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Healthcare Reforms and Pharmaceuticals Lessons from Turkey. Prof. Dr. Mehtap Tatar Hacettepe University Faculty of Economics and Administrative Sciences Department of Health Care Management. Agenda. General health care reforms Impact of reforms Reforms in pharmaceutical policies.

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healthcare reforms and pharmaceuticals lessons from turkey

Healthcare Reforms and PharmaceuticalsLessons from Turkey

Prof. Dr. Mehtap Tatar

Hacettepe University

Faculty of Economics and Administrative Sciences

Department of Health Care Management

agenda
Agenda

General health care reforms

Impact of reforms

Reforms in pharmaceutical policies

health transformation program 2003
Health Transformation Program2003 -

Purchaser-provider split

Family practitioner scheme

General health insurance

Hospitals with administrative and financial autonomy

slide4

Extension of family practitioner scheme

Transfer of SSK hospitals

Extension of private hospital use

Pilot family practitioner scheme

Introduction of GHI

Health campuses

Use of private pharmacies by SSK

2010

2003

2008

2004

2011

2005

Coverage of population under 18

Extension of Green Card Benefits

Full time and university performance based system

Performance based payment

Major reform initiatives

impact of the program
Impact of the program

Improved access

Increased share of private providers

Increased satisfaction with the system

Increased health expenditures

improved access
Improved access
  • Before reforms, among those who felt health care need:
    • 13% did nothing
    • 19% used self treatment
    • 30% used self prescribed medicine

(National Health Accounts Household Survey, 2003)

increasing share of private providers
Increasing share of private providers

Number of outpatient visits to private hospitals

MoH

pricing of pharmaceuticals
Pricing of pharmaceuticals
  • External reference pricing
    • cheapest of France, Greece, Italy, Portugal, Spain
  • Public price
    • Public discount on retail price (currently 41% for originals)
  • Internal reference pricing
    • Cheapest + 10%
slide13

External reference pricing

Pozitive list

Reimbursement commission

20% co-payment for Green Card

2009

2004

2007

2005

2006

Generic price 66% of the original

Internal reference pricing

cheapest + 22%

VAT to 8%

Internal reference pricing

cheapest+ 30%

Major pharmaceutical regulations

slide14

Internal reference pricing cheapest + 15%

32,5% public discount for originals

3D Barcode system introduced

2010

2010

2010

2011-?????

Global budget

2010:14,6 billion TL

2011: 15,6 billion TL

2012: 16,7 billion TL

New GMP regulations

Major pharmaceutical regulations

total pharmaceutical expenditure billion tl
Total pharmaceutical expenditure (billion TL)

Performance based payment system

Increased use of private hospitals

Family Practitioners

Coverage of population under 18

Transfer of SSK Hospitals

Health campuses

Autonomous hospitals

Extension of Green Card benefits

www.aifd.org.tr

i ssues on the agenda
Issues on the agenda

Health Technology Assessment

Further discounts

Rational drug use

Restrictions on prescriptions

slide18

Internal reference pricing cheapest + 15%

32,5%discount for originals

3D Barcode system introduced

2010

2010

2010

2011 - ???

New GMP regulations

Global Budget

Billion TL

2010: 14.6

2011: 15.6

2012: 16.7

Major pharmaceutical regulations

reorganization of the moh 2 11 2011
Reorganization of the MoH2.11.2011
  • Turkish Medicines and Medical Devices Agency
    • Market regulation
    • Marketing approval
    • Pricing (pharmacoeconomic analysis for pricing)
health implementation guideline 5 11 2011
Health Implementation Guideline 5.11.2011
  • Changes in public discounts
    • Originals without generics 41%
    • Originals with generics 28%
    • Generics 28%
  • Internal reference pricing cheapest + 10%
points to consider
Points to consider
  • Impact analysis of reforms is crucial?
  • What are the drivers for increasing expenditures
    • Isolated emphasis on spending or utilization alone can be problematic
  • What is the limit for discounts?
  • Who will be most affected by discounts?
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