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Abstract 213 ICIUM: Antalya, Turkey. November 14-18, 2011

Abstract 213 ICIUM: Antalya, Turkey. November 14-18, 2011. BACKGROUND. Medicine prices vary significantly across Sub-Saharan African countries Strengthening health insurance programs could improve the availability and affordability of essential medicines

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Abstract 213 ICIUM: Antalya, Turkey. November 14-18, 2011

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  1. Abstract 213 ICIUM: Antalya, Turkey. November 14-18, 2011

  2. BACKGROUND • Medicine prices vary significantly across Sub-Saharan African countries • Strengthening health insurance programs could improve the availability and affordability of essential medicines • Health insurance is intended to reduce the financial burden of purchasing medicines and improve access • Many types of national, social, private, and community-based health insurance schemes are emerging

  3. POLICY IMPLICATIONS • Defining an effective, affordable minimum medicine benefits package within a health insurance context is an important step • Strengthen transparency through improved record management systems, provider and member education, • Mechanisms to integrate local population ownership and joint decision-making, • Expanded risk pooling that could mitigate the effects of adverse selection • Capacity building for medicines policy decision making is needed to strengthen existing systems • Strong government commitment and international donor support is needed to expand medicines coverage through health insurance systems

  4. STUDY AIMS No published information exists on: • the scope of medicine benefits provided by Sub-Saharan Africa health insurance programs • what data these programs have available to monitor performance or evaluate effects of changes in medicines coverage We therefore: • describe health insurance programs in Ghana, Kenya, Nigeria, Tanzania and Uganda, their medicine benefits, and the routine data available to them

  5. METHODS • We developed a survey to: • assess program structure, • characteristics of medicine benefits, • availability of routine data for decision making. • Distributed through National Program Officers in WHO AFRO • Sampled 82 health insurance programs, 33 (40%) returned completed survey • Responses presented in aggregate with no individual program identified.

  6. Very few health insurance programs cover the poor, the unemployed, and pensioners RESULTS Total responses: 28

  7. Most programs require that inpatient and outpatient medicines be dispensed as generics RESULTS Total responses: 23 (Blue), 23 (Red)

  8. Delays in payment and fraud are a serious problem with medicines benefit RESULTS Total responses: 17 (Blue), 18 (Red)

  9. Programs reported the three most important questions they would like answered RESULTS • Some medicines policy or coverage issues included: • concern about expanding pharmacy budgets and controlling medicines prices, • addressing product selection, cost, and cost-effectiveness of medicines, • combating counterfeit medicines, • implementing specific medicines management approaches, • improving adherence to generic prescribing, • responding to quality concerns of patients and providers about generic medicines, • assessing the effectiveness of newer, costly therapies, and • implementing computerized data management.

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