medicines as a key component of universal health coverage...4. identify system needs and approaches...

Medicines as a Key Component

of Universal Health Coverage

International Expert Consultation

Kent Ridge Guild House, NUS Singapore

2 to 4 October 2013

Medicines as a Key Component of Universal Health Coverage International Expert Consultation ‐ Singapore, 2 to 4 October 2013 2

Dear Colleagues, Welcome to National University of Singapore! The Centre for Biomedical Ethics was established in 2006 in the Yong Loo Lin School of Medicine to undertake innovation in medical education in the areas of health ethics, law and professionalism. Since then, it has also initiated a wide range of multi‐disciplinary research projects on health policy and services, as well as fostered international research collaborations. In partnership with Harvard Medical School, we are pleased to facilitate, through this meeting, continuing regional discussion and collaboration on medicines management and policy strategies directed at implementing Universal Health Coverage (UHC). Values are implicit to fundamental questions that arise from UHC. They underlie decisions in priority‐setting and resource allocation. Optimal use of available resources is itself a value judgement, often defined only in terms of cost efficiency, which is but one among many different and competing values. As is well recognised, the most efficient way of using resources is not always the most equitable. What makes coverage “equitable” and what are the means to monitor and evaluate equity? What should be identified as “waste”? These are some questions that relate to notions of responsibilities that should be ethical and legally defensible – whether on the part of healthcare financiers, healthcare providers or individual patients and their significant others. In addition, there are values underpinning means of raising sufficient resources for health and in identifying, as well as removing financial risks and barriers to access. Some of the complexities and challenges in paying service providers could perhaps be more effectively addressed by cultivating a stronger sense of ethical commitment among healthcare institutions and workers. We would like to thank our collaborators, Associate Professor Anita K. Wagner and Associate Professor Dennis Ross‐Degnan of Harvard Medical School, and Dr Klara Tisocki and Mrs Laila Bunoan of the WHO Western Pacific Regional Office (WPRO), and our colleague Mr Karel Caals, for their untiring work in putting this meeting together. We are also grateful to WPRO for co‐sponsoring this event. We wish all of you an exciting and enriching time in networking, building and advancing collaborations, and sharing knowledge and experiences.

Alastair V. Campbell, CorrFRSE, MA, BD, ThD Chen Su Lan Centennial Professor of Medical Ethics and Director

Calvin W. L. Ho, LLM, MSc, JSD Advocate & Solicitor (Singapore) Assistant Professor

Centre for Biomedical Ethics, Yong Loo Lin School of Medicine National University of Singapore


Dear Colleagues. On August 15, 2013, WHO Director General Dr Chan introduced the World Health Report 2013 saying “Universal coverage means quality health care for all delivered in ways that protect users from financial ruin or impoverishment” and highlighted that ”[T]he challenge is to expand health services with constant attention to causes of waste and inefficiency that can be reduced through smart policies and wise decisions.”1 Medicines are a major driver of quality, safety, equity, and cost of care in low and middle‐income country (LMIC) health systems. UHC goals cannot be achieved and country medicines situations will not improve without wise medicines policies. The International Expert Consultation on Medicines as a Key Component of Universal Health Coverage takes place at a time when countries are operationalizing their plans to achieve universal health coverage. As co‐organizers of the IEC, we are delighted to have this opportunity to learn from and work with expert participants coming together in Singapore to share experiences, build on each other’s insights, and plan for ways to improve medicines situations of vulnerable populations as a key objective of universal health coverage.

Anita K. Wagner, PharmD, MPH, DrPH Associate Professor

Dennis Ross‐Degnan, ScD Associate Professor

Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute

1 Dr Margaret Chan. Remarks at the Launch of the World Health report 2013: Research for Universal Health Coverage. Beijing, 15 August 2013. [Cited 10 September 2013]. Available from: www.who.int/dg/speeches/2013/whr_20130815/en/index.html


