Hi all
In response to Wang Qing's contention:
WHO always recommends the systems of Australia and Scotland, but the
drug lists in these countries are health care insurance drug lists, not the essential
drug list.
WB added:
[Essential drug lists, hospital formularies, insurance reimbursing lists:
what's in a name? What matters is the concept of essential drugs, in my
view. Developed countries call their essential drug lists differently,
but they follow the same concept that some drugs are more important han
others!]
I don't think it's as simple as that. Yes, there is a core principle
that is shared - some drugs are more important than others. However,
the net result is not the same.
South Africa provides a good example
of where one can land up. In the pre-1996 era (before the National Drug
Policy was published), the State operated a system of drug lists for
the purpose of procurement. Only drugs on the various "codes" could
be procured through the State tender system. Drugs were also made
available in different ways - some were accessible to all prescribers
in State hospitals, others were restricted to particular medical
specialities, and some required special motivation by the prescriber.
In essence, that is how the private sector reimburses in some
settings - there are "maximum medical aid prices" set for certain
generic drugs and formularies based on price/rebate. Such third party
payers operate "reimbursement lists".
Where did we land up? The State "list" expanded to some 2700 items -
all included on the basis of discussions at "coding committees". The
17% of the population who enjoy medical insurance consume as much in
monetary terms each year as the rest who rely on the State. What was
missing was the complementary principle that it is acceptable to
deny easy access to non-essential drugs on the basis of disease
prevalence. It is this acceptance of a population approach, of the
principles of rationing scarce resources which has to be present
before an Essential Drugs programme can succeed.
Is it not acceptance of "rationing" that is the key stumbing block
in developed countries? It offends the individualistic principles
which underpin liberal democracies.
regards
Andy Gray
South Africa
Email: agray@pixie.udw.ac.za [added manually; WB]
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