healthcare reforms and pharmaceuticals lessons from turkey

Healthcare Reforms and Pharmaceuticals

Lessons from Turkey

Prof. Dr. Mehtap TatarHacettepe UniversityFaculty of Economics and Administrative SciencesDepartment of Health Care Management

Agenda

OGeneral health care reforms OImpact of reformsOReforms in pharmaceutical

policies

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 2009012345678

Total MoH PHC MoH Hospital Private University

2,79

7,27

MoH

Increasing share of private providers

2002 2003 2004 2005 2006 2007 2008 200905000000

100000001500000020000000250000003000000035000000400000004500000050000000

4.407.122

47.618.188

Number of outpatient visits to private hospitals

MoH

Increased satisfaction (%)

2003 2004 2005 2006 2007 2008 2009 20103035404550556065707580

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 200933.5

44.5

55.5

66.5

7

4.95.2

5.4 5.3 5.4 5.45.8

6 5.9

6.5

Pharmaceuticals

Pricing of pharmaceuticals OExternal reference pricing

O cheapest of France, Greece, Italy, Portugal, Spain

OPublic priceO Public discount on retail price (currently

41% for originals)OInternal reference pricing

O 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 200902468

1012141618

8.9210.06

11.2813.01

14.5216.21

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 youmtatar@hacettepe.edu.tr

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 you!mtatar@hacettepe.edu.tr