Mr. Daniel Yao Donkor, Nkwanta-North District Director of Health Services, has called on government to open a district National Health Insurance Scheme office for the area. He expressed worry that people in the District were unable to access NHIS because there was no office to facilitate the work of the scheme. Mr. Donkor made the [...]
Mr. Daniel Yao Donkor, Nkwanta-North District Director of Health Services, has called on government to open a district National Health Insurance Scheme office for the area. He expressed worry that people in the District were unable to access NHIS because there was no office to facilitate the work of the scheme. Mr. Donkor made the call when Mr. Joseph Amenorwode, Volta Regional Minister, paid a working visit to the district on Tuesday. The District Director of Health Services said the nearest NHI office was at Nkwanta in the Nkwanta-South District, which was remote to Nkwanta-North because of the bad nature of the road in the area. Mr. Donkor said that many people including the aged and lactating mothers have not registered with the scheme and could not have access to health care because of the situation. He said those who had registered could either not get their registration cards or renew them. Mr. Amenorwode said government was committed to providing health care to the people and gave the assurance that an NHI office would soon be opened in the Nkwanta-North District.
This week two panels of medical experts recommended fewer screening tests for breast and cervical cancer. And recently, men got similar advice about prostate cancer screening.
The recommendations come from something called evidence-based medicine, and are being met with resistance from some consumer groups and physicians.
Evidence-based medicine is a pretty simple concept. “The basic [...]
This week two panels of medical experts recommended fewer screening tests for breast and cervical cancer. And recently, men got similar advice about prostate cancer screening.
The recommendations come from something called evidence-based medicine, and are being met with resistance from some consumer groups and physicians.
Evidence-based medicine is a pretty simple concept. “The basic principle of evidence based medicine is that clinical decisions that are made between doctors and patients should be driven by data,” says Peter Bach, now a physician at Memorial Sloan Kettering Cancer Center, and once an adviser to the head of the Medicare
Read more here
News outlets focus on alleged fraud in the drug and insurance industries.
“A $112 million settlement involving alleged drug kickbacks that the Justice Dept. announced with the nation’s largest nursing home pharmacy and a generic drug manufacturer on Nov. 3 is part of a wide-ranging investigation of suspected Medicaid fraud by the pharmaceutical industry,” Business [...]
News outlets focus on alleged fraud in the drug and insurance industries.
“A $112 million settlement involving alleged drug kickbacks that the Justice Dept. announced with the nation’s largest nursing home pharmacy and a generic drug manufacturer on Nov. 3 is part of a wide-ranging investigation of suspected Medicaid fraud by the pharmaceutical industry,” Business Week reports. “Critics say the continuing probe, which involves Johnson & Johnson (JNJ) and other major drugmakers, highlights what they describe as an industry practice of paying money to outfits that provide drugs to consumers, in return for preferential treatment.” The practice has “the effect of compromising patient care and driving up costs for government and private health insurers,” and specific incidents “could bolster opposition to the controversial deal the Obama Administration reached with the pharmaceutical industry to win its support for health-reform legislation. Many Democrats say the Administration should have asked for much bigger cost savings from drugmakers” (Meyer, 11/4).
Read more: www.reducedrugprices.org/read.asp?news=4548
Carapinha, J. (2008) Setting the Stage for Risk-Sharing Agreements: International Experiences and Outcomes-based Reimbursement. South African Family Practice, 2008;50(4):62-65.
Abstract
Carapinha, J. (2008) Setting the Stage for Risk-Sharing Agreements: International Experiences and Outcomes-based Reimbursement. South African Family Practice, 2008;50(4):62-65.
Abstract
Background: Biological medicines are clinically effective but very expensive in South Africa. The business decisions of biological manufacturers and payers (medical schemes) impact the access patient’s have to biological medicines. This paper presents risk-sharing agreements as a means of managing the risk of introducing biological medicines into the healthcare market.
Methods: The paper critically reviews literature of some prominent international experiences with risk-sharing agreements and the nuances associated with such agreements. The paper also critiques the outcomes-based reimbursement of biological medicine and the structural necessities for its successful implementation.
Results: A risk-sharing agreement is a useful tool to manage the risk of introducing clinically effective and very expensive medicines into the healthcare market. It is also a tool that bridges the conflicting priorities of the manufacturer of biological medicine and the payer.
Conclusion: The application of risk-sharing agreements within an international context informs the local discussion. This paper is the first in a two-part series that serves to review the international experience with risk-sharing agreements and critique the outcomes-based reimbursement of biological medicines. The backdrop is set for a discussion of the application of risk-sharing agreements in South Africa, which is the purpose of the second paper in this series.
The patient perspective has not been heard during recent debates on healthcare restructuring – this is the unheard voice of the patients. We often assume we know their needs and expectations. But this is not necessarily a failure on our part – its simply about the perspective. I posit that we sitting on a tremendous opportunity, workers in the healthcare sector (we) have a strategic advantage. The good fortune that we have is that not only are we employees of healthcare companies (pharmaceutical industry, medical schemes, academia, consultants, etc.) but we are also patients.
The patient perspective has not been heard during recent debates on healthcare restructuring this is the unheard voice of the patients. We often assume we know their needs and expectations. But this is not necessarily a failure on our part its simply about the perspective. I posit that we sitting on a tremendous opportunity, workers in the healthcare sector (we) have a strategic advantage. The good fortune that we have is that not only are we employees of healthcare companies (pharmaceutical industry, medical schemes, academia, consultants, etc.) but we are also patients. This is a unique position to be in because we are privy to industry-specific information which we use to make more informed decisions. We are also in a unique position to realign decisions to patient needs and expectations. The only reason I introduce this as a topic for further discussion is because I propose that the only legitimate perspective in healthcare decision-making is the perspective of the patient (societal perspective). A patient incurs costs for transportation to healthcare facilities, care-giver time, and an opportunity cost for spending a day at home due to ill health lost income. All other perspectives are partial analytical approaches that provide weak estimates of the impact of healthcare interventions. A funder’s perspective that does not look beyond budgetary impact is illegitimate and should be disband as an inferior analytical approach. The perspective of the government that only includes health-related items on the medium term expenditure framework and medicine tender prices is also a skewed approach to fully understanding the true impact of healthcare interventions. These perspective should be disband in favour of the patient’s perspective. The patient’s perspective should be considered as the only approach with which to encourage transparency of the true cost of healthcare interventions. The true cost of the impact on a patient should reflect as an integral component of all healthcare decision-making.
Ethics, as it is applied to decision making in managed health care, is a growing area of debate.
Ethics, as it is applied to decision making in managed health care, is a growing area of debate. Mackie and Sim (2004) agree, and state in their editorial that the issue of ethical decision making is looming very large for public health. While the ethics of individual clinical decisions have long been explored, public health ethics have more recently become prominent. Decision making in managed health care is not just about the financial, legal and operational interests of the insurer but it also includes societal and medical interests of the patient. A balanced approach is therefore advocated to ensure good clinical practice is achieved in the interest of patients and simultaneously ensuring the financial sustainability of the private health insurer market. Thus the prerequisite of opening the debate of enabling ethical decision making in managed health care.
Carapinha, J. (2005) Ethical Decision Making in Managed Health Care. South African Pharmaceutical Journal, 72 (2).
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