Dear Friends and Colleagues, On behalf of the WHO Western Pacific Regional Office, it is a great pleasure to welcome you to Singapore to this International Expert Consultation on Medicines as Key Components of Universal Health Coverage. Medicines are often not adequately financed from public sources or sufficiently covered in health insurance benefit packages in many Asia Pacific countries. This lack of coverage increases health inequities for those who cannot afford to pay out of pocket for their medicines. Addressing such inequities in access to essential medicines must be a first priority in the efforts of countries to achieve universal health coverage (UHC). UHC is a key solution for this problem, when it ensures access to quality services, including effective and quality assured medicines, without placing heavy financial burden on patients. The goal of improving access to medicines and the health of populations in all countries is constrained by limits on resources. Policymakers in governments and insurance schemes have a tough task to deal with the numerous and complex issues in order to maximize coverage for medicines and bring value for money at the same time. This consultation has been designed to provide an opportunity for innovative and comprehensive discussions on what are the major challenges and the needs of policymakers to improve access to medicines as their health systems are moving towards UHC. We hope that your interactions with your colleagues will stimulate a creative exchange of ideas and also will be the start of long‐term collaborations, to learn about good practices and effective policy interventions in medicines management practices that result in equitable, affordable and sustainable access to and quality use of medicines as part of UHC. Have a pleasant stay in this beautiful city in Singapore! Klara Tisocki, B.Pharm, MSc Clin.Pharm., PhD Team Leader

Essential Medicines and Health technology, Division of Health Sector Development WHO Regional Office for the Western Pacific (WPRO)


Background Medicines are central to achieving the health care access, quality, and risk protection goals of universal health coverage (UHC). Wise medicines management and sound policies are also crucial for the financial sustainability of UHC schemes. Countries and schemes pursuing UHC are at different stages of developing and implementing targeted medicines management and policy approaches. They can benefit from and are interested in sharing strategies, tools, and experiences. Goals of the IEC The IEC’s goal is to facilitate regional collaborations on evidence‐informed medicines management and policy strategies in countries working toward UHC. The IEC brings together 57 experts from different stakeholder groups, including healthcare and health financing institutions, academia, and development partners in 14 countries: Australia, China, Germany, Indonesia, Korea, Lao, Malaysia, Netherlands, Mongolia, Philippines, Singapore, Thailand, United States, and Viet Nam. During the 2.5‐day meeting, participants will: 1. Share results from the Medicines and Insurance Coverage (MedIC) Initiative study of medicines

policies in 10 insurance schemes in 5 Asian countries; 2. Discuss key challenges and experiences in medicines management and policy design,

implementation, monitoring, and evaluation when working toward UHC; 3. Identify ethical, legal, and social issues that have arisen, or are expected to arise, on the path

to UHC; 4. Identify system needs and approaches for addressing medicines challenges as part of UHC

implementation; and 5. Propose to WPRO and other development partners a regional network for sharing tools,

approaches, and experiences across countries to support development, implementation, monitoring and evaluation of health system‐based medicines management and policy strategies.


IEC Structure The structure of the International Expert Consultation will be highly participatory. Topics for discussion have been selected to reflect key factors that need to be addressed for sound medicines management and policy development in health systems. These factors emerged from a previous survey of 10 insurance schemes in the region and from input by subject matter experts. In large group plenary sessions, participant experts will introduce a topic and provide overviews from the perspectives of different country settings. In moderated small group conversations, participants will generate ideas based on experiences regarding identified topics. The small group discussions will be conducted using the World Café Method. Briefly, in each small group session, 1/3rd of the participants will contribute their insights on a topic for about 20 minutes before they move on to the next topic; the small group facilitator will summarize the previous discussion for the next group of participants who will build on the previous discussion. Small group facilitators and rapporteurs will summarise the three sets of discussions for discussion by all participants in subsequent plenary sessions. Two key questions will guide World Café conversations: Which are your experiences regarding equitable access to affordable, appropriately used medicines? What would support your next steps toward this goal? During the course of the meeting, participants will identify available regional resources and system needs, which they will consider on Day 3 as input into a consensus statement. This statement may include a proposal to form a regional network on UHC and medicines. Opportunities will also exist for country experts who wish to do so to share their system’s experiences around medicines in individual video‐taped interviews, which, with permission from the interviewee, will be posted on an IEC summary webpage. Participants will be encouraged to share medicines policy and procedure documentation from their systems. Meeting organisers will assemble electronic files of documents on IEC topics to share with participants, and, to the extent permitted, on the IEC summary webpage.


