Government insurance coverage and use and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study

Diao, Yifan; Qian, Jie; Yang, Liu; Zhou, Yanping; Wang, Yan; Hong, Ma; Xiao-yan, Wang; Luo, Rong; Wagner, Anita K.; Sun, Jing

doi:10.1016/s0140-6736(18)32666-7

Cited by 4 publications

(2 citation statements)

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“…Many of the imported novel medicines are priced for the markets of high-income countries, and are not publicly funded in China, presenting a huge burden to families. A study in Zhejiang province found that, before being funded by the local health insurance program, patients had to pay out-of-pocket 3.0–13.1 and 6.2–27.3 times of the provincial average disposable annual income per capita in urban and rural areas, respectively, for novel anti-cancer medicines in 2015 27. Affordability blocked the access to dozens of life-saving novel medicines in China, which was veritably reflected by “Dying to survive,” a dark comedy about Chinese leukemia patients buying cheaper anti-cancer medicines from the Indian market.…”

Section: Key Findings and Discussionmentioning

confidence: 99%

<p>Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective</p>

Diao¹,

Li²,

Huang³

et al. 2019

RMHP

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China’s healthcare reform aims to provide affordable and equitable basic healthcare for all by 2020. Access to medicines is an essential part of the healthcare. The efforts of promoting access to medicines have been moving from meeting the needs of the basic healthcare, towards increasingly dedicated resources to offer breakthrough therapies. Looking at access to novel medicines from a health system perspective, and placing the changes China has made into that system context, this paper makes a comprehensive review of the progress of access to novel medicines in China. The review drew on two sources of information, which included desk review of published and grey literature, and key informant interview. Five hurdles were identified which create barriers of access to novel medicines, ranging from regulation and financing of medicines, intellectually property rights protection, and development of innovation capacity, to other health system components. Multiple policies have been implementing in China to remove the multiple access barriers gradually. Universal access to medicines has been moving from towards the basic common conditions to the world breakthrough technologies. We see cause for optimism, but recognize that there is a long way to go. Achieving broader and better access to modern medicines for Chinese patients will require multiple and coordinated government efforts, which would need to target the whole lifecycle regulation of novel medicines with a health system perspective, from balancing IP protection, strengthening R&D and public health, to appropriate regulatory approach and financing mechanism, and to supply chain management, as well as smart use.

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Section: Key Findings and Discussionmentioning

confidence: 99%

<p>Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective</p>

Diao¹,

Li²,

Huang³

et al. 2019

RMHP

Self Cite

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“…Existing evidence tends to confirm a negative association between (increased) co-payments and medicine use and adherence [44][45][46][47][48][49][50]. This adds to evidence that the introduction of coverage through a public benefits scheme as well as co-payment assistance such as reductions of and exemptions from OOP spending contributed to earlier filling of prescriptions and likely increased access and adherence [51][52][53]. While informal payments in health care have been investigated for several former Soviet Union countries, there is a paucity of evidence related to official copayments for medicines included in the outpatient benefits package schemes in these countries.…”

Section: Introductionmentioning

confidence: 99%

Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan

Vogler

Schneider

Dedet

et al. 2019

Int J Equity Health

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Background: Out-of-pocket (OOP) payments can constitute a major barrier for affordable and equitable access to essential medicines. Household surveys in Kyrgyzstan pointed to a perceived growth in OOP payments for outpatient medicines, including those covered by the benefits package scheme (the Additional Drug Package, ADP). The study aimed to explore the extent of co-payments for ADP-listed medicines and to explain the reasons for developments. Methods: A descriptive statistical analysis was performed on prices and volumes of prescribed ADP-listed medicines dispensed in pharmacies during 2013-2015 (1,041,777 prescriptions claimed, data provided by the Mandatory Health Insurance Fund). Additionally, data on the value and volume of imported medicines in 2013-2015 (obtained from the National Medicines Regulatory Agency) were analysed. Results: In 2013-2015, co-payments for medicines dispensed under the ADP grew, on average, by 22.8%. Co-payments for ADP-listed medicines amounted to around 50% of a reimbursed baseline price, but as pharmacy retail prices were not regulated, co-payments tended to be higher in practice. The increase in co-payments coincided with a reduction in the number of prescriptions dispensed (by 14%) and an increase in average amounts reimbursed per prescription in nearly all therapeutic groups (by 22%) in the study period. While the decrease in prescriptions suggests possible underuse, as patients might forego filling prescriptions due to financial restraints, the growth in average amounts reimbursed could be an indication of inefficiencies in public funding. Variation between the regions suggests regional inequity. Devaluation of the national currency was observed, and the value of imported medicines increased by nearly 20%, whereas volumes of imports remained at around the same level in 2013-2015. Thus, patients and public procurers had to pay more for the same amount of medicines. Conclusions: The findings suggest an increase in pharmacy retail prices as the major driver for higher co-payments. The national currency devaluation contributed to the price increases, and the absence of medicine price regulation aggravated the effects of the depreciation. It is recommended that Kyrgyzstan should introduce medicine price regulation and exemptions for low-income people from co-payments to ensure a more affordable and equitable access to medicines.

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Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

Cheng

Cai

et al. 2020

Environmental Research

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Government insurance coverage and use and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study

Cited by 4 publications

References 0 publications

<p>Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective</p>

<p>Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective</p>

Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

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