who medicines strategy - libdoc.who.int - World Health Organization

WHO MEDICINES STRATEGY 2004-2007 | 64EO 3.4Medicines benefits promotedwithin social health insurance andprepayment schemesRationaleDifferent forms of prepayment schemes involvingthe use of pooled resources are used by healthpolicy-makers to develop an organized healthsystem 28 . Direct public funding, expansion ofhealth insurance coverage and pharmaceuticalbenefits, extension of employer roles in healthand drug financing, support from NGOs, andcommunity financing sources have the potentialboth to increase the level of resources availablefor health and to promote equitable access.Prepayment schemes allow the healthy tosubsidize the sick and, through income-basedpremiums, the rich to subsidize the poor. Bothshifts imply that health care becomes moreaffordable for the poor and the sick.ProgressSocial and private health insurance coverage hasled to expanded medicine benefits in countriesas diverse as Argentina, the People’s Republicof China, Egypt, Georgia, India, the IslamicRepublic of Iran, Kyrgyzstan, South Africa,Thailand and Viet Nam. Some of these havespecial arrangements for rural and low-incomepopulations, and medicines represent 25%-70%of total costs for these schemes. Each country’ssocial and economic context defines the mostsuitable routes toward broader and deeperinsurance protection. In Western and CentralEurope, countries are increasingly collaboratingin the exchange of information and experienceson cost-containment measures, and in the use ofcost-effectiveness analysis as an aid to medicinesreimbursement decisions (including a WHOreview of the technology appraisal programme ofthe National Institute For Clinical Excellence inthe UK). WHO is working with such programmesto address the issue of medicines managementwithin health insurance.Challenges remainingThe development of widespread health insurancemechanisms is a capacity-intensive processwhich typically takes many years to reach fullimplementation and even then requires activemanagement. A country’s overall economicperformance in this period is a major enabling orconstraining factor. Most low- and middle-incomecountries start with a diverse set of health andmedicine financing mechanisms, with prepaymentsometimes accounting for only a minority shareof total health or medicine spending. Equitablesharing of financial risks and protection amongthe population is thus often very limited,particularly in relation to the cost of medicines.