RESUMO
The high cost of drugs for hepatitis C limits access and adherence to treatment. In 2017, the Colombian health care system decided to design a strategy. It consisted of centralized purchasing, regulations, clinical practice guidelines, and direct observation of the treatment and follow-up of patients. The main objective of this study was to assess the centralized purchasing strategy in Colombia. The study design was a policy implementation assessment. We analyzed the change in prices, the clinical outcomes, and the opinions of stakeholders using data from the Ministry of Health. Additional information about effectiveness came from the Colombian Fund for High-Cost Diseases and semi-structured interviews of the stakeholders. The follow-up was from October, 2017 to October, 2018. The total number of patients reported in the cohort period was 1069. The number that finished 12 weeks of treatment, completed the follow-up for the case closure, and were considered cured through the end of October, 2018 was 563 (53%). The remainder, 506 patients (47%), are currently in treatment. A total of 543 of these treated patients (96%) were cured. After implementing this strategy, the drug prices decreased by more than 90% overall. Before implementation, the total direct cost was $100 102 171.75 dollars. Afterward, the cost was $8 378 747 dollars.
Assuntos
Antivirais/economia , Atenção à Saúde/organização & administração , Custos de Medicamentos/legislação & jurisprudência , Implementação de Plano de Saúde , Hepatite C/tratamento farmacológico , Antivirais/uso terapêutico , Colômbia/epidemiologia , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício , Atenção à Saúde/economia , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/normas , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Indústria Farmacêutica/estatística & dados numéricos , Feminino , Compras em Grupo/economia , Compras em Grupo/legislação & jurisprudência , Compras em Grupo/organização & administração , Compras em Grupo/normas , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Negociação , Políticas , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Participação dos Interessados , Resultado do TratamentoRESUMO
OBJECTIVE:: The financial coordination of the System of Social Protection in Health (SPSS) was analyzed to assess its support to strategic purchasing. MATERIALS AND METHODS:: Official reports and surveys were analyzed. RESULTS:: SPSS covers a capita of 2 765 Mexican pesos, equivalent to 0.9% of GDP. The Ministry of Health contributed 35% of the total, state governments 16.7% and beneficiaries 0.06%. The National Commission for Social Protection in Health received 48.3% of resources, allocating 38% to State Social Protection Schemes in Health and paying 7.4% of the total directly to providers.The state contribution is in deficit while family contributions tend not to be charged. CONCLUSION:: SPSS has not built funds specialized in strategic purchasing, capable of transforming historical budgets.The autonomy of providers is key to reduce out-of-pocket spending through the supply of quality services.
Assuntos
Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde , Programas Nacionais de Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Orçamentos , Compras em Grupo/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , México , Programas Nacionais de Saúde/organização & administração , Política Pública , Cobertura Universal do Seguro de Saúde/organização & administraçãoRESUMO
Resumen: Objetivo: Analizar la coordinación financiera del Sistema de Protección Social en Salud (SPSS) y su capacidad para apoyar la compra estratégica de servicios. Material y métodos: Se analizaron informes oficiales y encuestas. Resultados: El SPSS cubre una cápita por afiliado de 2 765 pesos mexicanos, equivalente a 0.9% del PIB para 2013. La Secretaría de Salud asignó 35% del total; los gobiernos estatales 16.7%, y los beneficiarios 0.06%. La Comisión Nacional de Protección Social en Salud recibió 48.3% de estos recursos, de los cuales asignó 38% a los estados y pagó directamente a prestadores 7.4% del total. El aporte estatal está en déficit mientras que las contribuciones familiares tienden a no cobrarse. Conclusión: El SPSS no ha integrado fondos especializados en la compra estratégica capaz de transformar los presupuestos históricos. La autonomía de los prestadores es clave para que puedan contribuir a reducir el gasto de bolsillo mediante la oferta de servicios de calidad.
Abstract: Objective: The financial coordination of the System of Social Protection in Health (SPSS) was analyzed to assess its support to strategic purchasing. Materials and methods: Official reports and surveys were analyzed. Results: SPSS covers a capita of 2 765 Mexican pesos, equivalent to 0.9% of GDP. The Ministry of Health contributed 35% of the total, state governments 16.7% and beneficiaries 0.06%. The National Commission for Social Protection in Health received 48.3% of resources, allocating 38% to State Social Protection Schemes in Health and paying 7.4% of the total directly to providers.The state contribution is in deficit while family contributions tend not to be charged. Conclusion: SPSS has not built funds specialized in strategic purchasing, capable of transforming historical budgets.The autonomy of providers is key to reduce out-of-pocket spending through the supply of quality services.
Assuntos
Humanos , Gastos em Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/economia , Financiamento Governamental/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Política Pública , Orçamentos , Compras em Grupo/economia , Cobertura Universal do Seguro de Saúde/organização & administração , México , Programas Nacionais de Saúde/organização & administraçãoRESUMO
This article discusses the potential for health sector cost containment in developing countries through improved pharmaceutical procurement. By describing the specific example of the Eastern Caribbean Drug Service (ECDS), which provides a pooled procurement service to nine ministries of health in the small island nations of the Caribbean, it examines the elements of the procurement operation that allowed ECDS to reduce unit costs for pharmaceuticals by over 50 per cent during its first procurement cycle. The analysis of ECDS considers: (1) political will, institutional alliances, and the creation of a public sector monopsony; (2) pooling demand; (3) restricted international tendering and the pharmaceutical industry; (4) estimating demand and supplier guarantees; (5) reducing variety and increasing volume through standardizing pack sizes, dosage forms and strengths; (6) generic bidding and therapeutic alternative bidding; (7) mode of transport from foreign suppliers; (8) financing mechanisms, including choice of currency, foreign exchange, and terms of payment; (9) market conditions and crafting and enforcing supplier contracts; and, (10) the adjudication process, including consideration of suppliers' past performance, precision requirements in the manufacturing process, number of products awarded to suppliers, and issues of judgment. The authors consider the relevance of this agency's experience to other developing countries by providing a blueprint that can be adopted or modified to suit other situations.
Assuntos
Compras em Grupo/economia , Preparações Farmacêuticas/provisão & distribuição , Controle de Custos/métodos , Países em Desenvolvimento , Custos de Medicamentos , Indústria Farmacêutica , Compras em Grupo/organização & administração , Pesquisa sobre Serviços de Saúde , Preparações Farmacêuticas/economia , Política , Setor Público , Índias OcidentaisRESUMO
El presente Manual de Procedimientos contiene una descripcion detallada de la estructura y mecanismos de funcionamiento del Fondo de Medicamentos Esenciales de Centroamérica (FOMECA). Los objetivos principales del FOMECA son mejorar la disponibilidad de médicamentos seleccionados, aprovechar las economías de escala que se obtienen al efectuar compras conjuntas para siete países y contribuir al uso mas eficaz de las divisas que se destinan a la adquisicion de médicamentos en el sector publico