Pharmaceutical Pricing in Ethiopia

Ali, Eskinder Eshetu; Gilani, Anwarul Hassan; Fenta, Teferi Gedif

doi:10.1007/978-3-319-12169-7_5

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…49 For example, even though drugs could have been purchased at a subsidised price in public facilities, promised benefits may not be realised unless sustained availability and use of generic drugs is ensured. 50 We found drug costs to be major drivers in outpatient care costs—a finding also reported elsewhere. 6 42 Therefore, ensuring effective implementation of ongoing reforms would be vital to attain the desired financial risk protection benefits.…”

Section: Discussionsupporting

confidence: 80%

Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study

et al. 2017

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BackgroundCardiovascular disease poses a great financial risk on households in countries without universal health coverage like Ethiopia. This paper aims to estimate the magnitude and intensity of catastrophic health expenditure and factors associated with catastrophic health expenditure for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa.Methods and findingsWe conducted a cross-sectional cohort study among individuals who sought cardiovascular disease care in selected hospitals in Addis Ababa during February to March 2015 (n=589, response rate 94%). Out-of-pocket payments on direct medical costs and direct non-medical costs were accounted for. Descriptive statistics was used to estimate the magnitude and intensity of catastrophic health expenditure within households, while logistic regression models were used to assess the factors associated with it.About 27% (26 .7;95% CI 23.1 to 30.6) of the households experienced catastrophic health expenditure, defined as annual out-of-pocket payments above 10% of a household’s annual income. Family support was the the most common coping mechanism. Low income, residence outside Addis Ababa and hospitalisation increased the likelihood of experiencing catastrophic health expenditure. The bottom income quintile was about 60 times more likely to suffer catastrophic health expenditure compared with the top quintile (adjusted OR=58.6 (16.5–208.0), p value=0.00). Of those that experienced catastrophic health expenditure, the poorest and richest quintiles spent on average 34% and 15% of households’ annual income, respectively. Drug costs constitute about 50% of the outpatient care cost.ConclusionsSeeking prevention and treatment services for cardiovascular disease in Addis Ababa poses substantial financial burden on households, affecting the poorest and those who reside outside Addis Ababa more. Economic and geographical inequalities should also be considered when setting priorities for expanding coverage of these services. Expanded coverage has to go hand-in-hand with implementation of sound prepayment and risk pooling arrangements to ensure financial risk protection to the most needy.

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Section: Discussionsupporting

confidence: 80%

Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study

et al. 2017

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“…For example, the UK follows profit sharing and reference system, Canada uses mixed pricing system, Germany uses internal and external reference pricing system, and Iran uses reference and cost plus pricing system (Table 3). [ 22,65–75 ]…”

Section: Resultsmentioning

confidence: 99%

Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective

Sorato

Davari

Asl

et al. 2020

Journal of Pharmaceutical Health Services Research

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Background Access to quality essential medicines at affordable price to patients in the healthcare market is one of the main goals of universal health coverage and health‐related sustainable development goals. Healthcare market is imperfect, and the government cannot ensure access to essential medicines if the market is left to operate under invisible hand control. This scoping review was conducted with intention to provide the clear picture on impact of pharmaceutical price regulation on access to essential medicines, drug innovation and launching. Methods We searched articles written in the English language since January 2000 from PubMed, Embase, Scopus, Ovid/Medline and Google scholar with systematic search query. Results Access to essential medicines, which is defined in terms of availability, affordability, accessibility, acceptability and quality of drugs, can be improved by pharmaceutical price regulation. Countries can use different price regulation strategies based on their healthcare objectives and priority healthcare needs. Country‐specific pharmaceutical price regulation could not significantly affect drug innovation and launching. However, supportive strategies such as open public funding for drug innovation research, providing innovation awards and strong patent rights can counterbalance the effect of price regulation on innovation and drug development research in developed countries. Conclusion Regulating pharmaceutical pricing system is one of the key strategies to ensure access to essential medicines. Countries that have implemented pharmaceutical price regulation system (Germany, the UK, Canada and Iran) have achieved better access to essential medicines. However, the US and Ethiopian health systems that are unregulated concerning pharmaceutical pricing had a great challenge of affordability of essential medicines. Therefore, setting country‐specific pharmaceutical price regulation system along with additional strategies to improve drug innovation is critical to ensure access to essential medicines.

