Biologicals are the fastest growing segment of the global pharmaceutical market, reaching 199 billion USD sales per year with 9.8% 10-year compound annual growth rate (CAGR). Being less costly, yet equally efficacious and safe alternatives to originator reference products, biosimilars drive competition, promise budget savings and the opportunity for better patient-access. This paper examines the key factors and players of biosimilar competition in rheumatology in Hungary. Due to the scarcity of data, the total yearly expenditure on biologicals could only be estimated from different data sources. In 2015 the estimated expenditure on biologicals was around 100 billion HUF. In rheumatology indications the expenditure on biologicals was 10 (8.9-11.2) billion HUF, and the average annual net treatment cost was 1.2 (1.06-1.34) million HUF / per patient / year. The magnitude of societal benefits in terms of budget savings and health gains may result from the joint effort of policy makers, funders, physicians and patients. In rheumatology indications, biosimilar utilization could be increased by a policy supporting physician-driven interchange of the reference product to biosimilars. Also, creating a physician incentive system for broader use should be considered in order to realize the full economic advantages of biosimilars and contribute to sustainable healthcare financing in Hungary.
Authors:Liuba Murauskiene, Milena Pavlova, Marija Veniute, and Wim Groot
Patient payments have not been studied systematically in Lithuania. This limits the use of empirical evidence in policy making. More systematic and detailed evidence on the patient payments phenomena in Lithuania are needed to clarify who is seeking and paying for health care services, why, and how. This paper presents the main findings from a quantitative representative population survey on patient payments in Lithuania. The study results confirm the significant scope of the patient payment practices as well as the complexity of the issue. Overall attitudes towards informal cash payments are negative but there is a rather tolerant view on gifts-in-kind. In case of health problems, access to proper (good quality) treatment is crucial. When treatment is needed, Lithuanian patients are ready to pay irrespective of the legitimacy of the payments and despite of the significant financial burden that these payments may cause. Priorities for the quality of care and the protection of vulnerable groups against financial risks are important and should be addressed when discussing the design of patient payment policies in Lithuania. The lack of a transparent political and organizational arrangements and the failure to communicate properly with the general public are the main challenges for future policy.
Authors:Andriy Danyliv, Tetiana Stepurko, Irena Gryga, Milena Pavlova, and Wim Groot
The principle of free-of-charge health care services is written in the Ukrainian Constitution. However, the state fails to implement this principle in practice. Our analysis confirms that in spite of the proclaimed free-of-charge health care services, many Ukrainian patients pay for health care services and these payments are considerable. As much as 57% and 73% of patients using out-patient and in-patient services respectively reported having spent money for this. Among those who paid for health care services, the average annual expenditure is 636 UAH for out-patient services and 2,019 UAH for hospital services. Patients who paid formally on average spent 555 UAH for out-patient services per year, while those who paid informally, spent about 337 UAH. This unregulated patient payment system is a threat to the population’s health as it prevents many patients from obtaining the health care that they need. Hence, the current’ free-of-charge’ system does not work properly and cannot sustain the health of the nation any more. There is a need for a thoroughly designed official and transparent payment system as well as structural financial reforms.
Authors:Milena Pavlova, Jelena Arsenijevic, Wim Groot, and Godefridus Merode
Questions concerning the use of evidence in policy making increasingly attract the interest of both policymakers and researchers. It is broadly recognized that the development of integrated policy frameworks can be facilitated by the use of quantitative analytical methods, such as system modeling, computer simulation, trend analysis, and scenario analysis. Although policy projections based on these methods cannot provide direct solutions to policy problems, they can help to minimize the undesirable effects of a policy choice. This paper presents the concept design of a policy projection tool that estimates the macro-level effects of patient charges. In particular, the paper explores the usefulness of system dynamics modeling for the development of the projection tool. The overall objective of the policy projection tool is to generate evidence relevant for the analysis of patient payment policies. Based on the concept projection tool, a simplified consumption-revenue module is developed for the estimation of the annual health care consumption and the revenue from patient payments during one year. The module is applied to data from six Central and Eastern European countries to test its accuracy. The results from the module testing provide directions for further modeling steps.
