Interrupted Time Series Analysis Evaluating The Impact of A Pro-Generic Policy on Drug Pricing and Utilization In Argentina

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the appropriate use and risk association, problem encounter in concentrating things and current status of the user and the reason behind their use is less awareness, increased educational burden and lack of parental guidance. PHP10 Interrupted Time Series Analysis Evaluating The Impact of A Pro-Generic Policy on Drug Pricing and Utilization In Argentina Wilson L1, Yi EJ1, Lightwood J1, Lee B1, Garay U2 of California, San Francisco, San Francisco, CA, USA, 2Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

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in Hungary in 2015. We found that the rate of the above interventions was the highest in specialized hospitals (98.82%). The rate of the achievable same-day surgery’s case number was 60.03% in university clinical centers, which is lower than that in county hospitals (61.38%) and the city hospitals (66.90%), on the other hand, it is higher than the rate of Budapest’s hospitals (55.49%), children’s hospitals (50.66%), and national health care institutes (28.23%).  Conclusions: Our results showed that in 2015 the specialized hospitals performed the most, while the national health care institutes performed the least case numbers regarding same-day surgeries in Hungary.

1University

Objectives: In response to a 2001 economic depression, Argentina imposed a pro-generic law to enforce providers to prescribe generics, enable pharmacists to substitute generics, and allow consumers choice. We evaluate the impact of the generic policy on drug pricing and utilization in Argentina.  Methods: A quasiexperimental, longitudinal interrupted time series analysis of quarterly real price, and drug use in Argentina, 1995-2013, using IMS health data. Variables included total real and unit price in pesos, drug name, dose, quantity, originator brand, branded generic, manufacturer generic, true generic, and time. A random effects regression analysis using panel data assessed price and utilization trends before and after policy intervention and estimated interaction effects.  Results: 4,783 formulations for 42 active ingredients were observed. Prior to the policy, the overall unit price per formulation across all drugs was increasing by 0.005% (p< 0.01) per quarter. The immediate effect after policy implementation was a significant (0.085%, p< 0.01) decrease in unit price per drug per quarter. The interaction between policy and time showed the policy changed the unit price trend over time significantly downward (-0.002%, p< 0.01). The immediate policy effect was to significantly increase real drug use per quarter by 0.21% (p< 0.01)), and drug use continued to increase slightly over time by 0.004%. The originator brand had highest unit prices, then branded generics, manufacturer generics, with true generics with lowest unit prices. The policy had the most downward effect in unit price per quarter on branded generics, (-0.17%, p< 0.01) and true generics (-0.13%, p< 0.01).  Conclusions: The pro-generic policy produced the intended effect to decrease overall unit prices per quarter with corresponding increases over time in real drug use. Brand drug prices continued as highest, with policy decreasing unit price of branded generics and true generics. The decrease in unit prices and increased utilization allowed more access to drugs.

HEALTH CARE USE & POLICY STUDIES – Equity and Access PHP11 How Far Equity Has Been Achieved in the Indonesian Universal Health Coverage? Thabrany H, Adawiyah E The National Social Security Council, Jakarta, Indonesia

Objectives: Indonesia has been using social health insurance scheme since 1968 limited to civil servants and then to small portion of private employees since 1993. In January 2014, the expansion to cover all people by establishing a single payer, the National Health Insurance Corporation, was started. By March 2017, the universal health coverage (UHC) covers 174 million people, making it the UHC the largest single payer in the World. In addition, it is also the largest scheme applying capitation payment to primary health care and diagnosis related groups for outpatients and inpatients care nationwide. The main goal of the UHC is to ensure equitable access to medically necessary care.  Methods: To evaluate how far the UHC achieve its goal we used the National Social Economy Survey of 2013 and 2016 consisting of roughly 1.1 million respondents. We conducted logistic regression to assess differences in access among economic groups and across various provinces. We calculate concentration indices and to draw concentration curve to evaluate equity across income groups.  Results: We found the increase in access to hospital care higher among lower income groups and in rural provinces compared to the access of high income and urban population. Overall, in the national level, the concentration index (CI) decreased from 0.27 to 0.22 after three-year expansion of the UHC. We also assessed different concentration indices of various hospital types. The changes of CI were a little bit higher in public hospital (CI changes of 0.04) compared to access in private hospital (0.03).  Conclusions: The UHC is proven to improve equity in access to public and provide hospitals across provinces.

