Pharmaceutical market access will look very different under a South African national health insurance system.
A national health insurance system would result in an integrated healthcare system founded on the principles of solidarity and redistribution of healthcare resources. Every South African would contribute to funding the national health insurance system and in return receive “free” healthcare services when needed.
Others have said much about national health insurance. For instance:
In all this debate, a key question is how a national health insurance system impacts a patient’s access to innovations from a pharma market access perspective? The question is so fundamental because pharmaceuticals and medical devices are one of the most important interventions to reduce mortality and morbidity in healthcare systems.
To appreciate the importance of pharmaceuticals and medical devices, imagine for a moment a world without pharmaceuticals and medical devices? Access to innovations has over the decades been a major driver in reducing the burden of disease and prolonging life. The South African national health insurance system will include access to essential medicines but how likely is the government to buy new healthcare technologies for the national health insurance system?
An indicator may help us predict the ability of the South African government to increase pharmaceutical market access, including medical devices. The Global Competitiveness Report 2018 by the World Economic Forum measured the “future orientation of government” in 140 countries and South Africa ranked 102.
There were four questions in this category:
The questions are not related directly to pharmaceutical market access under a South African national health insurance system. However, they provide an important clue on how the government will consider new technologies, the policy framework and its flexibility, and the extent the government can think ahead.
South Africa’s low ranking on the Global Competitiveness Report suggests an uncertain future for government funding of new healthcare technologies. It ranked slightly better than Haiti and Zimbabwe but worse than Mali and Burkina Faso. Patients covered by the national health insurance system are unlikely to benefit from new medicines and medical devices available in the private and international market.
The success of NHI depends on the final national health insurance model and how national health insurance will work in practical terms. It also depends on how national health insurance policy will impact the health needs of a very diverse patient population.
For instance, national health insurance for senior citizens, for families, for government employees, and regulating national health insurance for foreigners. It also depends on the ability of pharma market access staff and their companies to address the advantages and disadvantages of a South African national health insurance system
We’ve compiled a list of the advantages and disadvantages related to national health insurance. The list is not exhaustive, there’s a lot more that we could add, but the purpose is to encourage a balanced and critical approach.
The advantages of a South African national health insurance system
The disadvantages of a South African national health insurance system
Solidarity and redistribution of healthcare resources under a South African national health insurance system is an important objective. However, so is a patient’s access to innovations and reducing morbidity and mortality.
The future of government funding new healthcare technologies is uncertain. Patients covered by the national health insurance system are unlikely to benefit from new medicines and medical devices available in the private and international market.
We analyze the impact on pharma market access of national health insurance systems, among other changing health policies.
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