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Linking Social Health Insurance, Essential Drug Program and Private Pharmacies
其他書名
The Case of the Revolving Drug Insurance Fund in Southern Leyte, Philippines
出版SSRN, 2007
URLhttp://books.google.com.hk/books?id=_f_fzwEACAAJ&hl=&source=gbs_api
註釋Making drugs available and accessible to the poor remains an important health care objective in developing countries. The Bamako Initiative has introduced the concept of a revolving fund, where users pay for medicines, thereby contributing to the replenishment of the fund. However, the inability of the poor to pay for drugs remains a major problem in this concept. This article describes an innovative approach in making quality medicines available to the poor through social health insurance. The Revolving Drug Insurance Fund (RDIF) manages a cash advance mechanism using funds coming from the social health insurance of the Philippines (PhilHealth). Patients enrolled with PhilHealth get a prescription from a state or private facility. Should the medicines not be available in the health facility (which is often the case, especially in public facilities), the patients can then go to an accredited private pharmacy to obtain the medicine with little co-pay. The pharmacy will be reimbursed by the RDIF. The RDIF receives money for outpatient drugs via contributions of the local governments, which stems from an outpatient capitation fund PhilHealth pays to these local governments. Money for the medicines for inpatients comes from direct reimbursements for medicines from PhilHealth to the hospital. The RDIF reduces the need for out-of-pocket spending for medicines among the beneficiaries and encourages the local government officials to enroll more of their poor constituents to the national social health insurance program. The RDIF works within the framework of social health insurance and acts on behalf of PhilHealth because PhilHealth at present cannot reimburse individual pharmacies. This intermediate role of the RDIF could eventually be integrated into the social health insurance programme. Initial results are promising but important technical issues remain (e.g. simplifying flow of finances, appropriate pricing of the reimbursed drugs, incentives for staff to participate). We present the conceptual framework and some initial results. Detailed analysis of coverage, utilization and its appropriateness as well as the mid- and long-term financial viability of the RDIF need to be done at a later stage.