Vinky Maria, William Nathanial Tjandrawidjaya, Ayu Rahmawati, Prih Sarnianto, Yusi Anggriani, Elizabeth Pisani
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引用次数: 0
Abstract
Background: Since Indonesia implemented one of the world's largest single-payer health insurance schemes in 2014, the price of many common medicines has fallen dramatically. Industry groups warn unsustainably low prices threaten quality, while the government says medicines remain overpriced. We investigate the relationship between the price and quality of essential medicines and the affordability of medicines paid for out of pocket.
Methods: We bought over 1000 samples of five common prescription medicines-allopurinol, amlodipine, amoxicillin, cefixime and dexamethasone-online and from randomly selected pharmacies and health facilities in four regions across Indonesia. We recorded the price paid and tested samples for quality using high-performance liquid chromatography. We compared prices with the median and lowest prices for each medicine, tested for correlation between quality and price, and calculated affordability compared with the district minimum wage.
Results: Medicines available in the public procurement system were less likely to fail quality testing than other brands/varieties (4.2% vs 8.3%) but the difference was not statistically significant (p=0.086). There was no other relationship between quality and price, or branded status. Branded generic medicines sold at a large variety of price points, from 0.3 to 18.6 times the median price for the medicine and dose (IQR: 0.9-5.0, median 1.4). Unbranded generics traded in a narrower range (range 0.1-2.6; IQR 0.6-1.0, median 0.8). Medicines were most expensive in the region with the lowest wages, but even there, medicines selling at the 25th percentile of available prices cost a maximum of 0.7% of 1 day's wage for a course.
Conclusion: In every study district, we found that Indonesian patients working at the minimum wage could access affordable, quality-assured versions of all studied essential medicines. More expensive brands were also widely available, but there was no relationship between price and quality.
背景：自2014年印度尼西亚实施世界上最大的单一付款人医疗保险计划之一以来，许多常见药物的价格大幅下降。行业组织警告说，不可持续的低价威胁到质量，而政府表示，药品仍然定价过高。我们调查了基本药物的价格和质量与自费支付药物的可负担性之间的关系。方法：我们在网上和从印度尼西亚四个地区随机选择的药店和卫生机构购买了五种常用处方药——别嘌呤醇、氨氯地平、阿莫西林、头孢克肟和地塞米松——1000多份样品。我们记录支付的价格，并使用高效液相色谱法检测样品的质量。我们将每种药物的价格与中位数和最低价格进行了比较，测试了质量和价格之间的相关性，并计算了与地区最低工资相比的可负担性。结果：公共采购系统药品质量不合格率低于其他品牌/品种（4.2% vs 8.3%），但差异无统计学意义（p=0.086）。在质量和价格或品牌地位之间没有其他关系。品牌仿制药以各种价格点销售，从药物和剂量中位数价格的0.3至18.6倍不等（IQR: 0.9-5.0，中位数1.4）。无品牌仿制药的交易范围较窄(范围0.1-2.6；IQR 0.6-1.0，中位数0.8)。在工资最低的地区，药品最昂贵，但即使在那里，以可获得价格的第25百分位数销售的药品，一个疗程的费用最多也只占一天工资的0.7%。结论：在每个研究区，我们发现印尼患者以最低工资工作，可以获得负担得起的、有质量保证的所有研究基本药物。更昂贵的品牌也随处可见，但价格和质量之间没有关系。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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