Towards Equitable Access to Medicines for the Rural Poor: Analyses of Insurance Claims Reveal Rural Pharmacy Initiative Triggers Price Competition in Kyrgyzstan


Show simple item record Waning, Brenda en_US Maddix, Jason en_US Tripodis, Yorghos en_US Laing, Richard en_US Leufkens, Hubert GM en_US Gokhale, Manjusha en_US 2012-01-11T15:51:15Z 2012-01-11T15:51:15Z 2009 en_US 2009-12-14 en_US
dc.identifier.citation Waning, Brenda, Jason Maddix, Yorghos Tripodis, Richard Laing, Hubert GM Leufkens, Manjusha Gokhale. "Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan" International Journal of Equity in Health 8:43. (2009) en_US
dc.identifier.issn 1475-9276 en_US
dc.description.abstract BACKGROUND. A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region. METHODS. We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. RESULTS. Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price. CONCLUSIONS. The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means of achieving their goal. Evaluations of interventions to increase rural access to medicines should include impact assessment on both formal and informal pharmaceutical markets. en_US
dc.description.sponsorship United States Agency for International Development en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2009 Waning et al; licensee BioMed Central Ltd. en_US
dc.rights.uri en_US
dc.title Towards Equitable Access to Medicines for the Rural Poor: Analyses of Insurance Claims Reveal Rural Pharmacy Initiative Triggers Price Competition in Kyrgyzstan en_US
dc.type article en_US
dc.identifier.doi 10.1186/1475-9276-8-43 en_US
dc.identifier.pubmedid 20003422 en_US
dc.identifier.pmcid 2803474 en_US

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