A time series design • consisting of 12 monthly time points immediately before and after a 3-month implementation period of the Positive List • 18 PHIC-accredited tertiary hospitals randomly selected from three major urban centers in the Philippines

  5. Methods • Main outcomes • Monthly average percentage antibiotic prescriptions (total, national formulary and positive list antibiotic prescriptions) • Monthly average total drug costs per hospitalization • Monthly average percentage of appropriate antibiotic types • PHIC vs non-PHIC members • Rolling 3 month averages

  6. RESULTS

  7. Positive List Implementation

  8. Monthly percent cefuroxime prescriptions unchanged government private Positive list implementation Positive List Implementation

  9. Conclusions • The Positive List expanded physicians’ choice. • We found no effect on prescribing patterns and drug costs. • We found an increasing trend in the use of appropriate antibiotic types unrelated to the Positive List.

  10. Implications • Suggests weak policy dissemination and resistant inappropriate practice patterns among largely unregulated “free agents” • May confirm lack of effectiveness of single interventions, including financial incentives

  11. Implications • Impact of discrete strategies on whole policy environment controlling access to drugs • Positive list strategy may be a low risk policy lever • Multiple interventions targeting both institutions and individual drug prescribers but also overall drug supply and demand

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