Towards Equitable& Affordable Medicine Prices Policies in Jordan

1. Towards Equitable& Affordable Medicine Prices Policies in Jordan

2. Strategies to overcome Over- dispensingand multiple dispensing to improvemedicine availability Ministry of Health Health Insurance Department DR. AHMAD BARMAWI

3. Health Care Providers, Demographic and HealthData • MOH • RMS • Universities • Other ministries • Private Sectors • International and NGOs

4. Health Care Providers…….. (cont) • MOH • Peripheral H.C: 243 • Primary H.C: 370 • Comprehensive H.C: 058 • MCH 406 • Dental Clinics: 274 • Chest Diseases Clinics: 012 • Hospitals 030

5. Health Care Providers…. (cont) • Population : 5,600,000 • G.D.P (2006): JD10,108,500,000 • Per Capita of GDP(2006) JD1,805 • General Budget(2006) JD3,448,600,000 • MOH Budget(2006) JD211,486,000 • 6.1% of Total Budget • Total Expenditure on Health: JD950,600,000 • =9.8% of GDP • Per Capita Health Care Exp: JD169

6. Health Care Providers….(cont) • Primary Health Care18.9% • Secondary and tertiary 78.59% • Administration and training 2.51% • Expenditure on Pharmaceuticals JD320,000,000 JD57 Per capita • 33.6% of ( H.Exp. per capita) • Public 18.5% • Private 81.5% • MOH JD30,000,000 • CHI JD3,250,000 • Expenditure on treatment abroad JD560731 • (insured)

7. Distribution of H.E. according toresources • Total JD950,600,000 100% • MOH JD211,000,000 22,2% • Other public JD120,000,000 12,6% • Civil Health Insurance JD59,000,000 6,2% • Military H.I. JD30,100,000 3,2% • Private H.E JD530,000,000 55,8%

8. Irrational use of Medicine inJordan • Over- dispensing • Multiple dispensing • Duplication of therapy • Fraud • Failure of adherence to treatment.

9. The Problem • High Expenditure onpharmaceuticals • Estimated Waste of medicine in Jordan JD90,000,000 • 9.5% of Health Expenditure • 28% of Exp.on pharmaceuticals • Estimated Waste of medicine in MOH JD 9,300,000

10. Causes of irrational use ofmedicine • Malpractices of prescribing bydoctors • Malpractices of dispensing by pharmacists • Drug pricing policies and non ethical promotional activities of the pharmaceutical industry • Lack of information and communication on rational drug use to providers and consumers • Lack of effective control and regulatory mechanism on drug use • Change in diseases prevalence and incidence patterns • ( NCD , CD)

11. Stake holders • Consumers • Providers • Ministry of Health • JFDA • Other Public Health Sector • Private medical sector • Professional associations • Pharmaceutical industry • Multinational pharmaceutical Companies

12. Promotion of Rational Drug usein Jordan • A - JFDA strategic objectives and activities • Promotion of JNDF&JRDL • Printing and dissemination • Increase awareness and importance of implementing RDU concept • Promotion, support and monitor PTCs in public hospitals • Increase awareness of prescribers , dispensers and pts. about drug use RDU news letters. • Reinforce JNDF core teaching resource in medical and pharmacy curriculum • Standardize the treatment for common diseases STGs

13. B- HID / MOH Previous Actions • ٠Clinical guide lines- (NCD) • Clinical treatment booklet (NCD) • Pts. health education programs • Control of drug representation and marketing • Restriction of drug promotion by media • Professional Committees: • Non listed drugs • Growth Hormones • Respiratory Diseases drugs • Monitoring adherence to NDL and substitutes • Coordination with dept. of procurement for availability of essential medicines • Encourage first choice treatment • Control dispensing certain groups of medicine (narcotics)

14. C- Joint Drug Procurementadministration • Strategies to improve efficiency in medicine procurement • Minimize zero- stock concept • Limit waste and duplication • Bar-coding inspection and control

15. Proposal Policy Extension • Comprehensive STGs • Training Programs( problem- based) • Problem based – pharmacotherapy (STG) • Licensure of health professions • Paramedical education (STGs) • National/Regional Drug information Centers • Encourage consumer organizations involvement in public education about RDU • Separate prescribing procedures from Dispensing • Dispensing fees • Price control on Generic and brand drugs

16. Proposal (cont) • Medicine booklet • Re imbursement limited to essential medicines • Reference Prices • National plan to enhance researches: • Pre- clinical studies • Clinical studies • Pharmaceutical studies • Studies to limit waste in the disbursement of medicines • Control of drug representation and marketing • Appropriate evidence –based Health system • Evidence-based medicine • Evidence – based practices and management.

17. Proposal (cont) • Introducing active connecting system for exchange of information with health care providers to prevent duplication of medicine prescription

18. Important tools of Control • **Smart card • Hold Medical History and N. ld. No • Prevents duplication of Medicine • Minimize abuse and malpractice • Medical audit • Used by doctor or nurse • Needs printer and reader • Issue center and equipments • Training

19. E. health • E. Network • E. Medical file form • Access to other Health Sectors • Access Medicine supply dept prescribing locations( hospitals, HC) balance of needs and • distribution • THANK YOU • DR.A.BARMAWI

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