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Medicines and Insurance Coverage (MedIC) Initiative
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MedIC Initiative - Mission
The Medicines and Insurance Coverage (MedIC) Initiative aims to improve the health of the poor by
supporting the design, implementation, evaluation, and routine monitoring of evidence-based
medicines benefit policies for vulnerable populations across the world.
Background and Rationale
Lack of affordable access to life-saving medicines contributes to enormous inequity in health between
developed and developing countries and leads to preventable mortality and morbidity, episodes of catastrophic illness that cause
further impoverishment,low quality of life, and large-scale economic and health system losses. Frequently economic factors are the most
important barriers to access. Insurance programs that cover medicines can play a key role in extending access to high risk populations
and in encouraging more economical and effective use of medicines.
Health insurance coverage for medicines offers significant potential to reduce the burden of disease and poverty,
because health insurance programs can:
- use their power as large-scale purchasers and expand access to medicines at affordable prices;
- leverage better prescribing by clinicians and more cost-effective use by consumers;
- design insurance-based financing for medicines that is both scaleable and sustainable;
Many developing and transitional countries are currently establishing or expanding health insurance
programs. Many of these programs successfully collect revenues and enroll beneficiaries, but they struggle to
devise optimal benefit packages and frequently provide inadequate medicines coverage.
Health insurance programs have routine enrollment and claims data that enable them to monitor medicines
utilization and cost, increase transparency, maintain efficiency, and design policies to increase quality of
care and promote equity. They often lack the capacity, tools, and networks to use existing data for evidence-based
medicines policy decision making.
MedIC Initiative staff works with policy makers and analysts in health insurance programs across the world to
generate evidence for medicines policy decision making.
History
Recognizing the potential of insurance programs, experts from 70 countries at the Second International Conference on Improving Use of Medicines
recommended medicines coverage through health insurance as a key global strategy to improve access to essential medicines, especially for the poor.
To facilitate this strategy, the WHO Collaborating Center in Pharmaceutical
Policy began the global Medicines and Insurance Coverage (MedIC) Initiative. MedIC’s goal is to improve the health and
economic well-being of people in developing and transitional countries by improving availability and affordability of
essential medicines through health insurance programs.
Objectives
MedIC has the following four core objectives:
- To build capacity through training programs in the design, implementation, management, and evaluation of medicines policies;
- To collaborate with health organizations and
insurance programs in designing, implementing,
evaluating, and monitoring policy interventions to
improve use of medicines among vulnerable populations;
- To develop, test, and disseminate locally relevant
standard indicators of the performance of medicines
policies with respect to cost, affordability, equity
in access, and quality use;
- To establish global and regional networks for health
insurance programs to share expertise, tools, and
model benefit policy programs.
Collaborating Health Insurance Systems
The MedIC Initiative focuses on a range of existing and emerging health insurance
programs, including private, public, and community-based programs, with emphasis on those that include a mission to
provide insurance coverage for the poor and for children. Collaborating health insurance systems include IMSS and PhilHealth.
Activities
Capacity Building
MedIC staff has developed modular Courses in Medicines
Policy Analysis. Training can be tailored to the needs of a particular organization or group of organizations.
Capacity building activities will include in-person
learning collaboratives and mentored on-the-job learning, as
well as web-based tutorials, on-line interactive learning,
on-site technical assistance by project staff, and exchange
visits among insurance programs.
Policy interventions and evaluation
MedIC staff work with health insurance policy makers and
analysts on (1) assessing their readiness to undertake systems
improvements; (2) defining key policy areas of concern; (3)
developing more efficient data systems on medicines use; (4)
developing and implementing performance measures of cost and
affordability of medicines, equity in access, quality use, and
health outcomes based on routine data; (5) conceptualizing,
implementing, and evaluating targeted policy interventions;
and (6) using results to establish more evidence-based
policies and programs.
MedIC Health Insurance Survey
Disparities in access to essential medicines remain among the most serious global public health problems.