World Café Method Small‐group IEC sessions will use the World Café Conversations methodology. Below we provide a brief overview. What are World Café Conversations? World Café Conversations are a method for collaborative dialogue to share knowledge and ideas. Café Conversations are designed to enable us to see new ways to make a difference. The Café method assumes that: people have the capacity to work together; we need differing perspectives to understand complex realities; individual contributions spark collective insights; and that, by listening to each other and building on each other’s’ contributions, new ideas emerge. How will the Café method be implemented at the IEC?

In each breakout session, participants discuss topics in three small groups around two tables each.

Each group has an overarching topic, up to three subtopics, and two key questions.

At 15‐20‐minute intervals, participants move from one group to the next.

Group hosts remain with their topic tables and summarize the previous discussion to the next group of participants. In this way, conversations are cross‐fertilized by previous conversations on the same topic among other participants; and by discussions of other, related topics in the other groups.

After 3 cycles, each participant had an opportunity to contribute to each topic.

Small group rapporteurs then summarize discussions on their topic in a plenary session and participants draw conclusions in plenary.

What are the responsibilities of IEC Café Facilitators? Facilitators will:

Welcome participants to group tables, and help observe the Café Etiquette;

Briefly explain the topic, subtopics, and questions for discussion, with a summary of prior key insights;

Listen carefully and encourage everyone to participate and note insights, ideas, connections on ‘sticky paper’;

Work with the rapporteur to make sure that key insights are recorded and posted. What are the responsibilities of IEC Café Rapporteurs? Rapporteurs will:

Listen carefully;

Record insights on sticky paper in large handwriting and post papers on walls, grouped by “affinity”;

Create and present in the subsequent plenary a 10‐minute summary of the insights, ideas, links generated;

Share a more detailed written summary (bullet point format, using the template at www.surveymonkey.com/s/IEC‐Rapporteur‐Form of the discussion with conference organizers by 9pm of the respective day.


What are the responsibilities of IEC Café Participants? Participants will:

Focus on what matters;

Contribute your thoughts;

Speak your mind and heart;

Listen openly to understand; to realize patterns, insights and deeper questions;

Link and connect ideas that emerge;

Write, doodle, draw – noting insights, ideas, connections on ‘sticky papers’;

We hope the IEC World Café Discussions will lead to new insights and actions, based on our collective wisdom.

Have fun!

Adapted from published descriptions of the method:

www.theworldcafe.com.

Brown J, Isaacs D. The World Café. Shaping our futures through conversations that matter. San Francisco: Berrett‐Koehler Publishers, Inc., 2005.

Slocum N. Participatory Methods Toolkit. A practitioner’s manual. Method: The World Café. 2005. Available at www.kbs‐frb.be/uploadedfiles/kbs‐frb/files/en/pub_1540_toolkit_13_worldcafe.pdf.


Wednesday, 2 October 07:05 ‐ 08:00 Bus transfer from hotel to conference venue 08:00 ‐ 08:30 Registration

08:30 ‐ 09:30 Welcome Facilitator: Dr Calvin Ho Rapporteur: Dr Wendy Lipworth Welcome: Professor John Wong, Vice Provost (Academic Medicine) and Isabel Chan

Professor in Medical Sciences, Yong Loo Lin School of Medicine, NUS Dr Kelvin Bryan Tan, Director, Policy Research and Economics Office, Ministry of

Health, Singapore Dr Klara Tisocki, Team Leader, Division of Health Sector Development, Western

Pacific Regional Office, World Health Organization Dr Andreas Reis, Technical Officer, Department of Ethics and Social

Determinants, World Health Organization, Headquarters, Geneva Dr Anita K. Wagner, Associate Professor, Harvard Medical School and Visiting

Associate Research Professor, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, NUS