Authors:Milena Pavlova, Marzena Tambor, Tetiana Stepurko, Godefridus Merode, and Wim Groot
The lack of systematic research on the assessment of patient payment policies emphasizes the need to evaluate the mechanisms of official patient charges. This paper aims to contribute to this research area by outlining a comprehensive framework for the assessment of patient payment policies, and by validating it on data for six CEE countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Three broad groups of assessment criteria are included in the framework: policy context, policy content and policy effects. Within each of these groups, several sub-groups of criteria are defined. Our application of the assessment framework to the six CEE countries shows its relevance for the comparison of patient payment policy across countries, and for outlining common policy options. At the same time, it also reveals the need of collecting data on other relevant indicators that are not included in this paper, as well as for updating indicators already included. Research on patient payments will be essential for a continuous monitoring of patient payment policies (e.g. those in CEE) and their prompt adjustment.
Authors:Petra Baji, Milena Pavlova, László Gulácsi, and Wim Groot
In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.
Authors:Elka Atanasova, Milena Pavlova, Emanuela Moutafova, Todorka Kostadinova, and Wim Groot
The implementation or amendment of patient charges in a country could benefit from preliminary analyses of their potential effects on health care demand. This paper focuses on hospital care. The paper aims to identify strategies for the empirical analysis of the demand for hospital services that are useful for the assessment of patient charges in the hospital sector, and to compare these strategies using empirical data for Bulgaria. The data were collected in 2010 in a representative survey among consumers. We apply both revealed- and stated-preference approaches. Within the framework of revealed preferences, we use data on various types of patient payments (total payments, formal payments and informal payments) as dependent variables to define three empirical models. Within the framework of stated preferences, we use data on stated willingness to pay for a hospitalization for different sub-samples (current users, users and all respondents), which also results in three empirical models. We observe some similarities and differences between the models based on stated-preference data and those based on revealed-preference data. Although our findings need to be studied further to establish how rigorous they are, they can be useful for setting up new studies on the convergent validity of the two approaches.
Authors:Andriy Danyliv, Milena Pavlova, Irena Gryga, and Wim Groot
Discrete choice experiments (DCE) and contingent valuation (CV) are often applied to value health care benefits. However, whether the two techniques yield converging willingness-to-pay (WTP) estimates is not studied well. This study aims to compare at a disaggregated level WTP estimates for physician services obtained from DCE and CV estimates. We study the consistency between the estimates and whether there are systematic differences between the two. The analysis is based on data from a household survey in Ukraine that includes 303 respondents and is taken to be representative of the Ukrainian population. The respondents participated in both DCE (16 choice tasks) and CV (4 valuation scenarios) in a form of payment scale followed by open-ended questions about the exact maximum WTP. We find that DCE produces higher WTP estimates than CV does, and the estimates are not consistent across the two techniques. A difference between the WTP estimates from DCE over those derived from the CV technique is found (i) for respondents who do not discriminate well between the profiles, and (ii) for an increase in the presented attribute level changes. The implications for achieving better convergence between the WTP estimates from the two techniques are discussed.
Croatia is faced with a low response to cancer-screening programs, especially the national cervical cancer screening program, which ultimately resulted in its suspension. If judged solely on the basis of revealed preferences, such a poor response would imply that the population assigns a low social value to preventive screening programs. However, the question arises as to whether revealed preferences (the population's response), in the case of the absence of response to a preventive program, provide insight into its value (utility). Therefore, the objective of this paper is to determine the value that respondents assign to different attributes of cervical screening and, in a broader sense, to decide whether the best-worst scaling (BWS) approach is appropriate for determining the marginal willingness to pay (MWTP) for public health programs. The MWTP for certain attributes of cervical cancer screening is derived from the results of a BWS study conducted in Primorje-Gorski Kotar County, Croatia. The cost function was estimated by regressing the conditional logit coefficients (level of utility) of three levels of the cost attribute on its corresponding values, that is, the hypothetical price. Because the sum of the MWTP corresponds with the market price of a gynecological examination in private practice, we conclude that the results obtained by the BWS confirm the revealed preferences (the market value of the service).
Authors:Petra Baji, Imre Boncz, György Jenei, and László Gulácsi
The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.