Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment

2020 ◽  
Vol 35 (6) ◽  
pp. 1503-1511
Author(s):  
Nazila Yousefi ◽  
Mahyar Polroudi Moghaddam ◽  
Gita Afsharmanesh ◽  
Farzad Peiravian
Author(s):  
Richard C. van Kleef ◽  
Wynand P. M. M. van de Ven ◽  
Rene C. J. A. van Vliet

An important goal of consumer cost-sharing in health insurance is to increase incentives for cost containment. A relatively new cost-sharing phenomenon is the “doughnut hole”: a gap in coverage starting at a predefined level of medical expenses. An important question is where to locate the starting point to achieve the strongest incentives for cost containment. We argue that the answer depends on an individual's health status. Using data from a Dutch insurer, this paper illustrates that using a risk-adjusted starting point results in both stronger incentives for cost containment and more equity than a uniform starting point.


2021 ◽  
Vol 9 ◽  
Author(s):  
Zornitsa Mitkova ◽  
Guenka Petrova

Health care systems worldwide are experiencing tremendous financial pressure because of the introduction of new targeted health technologies and medicines. This study aims to analyze and compare public and household healthcare expenditures in Bulgaria during the period 2015–2019, as well as present the major cost-containment measures implied by the government and their probable influence on the overall health care cost. Regulatory analysis of the endorsed cost-containment measures, budget analysis of public and household health care expenditures, and their extrapolations were performed. The regulatory analysis reveals that a large number of measures are introduced and valid until January 2021, considering pharmaceuticals, medical devices, and negotiations between the National Health Insurance Fund (NHIF) and Marketing authorization holders (MAHs). NHIF costs due to pharmaceuticals, food supplements, and medical devices are rising from 2015 to 2019. The overall health expenditures average per household and the average per person also grow in this period. The cost extrapolation reveals that an increase in 3-year periods is expected. Despite the implementation of variety of cost-containment measures in Bulgaria, such as HTA, ERP, discounts, and annual negotiations, The National Health Insurance Fund's (NHIF) spending on pharmaceuticals continues to rise in recent years, and further increases are expected in the next 3 years. The average expenditure per household and per person also increased, which confirms the global trend of rising medicine and outpatient services value.


1991 ◽  
Vol 5 (1) ◽  
pp. 66-78 ◽  
Author(s):  
Ok Ryun Moon

Cost containment is the major determinant of a successful national health insurance system. From this point of view, the financial situation and factors influencing the rise of health care costs in the Korean health insurance program were analyzed. Current measures of cost containment in use are discussed in terms of price cutting and utilization reduction approaches.


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