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Towards Equitable& Affordable Medicine Prices Policies in Jordan Strategies to overcome Over- dispensing and multiple dispensing to improve medicine availability Ministry of Health Health Insurance Department DR. AHMAD BARMAWI Health Care Providers, Demographic and Health Data •MOH •RMS •Universities •Other ministries •Private Sectors •International and NGOs Health Care Providers…….. (cont) MOH •Peripheral H.C: •Primary H.C: •Comprehensive H.C: •MCH •Dental Clinics: •Chest Diseases Clinics: •Hospitals 243 370 058 274 012 406 030 Health Care Providers…. (cont) •Population : •G.D.P (2006): •Per Capita of GDP(2006) •General Budget(2006) •MOH Budget(2006) 5,600,000 JD10,108,500,000 JD1,805 JD3,448,600,000 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 Health Care Providers…. (cont) •Primary Health Care 18.9% •Secondary and tertiary 78.59% •Administration and training 2.51% •Expenditure on Pharmaceuticals JD320,000,000 •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 (insured) JD560731 JD57 Per capita Distribution of H.E. according to resources •Total JD950,600,000 •MOH JD211,000,000 •Other public JD120,000,000 •Civil Health Insurance JD59,000,000 6,2% •Military H.I. JD30,100,000 •Private H.E JD530,000,000 100% 22,2% 12,6% 3,2% 55,8% Irrational use of Medicine in Jordan •Over- dispensing •Multiple dispensing •Duplication of therapy •Fraud •Failure of adherence to treatment. The Problem •High Expenditure on pharmaceuticals •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 Causes of irrational use of medicine •Malpractices of prescribing by doctors •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) Stake holders •Consumers •Providers •Ministry of Health •JFDA •Other Public Health Sector •Private medical sector •Professional associations •Pharmaceutical industry •Multinational pharmaceutical Companies Promotion of Rational Drug use in 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 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) C- Joint Drug Procurement administration •Strategies to improve efficiency in medicine procurement •Minimize zero- stock concept •Limit waste and duplication •Bar-coding inspection and control 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 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. Proposal (cont) •Introducing active connecting system for exchange of information with health care providers to prevent duplication of medicine prescription **Smart card Important tools of Control •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 E. health •E. Network •E. Medical file form •Access to other Health Sectors •Access Medicine supply dept balance of needs and distribution prescribing locations( hospitals, HC) THANK YOU DR.A.BARMAWI Title Title Title Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text text Text.