healthcare reforms and pharmaceuticals lessons from turkey prof. dr. mehtap tatar hacettepe...
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Healthcare Reforms and Pharmaceuticals
Lessons from Turkey
Prof. Dr. Mehtap TatarHacettepe UniversityFaculty of Economics and Administrative SciencesDepartment of Health Care Management
Health Transformation Program2003 -
OPurchaser-provider splitOFamily practitioner schemeOGeneral health insuranceOHospitals with administrative and
financial autonomy
Extension of private hospital use
2003
Performance based payment
2004
Pilot family practitioner scheme
2005
Extension of Green Card Benefits
Transfer of SSK hospitals
2008
Coverage of population under 18
2010
Extension of family practitioner scheme
2011
Full time and university performance based system
Introduction of GHI
Health campuses
Major reform initiatives
Use of private pharmacies by SSK
Impact of the program
OImproved accessOIncreased share of private
providersOIncreased satisfaction with the
systemOIncreased health expenditures
Improved access
OBefore reforms, among those who felt health care need:• 13% did nothing• 19% used self treatment• 30% used self prescribed medicine
(National Health Accounts Household Survey, 2003)
Outpatient visit per person per year
2002 2003 2004 2005 2006 2007 2008 2009
Total 2.79 2.93 3.36 4.27 4.98 5.73 6.28 7.27
MoH PHC 0.9 0.99 1 1.54 1.84 2.2 2.45 2.72
MoH Hospital 1 1.03 1.35 2.4 2.73 2.97 3.03 3.15
Private 0.07 0.08 0.09 0.16 0.22 0.33 0.5 0.66
University 0.13 0.14 0.16 0.17 0.18 0.21 0.26 0.27
0.5
1.5
2.5
3.5
4.5
5.5
6.5
7.5
Total MoH PHC MoH Hospital Private University
2,79
7,27
MoH
Increasing share of private providers
2002 2003 2004 2005 2006 2007 2008 20090
5000000
10000000
15000000
20000000
25000000
30000000
35000000
40000000
45000000
50000000
4.407.122
47.618.188
Number of outpatient visits to private hospitals
MoH
Increased satisfaction (%)
2003 2004 2005 2006 2007 2008 2009 201030
35
40
45
50
55
60
65
70
75
80
39.5
46.9
55.3
52.3
68.5
63.4
65.1
73.1
MoH
Increased health expenditures Health Expenditure/GDP (%)
2000 2001 2002 2003 2004 2005 2006 2007 2008 20093
3.5
4
4.5
5
5.5
6
6.5
7
4.9
5.25.4 5.3 5.4
5.45.8
65.9
6.5
Pricing of pharmaceuticals
OExternal reference pricingO cheapest of France, Greece, Italy,
Portugal, Spain
OPublic priceO Public discount on retail price (currently
41% for originals)
OInternal reference pricingO Cheapest + 10%
External reference pricing
2004
VAT to 8%
2005
Pozitive list
Internal reference pricing cheapest+ 30%
2006
20% co-payment for Green Card
Internal reference pricing cheapest + 22%
2007
Reimbursement commission
2009
Generic price 66% of the original
Major pharmaceutical regulations
2010
Internal reference pricing cheapest + 15%
Global budget2010:14,6 billion TL2011: 15,6 billion TL2012: 16,7 billion TL
2010
32,5% public discount for originals
New GMP regulations
2010
3D Barcode system introduced
2011-?????
Major pharmaceutical regulations
2004 2005 2006 2007 2008 20090
2
4
6
8
10
12
14
16
18
8.9210.06
11.28
13.01
14.52
16.21
Total pharmaceutical expenditure (billion TL)
www.aifd.org.tr
Performance based payment system
Transfer of SSK Hospitals
Increased use of private hospitals
Extension of Green Card benefits
Coverage of population under 18
Family Practitioners
Health campusesAutonomous hospitals
Issues on the agenda
OHealth Technology Assessment OFurther discountsORational drug useORestrictions on prescriptions
Thank [email protected]
2010
Internal reference
pricing cheapest +
15%
Global BudgetBillion TL 2010: 14.62011: 15.62012: 16.7
2010
32,5%discount for
originals
New GMP regulations
2010
3D Barcode system
introduced
2011 - ???
Major pharmaceutical regulations
Reorganization of the MoH2.11.2011
OTurkish Medicines and Medical Devices AgencyOMarket regulationOMarketing approvalOPricing (pharmacoeconomic analysis
for pricing)
Health Implementation Guideline 5.11.2011
OChanges in public discountsOOriginals without generics 41%OOriginals with generics 28%OGenerics 28%
OInternal reference pricing cheapest + 10%
Points to considerOImpact analysis of reforms is crucial?OWhat are the drivers for increasing
expendituresO Isolated emphasis on spending or
utilization alone can be problematicOWhat is the limit for discounts?OWho will be most affected by
discounts?
Thank [email protected]