Welcome of participants to the IEC by representatives of NUS, WPRO, and WHO

Introductions of participants by country

Rationale for goals, objectives, agenda, structure, and intended output of the IEC 09:30 ‐ 10:00 Break

10:00 ‐ 11:00 Universal health coverage and medicines Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Sun Jing Discussant: Dr Anita K. Wagner

Presentation of a framework of medicines in health systems, as basis for medicines management programs and benefit policies for universal health coverage (UHC), including stakeholder roles, responsibilities, and levers

The Medicines and Insurance Coverage (MedIC) Asia Study: collaborators, rationale, methods, and summary results

Country and scheme experiences regarding medicines in health systems of the path to UHC

Introduction to World Café conversations


Wednesday, 2 October

Supply and demand side factors from a system perspective 11:00 ‐ 12:00 World Café Discussion Groups 1a – Determining need and selecting medicines for coverage

Facilitator: Dr Klara Tisocki Rapporteur: Dr Noel R. Juban

Determining clinical and public health needs for medicines, by population groups and level of care

Determining economic needs of households for medicines coverage

Matching and continuously updating standard treatment guidelines, essential medicines and reimbursement lists

1b – Medicines supply strategy, setting prices, purchasing

Facilitator: Dr Anita K. Wagner Rapporteur: Ms Viktoria Rabovskaja

Ensuring continuity of supply

Ensuring product quality

Understanding medicines price components; negotiating or setting prices 1c – Provider accreditation and contracting

Facilitator: Dr Hans Hogerzeil Rapporteur: Dr Francisco Soria

Accrediting suppliers and providers, including private sector providers

Contracting with manufacturers, distributors, prescribers, and dispensers

Monitoring performance of contracted parties 12:00 ‐ 13:00 Lunch 13:00 ‐ 14:00 Discussion Summary

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Sun Jing Discussant(s): Break‐out group facilitators & rapporteurs

Break‐out group reports

Identification of system needs


Wednesday, 2 October

Medicines benefit design 14:00 ‐ 15:00 Plenary

Facilitator: Dr Hans V. Hogerzeil Rapporteur: Dr Anita Wagner Discussants: Dr Francisco Soria Dr Zhang Xiaotian Dr Soonman Kwon Dr Calvin Ho

Evolution of, current issues in, and plans for medicines benefits in three countries

Implicit and explicit values underlying benefit decisions > Analysis of values reflected in medicines policies > Tools and approaches for considering values in medicines policy decisions, including laws,

actuarial analysis, equity analyses, negotiation, mediation 15:00 ‐ 15:20 Break 15:20 ‐ 16:20 World Café Discussion Groups 2a – Defining a minimum medicines benefit

Facilitator: Dr Calvin Ho Rapporteur: Dr Sun Jing

Objectives of a minimum medicines benefit

Information needed to design a minimum medicines benefit

Policy tools and implementation approaches 2b – Innovative, high‐cost medicines

Facilitator: Dr Christine Lu Rapporteur: Dr Siritree Suttajit

Evaluating innovative high‐cost medicines – role of health technology assessment

Covering innovative high‐cost medicines – system approaches

Monitoring innovative risk sharing agreements with manufacturers, as well as system impacts of covering high‐cost medicines

2c – Chronic disease treatment

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Yusi Anggriani

Medicines as part of comprehensive disease management strategies

Evaluating effects of chronic disease management programs

Monitoring and improving treatment adherence


Wednesday, 2 October 16:20 ‐ 17:20 Discussion Summary

Facilitator: Dr Hans Hogerzeil Rapporteur: Dr Anita Wagner Discussants: Break‐out group facilitators & rapporteurs


Identification of system needs 17:30 ‐ 20:30 Welcome Dinner at the Café Terrace (at conference venue) 20:30 ‐ 21:15 Bus transfer from conference venue to hotel


Thursday, 3 October 07:05 ‐ 08:00 Bus transfer from hotel to conference venue 08:00 ‐ 08:30 Summary of day 1 discussions

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Christine Lu

Information for decision‐making 08:30 ‐ 09:00 Plenary

Facilitator: Dr Prastuti Soewondo Rapporteur: Dr Siritree Suttajit Discussants: Dr Dennis Ross‐Degnan Dr Netnapis Suchonwanich

