Guide to Drug Financing Mechanisms
J. Dumoulin, M. Kaddar, and G. Velasquez, 1998, vii + 55 pages (available
in English; French in preparation) ISBN 92 9036 068 2, CHF 19.-/USD
17.10; In developing countries: CHF 13.30. Order no. 1150461.
This book provides a practical guide to the use of economic criteria
to analyze a country's pharmaceutical sector and identify ways to
improve the drug supply. Addressed to decision makers responsible
for formulating drug policies, the book aims to facilitate the analysis
of expenditure on drugs within the context of a government's overall
economic policies and priorities. With this goal in mind, the book
explains the many complex economic factors that influence the drug
supply and identifies the corresponding policy options available for
introducing changes in different situations.
Information ranges from a discussion of strategies for avoiding
surpluses or shortages of drugs, through a comparison of the advantages
and disadvantages of four methods of delivering drugs to pharmacies,
to the simple reminder that cost alone should never be the sole criterion
for drug selection in national procurement schemes. Throughout the
book, recommended policies and strategies are presented in line with
the overall objective of ensuring that safe, effective, good-quality
drugs are available to those who need them at the least possible cost.
The book opens with a brief analysis of three interrelated systems
that shape the pharmaceutical sector: the pharmaceutical supply system,
the financing system by which the manufacturers and distributors of
drugs are paid, and the information system which influences consumer
demand and prescribing practices. Against this background, subsequent
chapters explain how these three systems affect the performance of
the pharmaceutical sector during the distinct steps of drug selection,
procurement, distribution, and prescribing. Each step is discussed
in terms of the objectives of a national drug policy, the processes
that allow these objectives to be attained, and the structures and
organizational arrangements needed to carry out these processes and
attain these objectives.
The chapter on selection considers strategies for avoiding drugs
of no therapeutic interest, reducing the number of drugs, and increasing
the efficiency of available drugs. Methods for measuring drug costs
and efficacy are also presented and illustrated with examples taken
from different countries. Chapter 2 explains the advantages and disadvantages
of three common strategies for drug procurement: blind confidence,
systematic distrust, and cooperation. Examples from various countries
are used to demonstrate the effects that specific procurement strategies
can have on both immediate and future drug costs.
Distribution is covered in Chapter 3, which considers factors that
influence geographical, physical, and economic access to drugs. Particular
attention is given to the advantages and disadvantages of different
options for financing drug consumption and preventing stock shortages,
surpluses, and losses of drugs. The final chapter considers lines
of action for improving prescribing practice and thus reducing the
economic costs of irrational prescribing.
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