Perspectives, Expectations, and Concerns of European Patient Advocates on Advanced Therapy Medicinal Products

This paper presents the results of a qualitative study based on semi-structured interviews of 10 expert patient advocates on several different issues around Advanced Therapy Medicinal Products (ATMPs). The interviews were conducted between February and May 2020 based on a guideline with a list of 8 topics that covered concerns about safety and ethics, access problems and limitations, pricing of ATMPs and educational needs for patient communities. Overall, the interviewees expressed a high degree of convergence of opinions on most of the topics and especially on the identification of the reasons for concern. Conversely, when asked about possible solutions, quite a wide range of solutions were proposed, although with many common points. However, it highlights that the debate is still in its infancy and that there are not yet consolidated positions across the whole community. A general concern emerging from all the interviews is the potential limitation of access to approved ATMPs, both due to the high prices and to the geographical concentration of treatment centers. However, patients recognize the value of a model with a limited number of specialized clinical centers administering these therapies. On the ethical side, patients do not show particular concern as long as ATMPs and the underlying technology is used to treat severe diseases. Finally, patients are asking for both more education on ATMPs as well as for a more continuous involvement of patient representatives in the whole “life-cycle” of a new ATMP, from the development phase to the authorization, from the definition of the reimbursement scheme to the collection of Real Word Data on safety and long-term efficacy of the treatment.

Cost-Benefit Analysis of a Children's Spectacle Reimbursement Scheme: Evidence for Including Children's Spectacles in Mongolia's Social Health Insurance

Background and aim: Globally, 12.8 million children have vision impairment due to uncorrected refractive error (URE). In Mongolia, one in five children needs but do not have access to spectacles. This cost-benefit analysis aims to estimate the net benefits of a children's spectacles reimbursement scheme in Mongolia. Methods: A willingness-to-pay (WTP) survey using the contingent valuation method was administered to rural and urban Mongolia respondents. The survey assessed WTP in additional annual taxes for any child with refractive error to be provided government-subsidised spectacles. Net benefits were then calculated based on mean WTP (i.e. benefit) and cost of spectacles. Results: The survey recruited 50 respondents (mean age 40.2 +/- 9.86 years; 78.0% women; 100% response rate) from rural and urban Mongolia. Mean WTP was US$24.00 +/- 5.15 (95% CI US$22.55 to 25.35). The average cost of a pair of spectacles in Mongolia is US$15.00. Subtracting the average cost of spectacles from mean WTP yielded a mean positive net benefit of US$9.00. Conclusion: A spectacle reimbursement scheme is a potentially cost-effective intervention to address childhood vision impairment due to URE in Mongolia. These preliminary findings support the inclusion of children's spectacles into existing Social Health Insurance. A much larger random sample could be employed in future research to increase the precision and generalisability of findings.

Prevalence and associated factors of medication nonadherence among Thai patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a chronic disease requiring complex treatment strategies to prevent disease flare ups and to reduce hospitalizations. Medication adherence is the main concern for improving patient outcomes. Although various studies on medication nonadherence for SLE have been conducted, no definite conclusions have been reached. Objective To quantify the prevalence of medication nonadherence among patients with SLE and to analyse the associated factors. Methods A prospective, self-reported questionnaire study was conducted in Songklanagarind Hospital. Patient aged 18 years or older, who had an established diagnosis of SLE, and who had been receiving medications for at least 6 months, were included in the study. Medication adherence was assessed through a visual analogue scale (VAS) and through the medication-taking behaviour measure for Thai patients (MTB-Thai) scale. Results One hundred and seventy-two SLE patients were enrolled in the study. Most SLE patients were young to middle aged (56.40%) and had no clinical disease activity (67.4%), as assessed by a clinical SLEDAI score. Nonadherence rates were 32% and 25.3% by VAS and the MTB-Thai scale, respectively. Patients aged 55 years or older, who used the universal coverage of health care system, who used multiple medications (>10 pills/day), and who had a good attitude towards the disease were associated with a low risk of nonadherence. Conclusion Up to 25% SLE patients poorly adhered to their prescriptions. Age, reimbursement scheme, pill number, and attitude towards SLE were associated with nonadherence in our patients with SLE.