The crucial role of information

Generating information from existing data

Working toward a comprehensive data system for routine monitoring of expenditures, utilisation, quality of care, and fraud

Periodic assessments of household behaviours, perspectives, policy impacts; and patient and provider satisfaction

09:00 ‐ 10:00 World Café Discussion Groups 3a – Key indicators and data sources

Facilitator: Dr Anita K. Wagner Rapporteur: Dr Socorro Escalante

Indicators of medicines situations from different stakeholder perspectives

Generating information for decision making from existing system data

Future data needs to be considered when developing information systems 3b – Coding systems

Facilitator: Dr Christine Lu Rapporteur: Dr Francisco Soria

Coding medicine products, diseases, services, and procedures – rationales

Coding medicine products, diseases, services, and procedures – options

Working across different facilities and systems with different coding systems and/or coding practices

3c – Information system architecture

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Noel Juban

Objectives and elements of current or planned information systems for payment and clinical care

Key elements needed in information systems for performance assessments

Collecting and linking additional data (at household, community levels) for policy information


Thursday, 03 October 10:00 ‐ 10:20 Break 10:20 ‐ 10:30 Welcome – Prof Alastair V. Campbell, Chen Su Lan Centennial Professor of

Medical Ethics and Director, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, NUS

10:30 ‐ 11:15 Discussion Summary

Facilitator: Dr Prastuti Soewondo Rapporteur: Dr Siritree Suttajit Discussants: Break‐out group facilitators & rapporteurs




Thursday, 3 October

Medicines use 11:15 – 12:15 Plenary

Facilitator: Dr Calvin Ho Rapporteur: Dr Wendy Lipworth Discussants: Dr Christine Lu Dr Lynn Weekes Dr Sun Jing Dr Madeleine De Rosas‐Valera

Value for money: Medicines use in systems ‐ data, indicators, examples

Strategies for improving use of medicines, targeting the health system, industry, communities, households, patients, and providers (prescriber, dispenser)

12:15 ‐ 13:00 Lunch 13:00 ‐ 14:00 World Café Discussion Groups 4a – Overuse and misuse

Facilitator: Dr Christine Lu Rapporteur: Dr Socorro Escalante

Assessing utilization of antibiotics, steroids, injections and infusions in primary care

Assessing quality of care

Policy options to decrease overuse and misuse 4b – Underuse

Facilitator: Dr Calvin Ho Rapporteur: Dr Madeleine De Rosas‐Valera

Assessing use of oral rehydration solution for diarrhoea; treatment of chronic conditions; secondary prevention of cardiovascular diseases

Assessing adherence and continuity of treatment

Policy options to increase appropriate use of medicines 4c – Role of traditional medicines

Facilitator: Dr Klara Tisocki Rapporteur: Dr Sun Jing

Integrating traditional medicines in universal health coverage implementation

Status of traditional medicines in treatment guidelines, essential medicines and reimbursement lists

Safe and appropriate use of traditional medicines 14:00 ‐ 15:00 Discussion Summary

Facilitator: Dr Calvin Ho Rapporteur: Dr Wendy Lipworth Discussants: Break‐out group facilitators & rapporteurs




Thursday, 3 October 15:00‐ 15:20 Break

Regional approaches for supporting UHC medicines strategies 15:20 ‐ 15:50 Plenary

Facilitator: Dr Wei Aun Yap Rapporteur: Dr Anita Wagner Discussants: Dr Klara Tisocki Dr Socorro Escalante 15:50 ‐ 16:35 World Café Discussion Groups 5a – Medicines management and policies

Facilitator: Dr Anita Wagner Rapporteur: Mr Kwesi Eghan

Examples of recent or planned medicines management and policy approaches

Defining critical needs for medicines management and policy changes

Identifying options for sharing management and policy experiences 5b – Information for decision‐making

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Ms Viktoria Rabovskaja

Examples of recent or planned use of information for decision making

Defining critical needs for generating and using information for decision making, including evaluation of medicines policies to achieve UHC goals

