Date Published: February 20, 2019
Publisher: Public Library of Science
Author(s): Chulaporn Limwattananon, Onanong Waleekhachonloet, David Hotchkiss.
Under the Universal Coverage Scheme (UCS) with payment per capita for outpatient (OP) services, hospitals’ financial risks will rise if access to essential drugs increases. This study examined trends in access to and price of essential drugs for noncommunicable diseases (NCDs) and an overall purchasing price index (PPI) for an OP drug basket from public hospitals. To examine drug access, OP prescription data from 2010–2012 were obtained from the UCS. Access to thirteen drugs for diabetes, hypertension, and dyslipidemia was examined for trend using a time-series analysis. To calculate the PPI, drugs in the same dataset in 2010 that each contributed at least 0.2% of the total OP drug expenditure (N = 118 items) were selected together with drugs expected for near future growth (N = 48 items). The PPI was constructed from purchasing prices in 16 hospitals using a standard method developed by the International Labour Organization. Based on 166 drug items accounting for 75% of OP drug expenditures, the overall PPI continually declined by 6.8% from 2010 to 2012. Access to the 13 selected NCD drugs, accounting for 22% of the total OP drug expenditure increased from 22 to 30 per 1,000 population for antidiabetics, 27 to 47 for antihypertensive agents, and 32 to 53 for antilipidemics from 2010–2012. Growth in the study drug recipients was relatively higher than that in the population and diagnosed patients. Due to generic market competition, metformin, glipizide, amlodipine, losartan, simvastatin, atorvastatin, and fenofibrate prices decreased by 6–22%. Antiretrovirals and risperidone prices decreased by more than 10% due to price negotiation by the UCS. Access to essential drugs for diabetes, hypertension and dyslipidemia has increased. A decline in the PPI could contain essential drug expenditure when the demand for the drugs increased. Generic market competition and price negotiation by the UCS led to price reduction.
Thailand has achieved universal health coverage (UHC) since introduction of the Universal Coverage Scheme (UCS) for the uninsured and medical indigents in 2002. Financed by general government revenue, the UCS relies mostly on public hospitals to provide inpatient (IP) and outpatient (OP) care to approximately 47 million members, covering three-quarters of the Thai population. Each year, the National Health Security Office (NHSO), which is the administrative body of the UCS, establishes payment contracts with hospitals for IP services based on global budgeting and diagnosis-related groups (DRGs). The hospital OP costs, which are largely driven by drug utilization, are compensated based on the fixed annual per capita payment rate.
Our study showed a marked increase in access to essential drugs for diabetes (metformin), hypertension (enalapril and amlodipine), and dyslipidemia (simvastatin) even though their price drops were modest to moderate. Most commonly prescribed drugs that contributed relatively largely to OP expenditures and drugs with relatively high prices had a declining price trend due to generic market competition. For the all-item basket, which accounted for approximately 75% of the OP drug expenditure, the overall price index decreased by 6.8% in 2012. Price negotiation by the NHSO led to a price reduction of sixteen out of 20 items with a range from 4% to 41%. Excluding the price-negotiated items, the price index decreased by 4.9% in 2012.