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1. Costing Healthcare Services Using Time-Driven Activity-Based Costing: A Simple Step-By-Step Guide for Data Collection and Analysis

Author:
Lumbwe Chola, Ryan McBain, and Y-Ling Chi
Publication Date:
10-2022
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Cost information is essential for priority setting and optimized resource allocation in the healthcare sector, especially in low- and middle-income countries (LMICs) where resource constraints and opportunity costs are significant. In recent years, a costing approach labelled time-driven activity-based costing (TDABC) has gained prominence, as a means for more closely estimating unit costs. TDABC is a process-based micro-costing methodology that adopts a patient perspective to identify resources that are allocated over the course of service provision, mapping each step of a patient journey. Unlike other activity-based costing methods, TDABC includes the recording of the amount of time that resources are utilized for each activity. The manuscript is developed as a step-by-step guide for researchers, students and policy makers intending to undertake TDABC. While there are many academic resources explaining the theory and steps to conduct TDABC, in this paper, we provide easily accessible descriptions of methods for collecting data, tools that can be adapted to diverse research questions and settings, as well as practical data collection “tips” we learned from applying approaches on the ground.
Topic:
Science and Technology, Health Care Policy, Medicine, and Cost-Benefit Analysis
Political Geography:
Global Focus

2. A Path to Resiliency: Mitigating the Impacts of COVID-19 on Essential Medicines Supply Chains

Author:
Anthony McDonnell, Elizabeth Pisani, and Somya Singhvi
Publication Date:
06-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
COVID-19 has put a spotlight on health product supply chains, highlighting the challenges in multiple steps in the global supply chain. This paper seeks to understand the impact of COVID-19 on the supply chain of a subset of essential medicines. It identifies the main categories of blockages in the global supply chain created by COVID-19, then uses data on trade flows, wholesalers, and pharma companies, and from surveys, to track the impact. There was significant short-term disruption to manufacturing caused by COVID-19. Surveys, pharmacy, and export data indicate that COVID-related disruptions impacted the supply of essential medicines, but this varied greatly by markets and product. The paper highlights that (1) data-driven approaches should be considered to make supply chains more robust, (2) solutions must account for the political and institutional landscape, (3) price surges benefit the wealthiest, and (4) local solutions are often needed to manage global shocks. More research is needed, particularly into how to obtain granular data to track supply shocks in real time? How do we increase surge capacity? Is it possible to improve procurement practices through pooled procurement, where applicable? And can pharmaceutical production be diversified, with products produced regionally to limit the risk of disruption?
Topic:
Pandemic, Resilience, COVID-19, and Medicine
Political Geography:
Global Focus

3. Blueprint for a Market-Driven Value-Based Advance Commitment for Tuberculosis

Author:
Kalipso Chalkidou, Martina Garau, Rachel Silverman, and Adrian Towse
Publication Date:
02-2020
Content Type:
Special Report
Institution:
Center for Global Development
Abstract:
Innovation—delivering new drugs, diagnostics, and devices—is a critical tool in the global fight against disease and premature death. Yet despite the potential for innovation to improve health around the world, the pharmaceutical industry’s investments in research and development (R&D) generally neglect diseases of the poor in favour of more lucrative high-income markets. Responding to this R&D gap, donor “push” investments have helped advance an innovation agenda to serve low- and middle-income countries. Though these investments have helped accelerate market entry of several important innovations, other donor-push products have fizzled upon market entry due to unaffordable or non-cost-effective pricing, disappointing efficacy, lack of political will, or lower-than-anticipated country demand. And with many large middle-income countries (MICs) poised to soon transition from donor aid, the sustainability of the current donor-led model is in question. Tuberculosis (TB), an infectious disease primarily affecting the poor and vulnerable, ranks among the top 10 global causes of death. Current TB treatment cycles are long and toxic, causing some patients to discontinue treatment, develop acquired drug resistance, and risk spreading a drug-resistant pathogen to others. Drug-resistant strains are more difficult to treat, traditionally requiring long-duration toxic regimens and high-cost hospitalization (though recent innovations offer a shorter, more tolerable, and more affordable treatment). Despite years of global investment in TB control, modelling suggests that global goals for TB cannot be achieved without major technological breakthroughs. One particularly desirable innovation would be a short-course universal drug regimen (UDR)—equally capable of treating drug-sensitive and drug-resistant strains, with a two-month or shorter treatment duration. Donors, particularly the Bill & Melinda Gates Foundation (BMGF), have funded substantial early-stage R&D to source new treatment compounds that could contribute to a UDR, but substantial additional investments in late-stage trials would be required to bring such a UDR to market.
Topic:
Health Care Policy, Drugs, Medicine, and Pharmaceuticals
Political Geography:
Global Focus

