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IN THE SPOTLIGHT

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Medicines and Insurance Coverage (MedIC) Initiative

Overview

Activities


Glossary of Terms Used for Pharmaceuticals and Pharmaceutical Policies in Low- and Middle-Income Countries
 

 

















Medicines and Insurance Coverage (MedIC) Initiative

MedIC Initiative - Mission

The Medicines and Insurance Coverage (MedIC) Initiative aims to improve the health of populations by supporting the design, implementation, evaluation, and routine monitoring of evidence-based medicines coverage policies for vulnerable populations across the world.

Background and Rationale

Lack of affordable access to medicines contributes to enormous inequity in health between developed and developing countries contributing to premature deaths, preventable morbidity, further impoverishment, and large-scale economic and health system losses. Frequently, economic factors are important barriers to access. Insurance schemes that cover medicines can play a key role in improving access to medicines and encouraging more economical and effective use of medicines.

Health insurance coverage of medicines offers significant potential to reduce the burden of disease and poverty, because health insurance schemes can:
  • Use information on member populations to characterize need for medicines;
  • Use their power as large-scale purchasers to expand access to medicines at affordable prices;
  • Incentivize appropriate prescribing by clinicians and cost-effective use by consumers;
  • Monitor and evaluate medicines use in health systems;
  • Design insurance-based financing for medicines that is both scalable and sustainable;
Many low and middle-income countries are currently establishing or expanding health insurance schemes. These schemes often successfully collect revenues and enroll beneficiaries, but they struggle to devise optimal benefit packages and frequently provide inadequate medicines coverage.

Health insurance schemes 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. However, schemes in low and middle-income countries often lack the capacity, tools, and networks to use existing data for evidence-based medicines policy decision making.


History

Recognizing the potential of insurance schemes, experts from 70 countries at the Second International Conference on Improving Use of Medicines recommended medicines coverage through health insurance schemes 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 low and middle income countries by improving availability, affordability, and appropriate use of medicines through health insurance schemes.

At the Third International Conference for Improving Use of Medicines, experts discussed state-of-the-art evidence on medicines coverage policies and recommended policy interventions and a research agenda.

Objectives

MedIC has the following four core objectives:
  1. To strengthen capacity in health care and insurance organizations to design, implement, manage, monitor and evaluate medicines policies;
  2. To collaborate with health care organizations and insurance schemes in evaluating impacts of medicines policy and management interventions ;
  3. 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;
  4. To establish global and regional networks for health insurance schemes to share expertise, tools, and model benefit policies.

Collaborating Health Insurance Systems

The MedIC Initiative focuses on a range of existing and emerging health insurance schemes, including private, public, and community-based schemes, with emphasis on those that include a mission to provide insurance coverage for the poor and for children. Collaborating health insurance systems to date include IMSS and PhilHealth, and the Zhuhai Human Resources and Social Security Bureau.


Activities

Capacity Strengthening

MedIC staff conduct modular Courses in Medicines Policy Analysis. Training is 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 schemes.

Evaluating policy interventions

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.

Contributions of the MedIC Initiative to evidence on medicines policies in health systems include:

Wagner AK, Valera M, Graves AJ, Laviña S, Ross-Degnan D.  Costs of hospital care for hypertension in an insured population without an outpatient medicines benefit: an observational study in the Philippines. BMC Health Services Research 2008, 8:161. DOI: 10.1186/1472-6963-8-161.

Vialle-Valentin CE, Ross-Degnan D, Ntaganira J, Wagner AK. Medicines coverage and community-based health insurance in low-income countries. Health Res Policy Syst 2008; 6:11. DOI: 10.1186/1478-4505-6-11.

Bertoldi AD, Barros AJ, Wagner A, Ross-Degnan D, Hallal PC. Medicine access and utilization in a population covered by primary health care in Brazil. . Health Policy 2009; 89:295-302. DOI: 10.1016/j.healthpol.2008.07.001.

Wagner AK, Ross-Degnan D.  The potential for insurance systems to increase access to and appropriate use of medicines in Asia-Pacific countries.  In: K. Eggleston, ed. Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific. Brookings Press 2009

Bertoldi AD, Barros AJ, Camargo AL, Hallal PC, Vandoros S, Wagner AK, Ross-Degnan D.  Household expenditures for medicines and the role of free medicines in the Brazilian public health system. Am J Public Health 2010; e1-e6. DOI: 10.2105/AJPH.2009.175844.

Chen W, Tang S, Sun J, Ross-Degnan D, Wagner AK.  Availability and use of essential medicines in China: Manufacturing, supply, and prescribing in Shandong and Gansu Provinces..  BMC Health Services Research 2010; 10:211. DOI: 10.1186/1472-6963-10-211.

Wagner AK, Graves AJ, Reiss S, LeCates R, Zhang F, Ross-Degnan D.  Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey. Health Policy 2011; 100: 151-158. DOI: 10.1016/j.healthpol.2010.08.004.

Faden L, Vialle-Valentin C, Ross-Degnan D, Wagner AK. Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence. Health Policy 2011; 100: 134-143.  DOI: 10.1016/j.healthpol.2010.10.020.

Faden L, Vialle-Valentin C, Ross-Degnan D, Wagner AK.  The Role of Health Insurance in the Cost-Effective Use of Medicines in Low- and Middle-Income Countries. Commissioned paper.  WHO/Health Action International, Amsterdam; 2011.

Carapinha J, Ross-Degnan D, Desta A, Wagner AK.  Health insurance systems in five Sub-Saharan African countries: Medicines benefits and data for decision making.  Health Policy 2011; 99: 193-202.  DOI: 10.1016/j.healthpol.2010.11.009.

 

Last updated on January 31, 2012

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Information from the Third International Conference for Improving Use of Medicines, ICIUM2011