Health insurance in developing countries: lessons from experience.
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Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches. (+info)
Hospital pharmacists' participation in audit in the United Kingdom.
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OBJECTIVE: To investigate systematically participation in audit of NHS hospital pharmacists in the United Kingdom. DESIGN: Questionnaire census survey. SETTING: All NHS hospital pharmacies in the UK providing clinical pharmacy services. SUBJECTS: 462 hospital pharmacies. MAIN MEASURES: Extent and nature of participation in medical, clinical, and pharmacy audits according to hospital management and teaching status, educational level and specialisation of pharmacists, and perceived availability of resources. RESULTS: 416 questionnaires were returned (response rate 90%). Pharmacists contributed to medical audit in 50% (204/410) of hospitals, pharmacy audit in 27% (108/404), and clinical audit in only 7% (29/404). Many pharmacies (59% (235/399)) were involved in one or more types of audit but few (4%, (15/399)) in all three. Participation increased in medical and pharmacy audits with trust status (medical audit: 57% (65/115) trust hospital v 47% (132/281) non-trust hospital; pharmacy audit: 34% (39/114) v 24% (65/276)) and teaching status (medical audit: 58% (60/104) teaching hospital v 47% (130/279) non-teaching hospital; pharmacy audit 30% (31/104) v 25% (68/273)) and similarly for highly qualified pharmacists (MPhil or PhD, MSc, diplomas) (medical audit: 54% (163/302) with these qualifications v 38% (39/103) without; pharmacy audit: 32% (95/298) v 13% (13/102)) and specialists pharmacists (medical audit: 61% (112/184) specialist v 41% (90/221) non-specialist; pharmacy audit: 37% (67/182) v 19% (41/218)). Pharmacies contributing to medical audit commonly provided financial information on drug use (86% 169/197). Pharmacy audits often concentrated on audit of clinical pharmacy services. CONCLUSION: Pharmacists are beginning to participate in the critical evaluation of health care, mainly in medical audit. (+info)
Competency, board certification, credentialing, and specialization: who benefits?
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Pharmacists are concerned with the rapid changes in the healthcare system and what the requirements will be for a pharmacist in the near future. The emergence of board certification, credentialing, and other certification programs for pharmacists are causing significant concern among pharmacists. Pharmacists must assess certification programs and decide on the value of certification to their careers and to the patients they serve. Employers of pharmacists and those paying for healthcare and pharmacy services must also evaluate the value of pharmacists certification. Perhaps the most direct and significant benefit of pharmacist certification lies in the ability of the pharmacist to provide better and more comprehensive care to patients or selected groups of patients (eg, diabetic patients). Better and more comprehensive care provided by a pharmacist benefits the patient, other healthcare professionals, the healthcare system generally, and payers of healthcare and pharmacy services. Demonstrated competence of the pharmacist to provide pharmaceutical care is essential to achieving this benefit. Board certification of pharmacists in current board-recognized specialty areas of nutrition support pharmacy, pharmacotherapy, psychiatric pharmacy, nuclear pharmacy, and oncology pharmacy totaled 2075 board certified pharmacists in the United States as of January 1997. (+info)
Long-term management of asthma: how to improve outcomes.
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Improved clinical outcomes in asthma patients have been demonstrated in several clinical trials that applied the National Institutes of Health (NIH) guidelines for the long-term management of asthma. Environmental control, objective monitoring, drug therapy, and partnership in patient education are the major components of optimal management. Inhaled antiinflammatory agents are of major importance for long-term control in patients with persistent asthma. Adequate patient education is absolutely essential for excellent, cost-effective care of patients with asthma. Improved outcomes in adults with asthma have been demonstrated at clinics initiated and managed by pharmacists. Further trials are needed with large numbers of patients in managed care organizations. (+info)
Patient consultation in a managed care setting: guiding pharmacy into the future.
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Managed care organizations are excellent environments for pharmaceutical care programs to demonstrate their impact on patient care outcomes and to decrease costs. Patient consultation is the cornerstone in implementing pharmaceutical care because it increases patient contact with the pharmacists while improving patient compliance with drug therapy (adherence). Implementation of a patient consultation program that verifies patients' understanding of their disease and therapy gives the pharmacist information necessary to monitor drug therapy. Use of strategic planning to overcome barriers, followed by the development of local standards of practice, will refocus the practice philosophy to one of improving patient outcomes. Pharmacy managers must demonstrate and document the value that patient consultation brings to the patient and the healthcare system. Then, they must integrate their counseling effort with other health education efforts of the managed care system. Pharmacists will gain the support of other disciplines by reinforcing their efforts. Together they can work to decrease the problems that are inherent with drug therapy. These goals can be accomplished with minimal expense and have the potential to produce significant savings in healthcare costs. (+info)
Impact of pharmacist consultations provided to patients with diabetes on healthcare costs in a health maintenance organization.
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We conducted a study to assess the impact on healthcare utilization and costs of pharmacist consultations provided to patients with diabetes. Data for this study were derived from a larger study conducted by Kaiser Permanente and the University of Southern California that evaluated three alternative models of pharmacist consultations (control, state, and Kaiser). Computerized data were available for patient demographic characteristics and healthcare utilization. We used medication data to classify patient cohorts as insulin only or oral antidiabetics +/- insulin. We estimated hospitalization costs based on diagnostic related group and medication costs based on average wholesale price; office visits were estimated at $70 each. In the insulin only cohort, total costs for patients who had their prescriptions filled at a state model pharmacy were 7.8% less than those for patients filling prescriptions at a control model pharmacy (P = 0.008). In the oral +/- insulin cohort, total costs for patients filling new prescriptions at a Kaiser model pharmacy were 21.9% less than those for patients using a control model pharmacy (P = 0.0001). The state model also was negatively correlated (beta coefficient, -0.0997) with total costs (P = 0.0001). These data suggest that pharmacist consultations provided to patients with diabetes can decrease total healthcare costs in a health maintenance organization. (+info)
Generic drug product equivalence: current status.
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This activity is designed for healthcare professionals involved in the selection of multisource drug products. GOAL: To understand the basis for approval of generic drug products by the Food and Drug Administration. OBJECTIVES: 1. Identify the criteria employed by the Food and Drug Administration to approve generic drug products. 2. Discuss controversial issues that have been raised relative to generic drug products. 3. Identify narrow therapeutic index drugs. 4. Describe the different types of bioequivalence studies that are required by the Food and Drug Administration. 5. Discuss the responsibilities underlying the selection of multisource drug products by healthcare professionals. (+info)
Development and evaluation of a pharmacist-directed pharmacotherapy center.
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This article is designed for ambulatory pharmacy specialists, pharmacy administrators, and managed care pharmacy and/or medical directors interested in developing systems for improved drug therapy outcomes. GOAL: To describe an alternative method for the effective delivery of pharmaceutical care. OBJECTIVES: 1. Identify the barriers to delivery of pharmaceutical care in current systems. 2. Describe the steps to take to implement a referral-based pharmaceutical care service. 3. Describe the financial and patient satisfaction outcomes of a referral-based pharmacy. 4. Describe the services that can be offered by a referral-based pharmacy. (+info)