Spotlight

The following topics are under this section: National Health Insurance and Drug Reimbursement Scheme in Taiwan Accelerating HealthTech Start-ups in Southeast Asia Cybersecurity for Healthcare in a Digital Age

Winner’s Optimal Reimbursement in Contest

This paper explores a designer-optimal reimbursement scheme in all-pay auctions with winner’s reimbursement. Assuming the reimbursement is a linear function of the cost of effort, we obtain analytical solutions for the contestants’ symmetrical equilibrium effort and the contest organizer’s expected revenue. We show that if the effort cost function is concave, the optimal reimbursement scheme is to return the full cost to the winner. On the contrary, if the effort cost function is convex, the optimal reimbursement scheme is not to compensate the winner. Moreover, we find that the organizer’s expected revenue may increase or decrease as the number of contestants increases when the winner is fully reimbursed.

Economic Evaluation of Changes in Reimbursement for Medications Purchased Through the 340B Drug Pricing Program

Background: The Centers for Medicare and Medicaid Services (CMS) implemented changes to the reimbursement scheme for 340B-acquired medications on January 1, 2018, reducing payments by approximately 25%. It was recognized that these changes would have a significant fiscal impact to Medical University of South Carolina (MUSC) Health. The purpose of this assessment was to review the financial impact of changes in Medicare reimbursement for clinic-administered medications. Methods: This study was a single-center, retrospective, financial evaluation of closed outpatient encounters for Medicare beneficiaries in calendar year 2018. Actual reimbursement was calculated for 2018. To better characterize the margin obtained, exploratory analyses were completed to identify best- and worst-case reimbursement outcomes. This exploratory analysis was conducted for both the new (ASP-22.5%) and old (ASP+6%) reimbursement schemes. Results: Overall, 10 973 encounters were reviewed for inclusion. Ultimately, 8028 encounters were included in the final analysis. Of all encounters, 88 unique medications were administered. Most of the drugs (55%) were associated with oncologic indications. An unfavorable variance was found in 3761 encounters (47%). The actual reimbursement margin for 2018 was $3 193 525. Conclusion: Changes to reimbursement outlined by the CMS at the start of 2018 resulted in decreased reimbursement for 340B-eligible, clinic-administered medications. Most of the unfavorable variances were associated with 340B acquisition prices that exceeded reimbursement. Although the original intent of the 340B Drug Pricing Program was to stretch federal resources, decreased payments could reduce institutional ability to fund programs that support medically vulnerable populations.

Reimbursement scheme for China’s public hospitals from perspective of stakeholders

Purpose Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients. Design/methodology/approach In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups. Findings Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost. Originality/value In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

Evidence and projections on the progressivity of health care financing in Finland

This paper examined the distribution of health care financing in Finland in 1990-2012. In addition, the study provided insight to recent developments in the financing system, and analyzed various scenarios associated with the planned financing reform of 2020. The results indicated, that over the two decade study period overall progressivity first steadily decreased, and after turning regressive by 2006, returned to a progressive track leading to the highest level of measured progressivity by 2012. The distributional implications of the financing reform in the “stationary” scenario were shown to be significant; substituting revenue collected previously by local income taxes by an equiproportinate increase in state income tax revenue would increase the progressivity of overall financing to an unprecedentedly high level. In the “counterbalanced” scenario, where the state income tax scales were adjusted to correspond to the average income tax rate, the progressivity of overall financing increased more moderately. Finally, the “system-level” scenario indicated that taking into account recent changes in other financing sources outweighed the progressivity effect, and a slightly less progressive overall financing distribution would emerge in 2020 in comparison to 2012. The monetary effects of abolishing the public reimbursement scheme of private health services fees were shown to be rather small in magnitude, but the economic burden fell more heavily on low-income households. Published: Online May 2018.