The WHO-model National Medicine Policy focusing access to essential medicines has been adopted in Thailand since 1980s. The National Lists of Essential Medicines were continually updated until 2008 and has been referent for the pharmaceutical benefit package under the three major public insurance schemes. However, drug costs have been rapidly escalating beyond economy-wide inflation in the open-end schemes probably due to inefficient use. On the other hand, access to certain medicines in some close-end schemes is restricted under the pre-authorized conditions.
Capacity building of human resources for pharmaceutical system has been evident through post-graduate training in-country and aboard. At the moment, approximately 70+ pharmacists with doctoral degrees are actively engaged in academics and practice in health service systems.
To steer the policy-relevant research in pharmaceutical system, HSRI sets a network for conducting the national-scale analytic works and model development conducted by the above researchers. By the 2010 year end, two research program areas including approximately ten projects will be launched by this network. One research cluster focuses on strategies to improve quality use of medicines in the elderly. Projects include epidemiology study and management mechanisms on the quality use. Another cluster aims to develop strategies to improve accessibility to medicines and to sustain an efficient use. The latter involves projects on streamlining drug registration process, developing tools for price negotiation, and implementing reference pricing and prospective payment for chronic diseases.
A priority programme area led by HSRI is in need for nourishing such a networking of human resources for country priorities in pharmaceutical system.
Targets For 2010-2013
- Quality use of medicines is improved and maintained. Routine monitoring within health facilities will be developed and appropriate interventions e.g., Antibiotics Smart Use (ASU) Program will be piloted.
- Equitable access to essential medicines is improved. Pharmaceutical benefit package and utilization patterns across major health insurance schemes will be assessed for discrepancies against established process indicators. Drug management programs, especially for high-cost chronic care will be examined for technical and administrative feasibilities.
- Inefficient use of high-cost medicines is reduced. Cost-containment strategies would be tailored based on the local evidence at the national and health facility levels. Models for reference pricing and prospective payment for chronic cases will be developed and tested.
- Pharmaceutical Systems Research Network (PSRN) of 30+ health academia and practitioners with doctoral degree qualification has been established under the HSRI initiative for over one year. Expanding of the network will be encouraged.
- Country priority in pharmaceutical-related issues has been identified under technical peer reviews and user agency consultation for two areas: (1) quality and safety use of medicines; and (2) improved access to medicines and cost management. Regularly review and update will be undertaken.
- Research process, including literature review of internationally advance models and domestic regulatory context, stakeholder/policy analysis, analytic works of locally available databases.
- Model development, including (piloting of and institutionalization for) drug reference pricing, price index, and expenditure forecast; and monitoring and evaluation of drug use indicators.
- Knowledge sharing among researchers and translation to policy platforms.
Research and Development Program on Drug Systems
This program aims at strengthening the people to equally access to essential and quality drugs, starting from reviewing drug register systems, logistics development, promoting reasonable drug use by providing knowledge for all sectors concerned, together with using financial measures, the support of the Comptroller General’s Department for controlling drug expenditures, and developing reference reimbursement price, through research networks for developing drug systems established in 2009.
- Pornpit Silkavute