Authors: Anderson Rossatto and Gabrielle Gimenes (FEBRAF, Brazil)
Access to medicines and health products, promoting the rational use of these technologies and ensuring their effectiveness, safety and quality are basic guidelines for national drug policies in many countries. To achieve these objectives, there are several strategies that include different models for managing the stages of the logistical cycle, with possibilities from totally public to totally private systems. Associated with the management models, there are also several financing possibilities. Thus, the national pharmaceutical assistance financing systems have different configurations, which derive from the model adopted by the country. 1
Traditionally, the supply of medicines and health supplies can be classified into six main models, according to the distribution of responsibilities between the public and private sectors. 2:
- Completely public: in this system, the purchase and distribution of medicines are the responsibility of the governmental sphere, through resources from the treasury and its own network, responsible for storage, distribution and dispensing. Many countries in Africa, Asia, Europe and Latin America use this standard strategy.
- Supply of medicines through autonomous agencies: alternative system to totally public supply, in which the financing is public, but the management is carried out by an autonomous or semi-autonomous pharmaceutical supply agency. This strategy can be found in countries in Africa, Asia and America.
- Social health insurance: reimbursement system to private pharmacies or to patients themselves, using resources from the public budget and health insurance. The reimbursement can be of the total value of the medication or partial (co-payment), according to the established policy. This model is used by Australia and many countries in Western Europe and America.
- Private financing and public supply: the supply of medicines occurs in public health units, but the products are paid (in whole or in part) by patients. In the 1990s, this model was used by China and some countries in Asia, Africa and Latin America.
- State monopoly: pharmaceutical products are purchased and distributed by a company that holds the monopoly and supplies the products to private pharmacies, as well as to government health services. Although this model has historical significance, it is rarely found today.
- Totally private: patients pay the full cost of the drugs, purchasing them in private pharmacies and drugstores. This strategy is also present in countries with a public supply model, and can account for up to 90% of local demand.
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