Identifying options for improving quality and timeliness of information 5c – Technical support

Facilitator: Dr Klara Tisocki Rapporteur: Mr Karel Caals

Examples of recent or planned cross‐system information exchange

Facilitating technical assistance across systems in the region

Consolidating capacity strengthening tools and accumulating resources for decision‐makers 16:35 – 17:20 Discussion Summary

Facilitator: Dr Wei Aun Yap Rapporteur: Dr Anita Wagner Discussants: Break‐out group facilitators & rapporteurs


Discussion of regional support network goals, structure 17:45 ‐ 18:30 Bus transfer from conference venue to hotel


Friday, 4 October 07:35 ‐ 08:30 Bus transfer from hotel to conference venue 08:30 ‐ 09:00 Summary of day 2 discussions

Facilitator: Dr Klara Tisocki Rapporteur: Dr Christine Lu

09:00 ‐ 10:30 A proposal for collaboration

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Christine Lu Discussants: Dr Darren W. Dorkin Mrs Viktoria Rabovskaja Dr Yap Wei Aun Dr Xu Ke

A draft consensus statement and potential objectives for a regional collaboration network on medicines in health systems working toward UHC

Comments from each stakeholder group represented

Key take away points from the IEC discussions

Summary and suggested next steps 10:30 ‐ 11:00 Break 11:00 ‐ 11:30 A proposal for collaboration (continued)

Facilitator: Dr Dennis Ross‐Degnan Rapporteur: Dr Christine Lu

Take away messages, summary & next steps

11:30 ‐ 12:00 Closing Facilitator: Dr Calvin Ho Rapporteur: Dr Christine Lu Discussant: Dr Klara Tisocki

Thanks on behalf of IEC hosts and organisers 12:15 ‐ 13:00 Bus transfer from conference venue to hotel


Biographies of the co‐organisers

Anita Katharina WAGNER, PharmD, MPH, DrPH USA Associate Professor, Harvard Medical School and Harvard Pilgrim Health Care Institute Visiting Research Associate Professor, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore www.populationmedicine.org/node/235/91 [email protected] skype alias: anita.wagner

Anita Wagner is a clinical pharmacist, pharmacoepidemiologist, and pharmaceutical policy researcher. She collaborates on research and capacity strengthening activities to improve medicines situations for vulnerable populations, particularly in low and middle‐income countries. She founded and leads the global Medicines and Insurance Coverage Initiative (MedIC). MedIC is a unique partnership between academics, health care delivery systems, health financing institutions, international organizations, and others which aims to improve population health by supporting the design, implementation, evaluation, and routine monitoring of evidence‐based

medicines benefit policies. Dr Wagner co‐directs the Harvard Medical School Fellowship in Pharmaceutical Policy Research and directs global MedIC Courses in Pharmaceutical Policy Analysis.

Calvin WL Ho, MSc, LLM, JSD; Advocate & Solicitor (Singapore) Singapore Assistant Professor, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore Research Associate, Ethox Centre, Department of Public Health, University of Oxford cbme.nus.edu.sg/ourstaff.html#research www.ethox.org.uk/ethox‐members/research‐associates/calvin‐w.l.‐ho [email protected] skype alias: calvin.ho16

Calvin Ho is Assistant Professor at the Centre for Biomedical Ethics of the Yong Loo Lin School of Medicine, National University of Singapore. He is also Research Associate with Ethox Centre at the University of Oxford, and an Advocate and Solicitor of the Supreme Court of Singapore. Calvin was Senior Research Associate with the Bioethics Advisory Committee, an expert body appointed by the government of Singapore to provide advice and recommendations on human biomedical research. His research interests include comparative analysis of healthcare systems, research policy analysis, social determinants of health, and biomedical law and ethics.