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“…Ethiopia [25] , Ghana [26] and Nigeria [27] practice free pricing, wherein companies have the authority to set price for their products. Ethiopia has a three-tiered retail outlet system for medicines, which is heavily privately owned [35] ; further, inverse relation has been observed between price and availability [36] . Non-uniformity in prices exists across different geographical regions in Ghana, which has to rely on private sector even for procurement in public sector [37] .…”

Section: Resultsmentioning

confidence: 99%

“…Nigeria, on the other hand, has yet to achieve significant coverage through its insurance scheme [46] . Countries such as Rwanda [34] and Ethiopia [35] have banked on CBHI for health coverage. Rwanda through Mutuelles (CBHI), RAMA and MMI has attained near universal coverage, with pharmaceuticals covered based on essential medicines list and the extent of coverage depending on the type of insurance scheme [34] .…”

Section: Resultsmentioning

confidence: 99%

Adapting Pharmaceutical Pricing and Reimbursement Strategies for Achieving Universal Health Coverage in Nepal: Lessons from Selected Low- And Lower-Middle-Income Countries

Acharya¹

2016

IJPS

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Universal health coverage is increasingly being embraced by low-and high-income countries alike, and pharmaceuticals are an integral part of it. With Nepal adopting national health insurance policy and willing to implement the same, guidance regarding pharmaceutical pricing, coverage and reimbursement becomes the order of the day. This study reviews pricing and reimbursement policies and techniques in low-and lower-middle-income countries which are implementing or intend to implement universal health coverage schemes, and provides recommendations on policies and techniques applicable and most pertinent to Nepal. For this, relevant literature on 11 countries was searched. The countries studied here are at different stages of universal health coverage, and they are aligning their pharmaceutical pricing and reimbursement policies and techniques with their universal health coverage policy. Considerable variation exists among these countries in regard to pricing, ranging from ceiling pricing (based on cost-plus, external referencing or market-based technique) to free pricing. All these countries have framed their essential medicines list; few or all of the medicines in the list are provided free of charge to targeted groups. Different universal health coverage schemes are at work in these countries, financing strategy for which span tax-based, premiumbased and payroll deductions. Reimbursement decisions are intricately linked with pricing, with majority of the countries putting into effect a fixed reimbursable amount strategy for reimbursed products. In regard to Nepal, as it is beginning its universal health coverage journey, the ideal approach would be a ceiling price for essential medicines (applicable to both in-insurance and out-insurance) and reference or index pricing for reimbursed products. Key words: Universal health coverage, pharmaceutical pricing, reimbursement, low-and lower-middleincome countriesTouted as a global health transition, third of its kind, Universal Health Coverage (UHC) has entered the health lexicon of low, middle and high-income countries alike [1] . Countries are formulating and implementing their health policies with an eye to UHC. UHC was founded with two core objectives, to provide accessibility to health care services, and to provide financial risk protection for utilization of those services [2] . It encompasses three elements namely health services, population, and proportion of cost [3] . It necessitates a health services package, which is made available to the populace with no or minimal charge (in the form of co-payment, co-insurance or deductibles) at the time of service use [3] . Among different health services covered, or considered to be covered, by the health benefits package, pharmaceuticals pose a peculiar challenge.Coverage of pharmaceuticals entails decisions regarding their pricing and reimbursement. Total pharmaceutical expenditure (TPE) is on the rise globally, accounting for an average 1.5% of global gross domestic product (GDP) in 2006 [4] . TPE has a share of 24....

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Pharmaceutical Pricing in Ethiopia

Cited by 9 publications

References 13 publications

Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study

Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study

Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective

Adapting Pharmaceutical Pricing and Reimbursement Strategies for Achieving Universal Health Coverage in Nepal: Lessons from Selected Low- And Lower-Middle-Income Countries

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