Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries

Katrina Perehudoff, Ivan Demchenko, Nikita V. Alexandrov, David Brutsaert, Angela Ackon, Carlos E. Durán, Faris El-Dahiyat, Firdaus Hafidz, Rezwan Haque, Rabia Hussain, Roderick Salenga, Fatima Suleman and Zaheer-Ud-Din Babar
Additional contact information
Katrina Perehudoff: Law Center for Health and Life, University of Amsterdam, 1018 WV Amsterdam, The Netherlands
Ivan Demchenko: Forensic Medicine and Medical Law Department, National Medical University ‘O.O. Bogomolec’, 01601 Kyiv, Ukraine
Nikita V. Alexandrov: Global Health Law Groningen Research Centre, Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, 9700 AS Groningen, The Netherlands
David Brutsaert: Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium
Angela Ackon: Directorate of Pharmacy, Ministry of Health, P. O. Box M 44 Accra, Ghana
Carlos E. Durán: Clinical Pharmacology Research Group, Department of Basic & Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium
Faris El-Dahiyat: College of Pharmacy, Al Ain University, 64141 Al Ain, UAE
Firdaus Hafidz: Department of Health Policy & Management, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
Rezwan Haque: Access to Information (a2i) Programme (Former Project Director, SWASTI), Dhaka 1207, Bangladesh
Rabia Hussain: Faculty of Pharmacy, The University of Lahore, Lahore 54590, Pakistan
Roderick Salenga: College of Pharmacy, University of the Philippines Manila, Metro Manila 1000, Philippines
Fatima Suleman: Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
Zaheer-Ud-Din Babar: Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK

IJERPH, 2020, vol. 17, issue 24, 1-30

Abstract: Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives ( n = 14 articles), health equity ( n = 10), information dissemination ( n = 3), infrastructure ( n = 2), and sanctions ( n = 1) (not mutually exclusive). Cross-sectional descriptive designs ( n = 8 articles) and time series analyses ( n = 5) were the most frequent designs. Change in patients’ spending on medicines was the most frequent outcome measure ( n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.

Keywords: universal health coverage; universal health insurance; health insurance; access to medicines; legislation; drug; insurance; pharmaceutical services; health services accessibility; pharmaceutical policy; middle income country; essential medicines (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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