Klara Tisocki, B. Pharm. Hungary M.Sc. Clin. Pharm., UK; PhD, UK Philippines Team Leader, Essential Medicines and Health technology, Division of Health Sector Development, WHO Regional Office for the Western Pacific (WPRO) www.wpro.who.int/en [email protected] skype alias: klaratisocki

Klara Tisocki is responsible for the essential medicines and health technologies related work in the WHO Western Pacific Regional Office in Manila, Philippines. She has worked in more than 15 countries in Africa and Asia and has wide ranging international experience in pharmaceutical policy development, supply management and logistics as well as drug regulatory matters in developing countries. She worked closely with several countries in the area of pharmaceutical price measurements and related policy and regulations as part of the World Health Organization (WHO) and Health Action International (HAI) lead collaborative

project to measure and monitor medicine prices in developing countries. Her research interest includes implementation of evidence based interventions to improve medicines management and expand access to essential medicines.

Dennis Ross‐Degnan, MSPH, ScD USA Associate Professor, Harvard Medical School and Harvard Pilgrim Health Care Institute www.populationmedicine.org Dennis_Ross‐[email protected] skype alias: drossdeg

Dennis Ross‐Degnan is Associate Professor at the Department of Population Medicine at Harvard Medical School and Director of Research at Harvard Pilgrim Health Care Institute. His career has focused on improving health systems in the US and developing countries, including research on factors underlying use of medicines, impacts of pharmaceutical policies on utilization and clinical outcomes, interventions to improve quality of care, and methods for pharmaceutical research. In 1990, he co‐founded the International Network for Rational Use of Drugs (INRUD), a global network of academics, health managers, and policymakers involved in testing interdisciplinary interventions to improve use of medicines.


Christine Lu, MSc, PhD USA Instructor, Department of Population Medicine, Harvard Medical School www.populationmedicine.org [email protected]

Christine Lu is an Instructor in the Department of Population Medicine at Harvard Medical School. She is a pharmacist, pharmaco‐epidemiologist, and health services researcher. She received a M.Sc. (Biopharmaceuticals) and a PhD in Clinical Pharmacology from the University of New South Wales, Australia. Her research interests include health system coverage and reimbursement, health care delivery, health policy, and comparative effectiveness research. Her research primarily focuses on personalized medicine products (including biologics, genetic tests and molecular diagnostics) and psychotropic medications. Dr Lu currently leads a national investigation of effects of Food and Drug Administration‘s black

box warnings and media attention regarding antidepressant and suicidality among youth within the Mental Health Research Network. In her teaching role, Dr Lu mentors students and fellows through the Harvard Medical School Fellowship in Pharmaceutical Policy Research, the Harvard Medical School Scholars in Medicine program, and the global Medicines and Insurance Coverage (MedIC) Initiative.

Karel Caals Singapore Research Assistant, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore cbme.nus.edu.sg/ourstaff.html#research [email protected] skype alias: cbme‐karel

Karel Caals is a research assistant at Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore. He has a degree in Tourism Management from Lessius University College, Belgium, and has extensive experience in the corporate travel industry. He is currently working on a number of projects, which include the development of an online teaching casebook on the ethics of end‐of‐life care, access to medicines and clinical trials. Karel’s research interests include medical travel.


Funders and Acknowledgements The IEC Organisers are grateful for the financial support for this meeting by the WHO Western Pacific Regional Office (WPRO) and through grants from the National University of Singapore (NUS) Yong Loo Lin School of Medicine. NUS grants supported Calvin Ho for his research and Anita Wagner for a Visiting Research Associate Professorship in 2012/2013 and funded the MedIC Asia Study of insurance medicines approaches in five countries. We also greatly appreciate the travel funding for participation of experts by:

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Germany

Groningen University, Netherlands

Management Sciences for Health (MSH), USA

Ministry of Health, Indonesia

National Health Security Office (NHSO), Thailand

The World Bank

University of Indonesia

University of New South Wales, Australia

University of the Philippines

WHO headquarters

WHO Western Region Pacific Office (WPRO) The IEC continues the learning in the Medicines and Insurance Coverage (MedIC) Initiative, which has been supported by the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute. Since 2007, participants in MedIC pharmaceutical policy analysis courses as well as country leaders and insurance scheme collaborators in the MedIC Asia Study have shared their experiences, insights, and questions. We are grateful to extend these in the IEC discussions.

medicines as a key component of universal health coverage...4. identify system needs and approaches...

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