Achieving Successful Universal Health Coverage Depends on Medicines Management

Achieving Successful Universal Health Coverage Depends on Medicines Management

Ghana. {Photo credit: Rui Pires}Photo credit: Rui Pires

Modern medicines, vaccines, and other health technologies have revolutionized health care. Yet these products haven’t improved lives everywhere, often because health systems haven’t made them accessible and affordable. In many developing countries, where health systems still rely heavily on out-of-pocket expenditure, patients face high costs at the point of service. Some people forgo necessary care; others endure financial hardship or even impoverishment. A majority of out-of-pocket spending goes towards medicines.

The goal of universal health coverage (UHC) is to improve equitable access to health services while protecting households from impoverishing out-of-pocket health spending. Momentum for UHC in the global community has been growing significantly, with a United Nations resolution in its favor and strong support from the World Health Organization (WHO) and World Bank. In principle, UHC means lifesaving drugs will be accessible and affordable for those who need them. But in practice, medicines coverage in country UHC plans and in private insurance schemes is often under-rated in terms of cost or importance and is sometimes not recognized at all.

Countries must understand that medicines are a major cost factor and that runaway medicine benefit costs will limit UHC progress. For example, in the first three years of Ghana’s national health insurance scheme, from 2006 to 2008, medicines rose from 25 percent to 46 percent of the total benefits, which contributed to reimbursement delays and service disruption. Some of the growth reflected unmet need; however, a 30 percent increase in the number of medicines prescribed per patient, a quadrupling of medicines cost per claim, and large inexplicable cost variations among districts indicated inefficiencies and overuse.

solutions for controlling medicines costs

Monitoring UHC performance and strengthening pharmaceutical management can contain costs and maximize efficiencies: five of the ten leading causes of waste in health systems relate directly to pharmaceuticals. Effective procurement and distribution, a robust quality assurance system, and financial and managerial audits decrease waste. Because medicines are relatively expensive and easy to divert, corrupt practices occur in pharmaceutical systems everywhere in the world; therefore, transparency must be the hallmark of good governance for UHC.

Starting a Dialogue on Medicines in UHC

To start a dialogue on medicines in UHC, MSH, in collaboration with Harvard Medical School Department of Population Medicine and the Rockefeller Foundation, and with additional support from the Pan American Health Organization (PAHO) and the US Agency for International Development (USAID), held a meeting on June 2–4, 2013 in Washington, DC. The event brought together representatives from ministries of health, country insurance schemes, international development agencies, the donor community, academia, and the private sector, and provided an opportunity to advance the understanding of the important role medicines play in UHC expansion. Country representatives traveled from Bangladesh, Costa Rica, Ethiopia, Ghana, Mexico, Myanmar, Namibia, the Philippines, and South Africa.

["Knowledge Wall" from Medicines as Part of Universal Health Coverage".] {Graphic facilitation by dpict}"Knowledge Wall" from Medicines as Part of Universal Health Coverage".Graphic facilitation by dpict

Meeting participants agreed to advocate for the need to align pharmaceutical policies with UHC goals from the very beginning and to target how medicines are chosen, managed, and used if UHC is to positively affect health outcomes in an affordable way. To continue the dialog that we launched at the June 2013 meeting, MSH has introduced a website dedicated to information surrounding medicines in universal health coverage:

MSH is helping countries consider options and implement strategies for effectively managing the pharmaceutical benefit component of UHC. We hope to facilitate future efforts through our work and share supportive information on the website. Without access to medicines, countries cannot make any progress toward goals to reduce the number of avoidable deaths due to common conditions (such as malaria and high blood pressure). Along with preventing illness in the first place, ensuring access to equitable, appropriate, and affordable medical treatment is crucial to achieving UHC’s health and financial protection goals.

Douglas Keene is vice president of the Center for Pharmaceutical Management and global technical lead on universal health coverage at MSH.

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