Home' Australian Pharmacist : Australian Pharmacist July 2014 Contents Australian Pharmacist July 2014 I ©Pharmaceutical Society of Australia Ltd. 31
'Substandard or fraudulent medicines
are a problem in some countries, and
unregulated access to antibiotics
contributes to growth of antimicrobial
resistance,' she said.
'In addition, traditional medicines are
in widespread use without necessarily
having a quality control or regulatory
system in place.'
Ms Lin said many governments tried to
implement their commitment to UHC
by developing health financing systems
but access to essential medicines was
not always incorporated into that
'For UHC to become a reality in
countries in Asia-Pacific, there must be
a commitment to developing a health
technology assessment system that links
policies related to health financing and
regulation of medicines. These policy
measures must also be accompanied
by systems to educate prescribers and
dispensers as well as consumers on
quality use of medicines.
'There is huge economic growth in the
region and we are seeing big operators
and small operators trying to take
advantage of this growth.'
Ms Lin said there were many issues in
the region as it moved towards UHC and
medicines were critical in this picture.
'One of the problems we face is that
in most of the countries in the region,
the health systems are very weak and
by that I mean there is very little in the
way of financial protection through
insurance so if you seek healthcare you
are paying for it out of pocket,' she said.
'This is the kind of situation we are
seeing. The underlying problem is of
access to health services and medicines
and these are some of the critical issues
we have to confront when trying to
address TB, malaria and so on.'
UHC was an important part of the
solution, but one which was not so easy
'At the core of UHC is the notion
of universality, of solidarity. UHC is
not new. It is enshrined in the WHO
constitution,' she said.
'We face a lot of challenges. With
economic growth we are seeing massive
urbanisation and rapid ageing and with
that some chronic disease and I dont
just mean diabetes, heart disease and
cancer. We are also seeing a rapid rise in
medical tourism and these factors are
combining to see countries where health
sector reform is very much on the agenda
because of the rising middle class.
'So this provides a political opportunity
to improve health systems and we have
a lot of countries that have articulated
UHC as a goal and many countries are
committed to it.
'But one of the problems we still face
is high out-of-pocket expenses for
health costs and some countries in the
Asian region have a huge proportion
of out-of-pocket expenses and this is
where health inequalities are generated.'
Ms Lin said the difference in systems
in various countries added to the
complexity of UHC implementation.
One issue was the lack of regulatory
framework for areas such as health
workforce registration so basic
regulatory systems needed to
'We also have to address how we
manage out-of-pocket expenses,' she
said, adding that 100 million people
being impoverished by medical costs
annually were a stark reminder of the
magnitude of the problem.
'Improved primary care and improved
hospital admission prevention is where
we are focused but in all countries we
want to see much stronger community
based initiatives and much stronger
primary care and a good regulatory
framework. Medcines are an important
part of UHC and the World Health Report
highlighted inefficiencies in medicines
accessibility and use as major problems,'
'Part of the problems is how we engage
with the patient, the communities,
the families and the carers and this is
something which many health systems
are not doing very much of.
'The pricing of medicines is at the
very core in many countries. When we
look at medicines in the path of UHC
implementation we have to ensure that
when countries shore up their medical
systems they are not forgetting medicines
for all the programs and not just the
ones that are funded by external donors.
And of course we do have issues of
prices set over invoicing, counterfeiting,
substandard product, conflict of interests,
collusion, falsification of data, waste and
so on -- these are the practical challenges
we face when we try to implement
medicines systems that have to be at the
absolute core of UHC.'
Quality use of medicines
Quality use of medicines had to be part of
the agenda and Ms Lin pointed to a report
indicating massive savings available
through better use of medicines.
The report by the IMS Institute for
Healthcare Informatics pointed to
potential savings of $500 billion a year --
or 8% of total annual health expenditures
worldwide -- if health system stakeholders
used medicines more responsibly and
aligned their capabilities, resources and
activities more strongly.
The 2012 IMS Institute report highlighted
six specific levers of opportunity to
improve the use of medicines:
• increasing patient adherence
• ensuring timely medicine use
• optimising antibiotic use
• preventing medication errors
• using low-cost generics where
• managing polypharmacy.
It found improvements in patient
adherence accounted for $269 billion of
the $500 billion annual potential savings.
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