HEALTH CARE USE & POLICY STUDIES – Diagnosis Related Group PHP4 The Analysis of the Number of Same-Day Surgery Cases in 2015 in Hungarian Hospitals Pónusz R, Németh N, Kovács D, Endrei D, Boncz I University of Pécs, Pécs, Hungary

Objectives: Over the past few years one day surgery has become more specific in health care systems throughout the world. This study analyzed the available same-day surgical procedures in the Hungarian health care system in the year 2015.  Methods: Data were derived from the financial database of National Institute of Health Insurance Fund Administration and covering the year of 2015. We applied the usual performance indicators by comparing the actual number of same-day surgical interventions to the theoretical number of same-day surgical intervention which could have been performed by the hospitals among ideal circumstances. The number of cases was used to establish the rate of same-day surgical procedures. Hungarian hospitals were classified into the following groups: university clinical centers, county hospitals, city hospitals, specialized hospitals, Budapest’s hospitals, children’s hospitals and national health care institutes.  Results: 62.29% of the achievable same-day surgeries was accounted for by the publicly funded institutes

PHP5 Funding New Technologies in German Inpatient Care - Does it Work? Ex P, Henschke C Berlin University of Technology, Berlin, Germany

Objectives: Due to disincentives inherent in systems of diagnosis-related groups (DRGs), additional payments for newly approved technologies complement these prospective payment systems. In Germany, so called innovation payments are negotiated between individual hospitals and health insurances. Thus, hospitals may not have the same chance of being reimbursed for new, more expensive technologies. This study aims at investigating this temporary reimbursement mechanism. We examine factors that might be associated with agreeing innovation payments.  Methods: Based on a data set of the Scientific Institute of the AOK (including agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances) and data of the German Federal Statistical Office on state level, multilevel logistic regression was estimated to examine factors at hospital and state level. All German acute hospitals and innovation payments on all diagnoses are thus included in the study. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n= 1,358).  Results: In total, 32.9 per cent of the hospitals successfully negotiated innovation payments in 2013 (31.3 per cent of non-university hospitals, 91.9 per cent of university hospitals). The share of hospitals that successfully negotiated innovation payments varied considerably among the states. The chance of negotiating innovation payments increased for large and private for-profit hospitals and hospitals with university status. Additionally, hospitals located in areas with a low degree of competition – such as rural areas – had a lower chance of negotiating innovation payments.  Conclusions: The study indicates that policy making generally compensates disincentives of the DRG system by additional innovation payments. Patient safety is implicitly fostered by favouring university hospitals and large hospitals to use new technologies. However, the innovation payments may impede patient access in rural areas since hospitals in regions with low competition have a smaller chance to receive innovation payments.

HEALTH CARE USE & POLICY STUDIES – Disease Management PHP6 Multiple Chronic Conditions in Older People and their Effects on Health Care Utilization: A Network Analysis Approach Using Share Data Srakar A1, Prevolnik Rupel V2 for Economic Research, Ljubljana and Faculty of Economics, University of Ljubljana, Ljubljana, Slovenia, 2Institute for Economic Research, Ljubljana, Slovenia 1Institute

Objectives: The presence of multiple coexisting chronic diseases in individuals and the expected rise in chronic diseases are major public health challenges of modern societies. Individuals with multiple conditions are presumed to have greater health needs, more risk of complications, and more difficulty to manage treatment regimens. In our article we model the presence of multiple diseases in older people using network analysis and explore the influence of the presence of multiple diseases on health care utilization.  Methods: We use SHARE dataset of Wave 5, including data on 14 European countries and Israel for the people aged 65+. We model the presence of multiple coexisting diseases as a two-mode network analysis problem (the individuals are connected in a network through their diseases). This has special scientific relevance as network analysis has not been used so far to study this problem and very seldom before in the analysis using SHARE data. To appropriately model the presence of multiple chronic diseases we use modularity and blockmodelling techniques for two-mode networks. To verify the effects of multiple diseases on the rates of health care utilization we also use microeconometric models from causal inference (controlling for endogeneity).  Results: We show the presence of consistent clusters of diseases across the analyzed countries and confirm particular influence of the groups/clusters encompassing mental diseases (including dementia), arthritis (including osteoarthritis) and different types of ulcers, with slight variation by welfare regimes. In particular, there is a high influence of those clusters on the usage of drugs and hospitalizations.  Conclusions: In the article, we develop a new method to study multiple diseases and their influence on health care utilization of older people, having wide application for health economic and medicine sciences in future. In conclusions, we also provide reflection of the research and policy relevance of the study. PHP7 The Practical Application of a Digital Therapeutic Education Platform for Cardiovascular Rehabilitation Abdennbi K1, Bader J2, Atellian L2 1Hôpital Léopold Bellan, Paris, France, 2Observia, Paris, France

Objectives: Describe the patient population of patients enrolled in the “AtoutCoeur” platform - Evaluate the patient education activity in the cardiac rehabilitation centre following AtoutCoeur’s launch - Evaluate AtoutCoeur’s performance in terms of helping patients to achieve objectives  Methods: The platform will be evaluated retrospectively based on real life data. To determine AtoutCoeur’s performance, the patients’ score for each of their objectives was considered. This score is determined based on an algorithm that takes into account their medical profile