Health insurance systems are emerging in developing countries and, if they offer medicines coverage, have the
potential to decrease the global gap in access to and use of medicines. However, it is unclear to what extent
existing and emerging health insurance systems offer medicines benefits; how existing benefits are structured;
and what issues insurance programs face when offering and implementing medicines benefits. To make evidence-based
medicines policy decisions, emerging health insurance systems must use routinely collected data to monitor and
evaluate the impact of their policies on equity, affordability, quality of care, and health outcomes. It is
unclear to what extent programs conduct such monitoring.
With funding from the DACP, Drs. Anita Wagner and Dennis Ross-Degnan have developed a 4-part health
insurance survey that assesses health insurance program structure and covered populations; medicines coverage
they may provide; availability and use of routine data; and health and utilization characteristics of the
covered population. The survey exists in English, French, Spanish, and Russian and can be completed online.
Data collection is in progress. Survey forms and a glossary are available
here.
Creating Evidence for an Outpatient Medicines Benefit in the Philippines
Like other developing and transitional countries, the Philippines has made a commitment to health
insurance coverage for the country’s population. The Philippine Health Insurance Corporation (PhilHealth),
which insures about half of the Filipino population, currently reimburses for inpatient care of its members,
while providing very limited outpatient benefits (for maternal care and tuberculosis treatment) which do not
include medication coverage for chronic conditions. Lack of access to outpatient medicines leads to avoidable
disease progression and costly inpatient admissions to treat chronic conditions and their sequelae.
Together with leadership of PhilHealth, members of the CCPP are generating evidence to support the
design and implementation of a PhilHealth outpatient medicines benefit for chronic conditions. The first study,
led by Anita Wagner, estimated current costs to PhilHealth for inpatient care of hypertension. Specifically,
we assessed how much PhilHealth paid in total, per hospitalization, and per patient per year for inpatient
care of members hospitalized with hypertension or its sequelae. We also characterized high cost members who
incurred multiple admissions for hypertension or its sequelae during the 3.5 year follow-up period and
assessed the progression of their hypertensive disease over time.
An accompanying field study, led by Madeleine Valera of PhilHealth, assessed access to, use of, and
willingness to pay for medicines to treat hypertension among PhilHealth members who were recently discharged
from hospitals after care for hypertension. CCPP members are now planning an outpatient benefit pilot study to
be conducted in 2008.
The WHO Office of the Western Pacific Region supported these studies. The first of a series of
manuscripts from the study was presented at the 2007 Pharmaceutical Policy Conference in The Netherlands
and is being submitted.
Medicines
Coverage and Community-Based Health Insurance
Community-based
Health Insurance (CHI) are not-for-profit prepayment plans for
health care, with community control and voluntary membership
that provide risk pooling to low-income populations. Evidence
that these plans contribute to improving access to medicines in
poor settings is lacking. Through literature review and interviews,
Dr. Catherine Vialle-Valentin has analyzed quantitative and
qualitative data about medicine policies in CHI to frame further
research questions about utilization and costs of medicines in
CHI.
Research Using the Electronic Health Information System of the Mexican Institute of Social Security (IMSS)
The prevalence of hypertension, dyslipidemias, and diabetes is rapidly growing in Mexico. The Mexican Social
Insurance System (IMSS) insures and provides care for about half of the Mexican population (around 50 million people).
Researchers from IMSS are collaborating with DACP colleagues including Drs. Dennis Ross-Degnan and Anita Wagner on proposals
for using the extensive electronic health information system at IMSS to 1) describe patterns of care for IMSS members with
hypertension, dyslipidemia, and diabetes; 2) describe risk factors for disease progression; and 3) create interventions to
improve care.
A proposal for Phase I of this research has been prepared for submission to Merck & Co. in Mexico.
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LATEST UPDATES
WHOCCPP
awarded funding for Interdisciplinary
Research and Training for Improving
Access to and Use of Medicines in China by Harvard
China Fund
Upcoming Courses
MedIC
Initiative Courses in Accra, Ghana, November 16-25, 2008
and Beijing, China in the Spring of 2009
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