4. Can Transparency Lower Prices and Improve Access to Pharmaceuticals? It Depends

Author:
Kalipso Chalkidou and Adrian Towse
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
spending on pharmaceuticals and other healthcare commodities is high and makes up a large proportion of healthcare spending in rich and poorer markets alike. A popular response to the problem of escalating drugs budgets has been transparency of drug pricing within and across borders. In a rare alignment of policy priorities, the Trump administration, the US Senate, and the World Health Organisation are calling for more transparency of the prices paid for prescription drugs as a means of tackling the ever-growing pharmaceuticals bill. Recently Italy’s health minister joined in, calling for a World Health Assembly resolution which would mandate WHO to “provide governments with a forum for sharing information on drug prices, revenues, research and development costs, public sector investments and research and development subsidies, marketing costs and other related information.” But is price transparency really the answer to healthcare systems’ fiscal sustainability challenges as they strive to expand access to new technologies or even merely sustain provision within strained public budgets? Well, it depends!
Topic:
Transparency, Medicine, Pharmaceuticals, and Price
Political Geography:
Global Focus

5. WHO Technical Report on Cancer Pricing Misses the Mark—It Should Focus on the “Demand Side”

Author:
Kalipso Chalkidou, Adrian Towse, and Richard Sullivan
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Criticising cancer medicine pricing as too high is what football fans know as an "open goal"—a target that is hard to miss. Yet somehow the World Health Organization (WHO) Technical Report on Cancer Pricing manages to do just that with a paper to the WHO Executive Board calling for price and cost transparency. The assumption goes that transparency will reduce the prices and costs of cancer medicines, a mantra that has united the Trump administration, the US Congress, and the Italian health minister with many NGOs who have called for “greater cost and price transparency”—a sentiment echoed by KEI, which states that “international action is required to improve transparency in reporting the costs of R&D and production, including public sources of funding.”
Topic:
World Health Organization, Health Care Policy, Medicine, Cancer, and Price
Political Geography:
Global Focus

6. Pooled Procurement of Drugs in Low and Middle Income Countries

Author:
Pierre Dubois, Yassine Lefouili, and Stephane Straub
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. Our empirical analysis is based on exhaustive data on drug sales quantities and expenditures over several years for forty important molecules. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated.
Topic:
Drugs, Medicine, Centralization, and Price
Political Geography:
Global Focus

7. Who Benefits from Pharmaceutical Price Controls? Evidence from India

Author:
Emma Boswell Dean
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
With the goal of driving down drug costs, governments across the globe have instituted various forms of pharmaceutical price control policies. Understanding the impacts of such policies is particularly important in low- and middle-income countries, where lack of insurance coverage means that prices can serve as a barrier to access for patients. In this paper, we examine the theoretical and empirical effects of one implementation of pharmaceutical price controls, in which the Indian government placed price ceilings on a set of essential medicines. We find that the legislation resulted in broadly declining prices amongst both directly impacted products and competing products. However, the legislation also led to decreased sales of price-controlled and closely related products, preventing trade that would have otherwise occurred. The sales of small, local generics manufacturers were most impacted by the legislation, seeing a 14.5 percent decrease in market share and a 5.3 percent decrease in sales. These products tend to be inexpensive, but we use novel data to show that they are also of lower average quality. We provide evidence that the legislation impacted consumer types differentially. The benefits of the legislation were largest for quality-sensitive consumers, while the downsides largely affected poor and rural consumers, two groups already suffering from low access to medicines.
Topic:
Medicine, Pharmaceuticals, Price, and Price Control
Political Geography:
Global Focus

8. Aggregating Demand for Pharmaceuticals is Appealing, but Pooling Is Not a Panacea

Author:
Cassandra Nemzoff, Kalipso Chalkidou, and Mead Over
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
As low- and middle-income countries reduce their reliance on donor aid, they are increasingly obliged to assume some degree of financial responsibility for donor projects. This challenge will be particularly complex in the procurement of health commodities. In recent decades, recipient countries have benefitted from donor-aggregated demand and pooling mechanisms, negotiated prices, purchasing, and delivery of commodities. However, as countries shift away from donor support, their challenge will be finding a way to aggregate demand in order to achieve the benefits that the pooled purchasing arrangements of vertical health programs now provide. As a first step in tackling this challenge, much can be learned from a diverse group of pooled procurement initiatives that have developed over the past 40 years in high-, middle-, and low-income countries. This note reviews the rationale and functions of these initiatives, notes their potential benefits and barriers, and draws lessons regarding how best to incorporate pooled pharmaceutical purchasing models into the design and implementation of health financing reforms in countries in transition. We first provide a brief background on the procurement challenges faced by countries in transition. In section 2, we provide an overview of different types of pooling initiatives, highlighting the key features of each. Leveraging our research and key interviews, we outline the real and potential benefits of pooling in section 3, and the most pressing barriers that organizations or countries will face as they seek ways to aggregate demand in section 4. In section 5 we discuss some of the issues that countries and development partners should address when considering pooled procurement initiatives and make two recommendations: (1) countries and development partners should conduct further research on the merits of pooled procurement, and (2) they should develop a straw model of a pooled procurement governance structure that could be tested using a series of pilots.
Topic:
Budget, Public Health, Medicine, and Pharmaceuticals
Political Geography:
Global Focus

9. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
Topic:
Health, Public Health, Pandemic, Procurement, and Medicine
Political Geography:
Global Focus