Spiralling Healthcare Expenditure in Malaysia: Is it Sustainable?

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Kannur. Mean kinetic humidity was more in coastal area, which may have accelerated the degradation of samples from Cochin. A significant statistical difference (p=  0.0000) was observed across brands in the potency of Cephalexin. Microbiological data showed significant reduction in zone of inhibition for samples collected from Cochin in comparison with other regions  Conclusions: The study identifies the importance of storage conditions of antibiotics in pharmacies for the better pharmaceutical care. Improper storage can leads to therapurtical failure and adverse reactions to patients.

Health Care Use & Policy Studies – Health Care Costs & Management PHP33 Construction of System Dynamics Model for Medical Care System of Japan Inoue S1, Xu H2, Maswana J2, Kobayashi M1 1CRECON Medical Assessment Inc., Tokyo, Japan, 2University of Tsukuba, Tokyo, Japan

Objectives: Japan has been facing dramatic changes with the aging population and soaring medical care expenditure. Responding to this situation, it has been urged to reform the medical care system for efficient use of limited medical care resources. The objectives of this research are to construct a system dynamics (SD) model to estimate the future medical care expenditure and to address the dynamic issues of the health care that should be overcome.  Methods: The SD model was constructed by referring to existing models and mainly consisted of three variables; namely per capita medical care expenditure, population, and annual medical care expenditure. The parameters of the model were drawn from relevant articles and official database of Ministry of Health, Labour and Welfare. Japan’s population projections were sourced from the estimates of the National Institute of Population and Social Security Research. Total medical care expenditure was first calculated by age-groups and subsequently summed up as total medical care expenditure. The time period of the simulation was set from FY 2010 to FY 2030. Last, the SD model was constructed by using iThink® (isee systems, USA).  Results: Annual total medical care expenditure in FY 2030 was estimated as 70.2 trillion yen (T yen) (0-14 years; 2.6T yen, 15-44 years; 5.6T yen, 45-64 years; 13.4T yen, over 65 years group; 48.6T yen). The cumulative medical care expenditure in 20 years was estimated as 1,121.7T yen.  Conclusions: As a result of the simulation, annual total medical care expenditure was estimated to be 1.9 times in 20 years under current setting. Impact of the spread of generic drugs usage and the change of disease prevalence are required to be assessed in the next phase of our study. PHP34 The Study of Drug Price Comprison Between China and 14 Other Countries Liu B1, Su W2, Mo Y1 of Health Economics, School of Public Health, Fudan University, Shanghai, China, 2IHS Life Sciences, Washington, DC, USA

1Department

Objectives: This research aims to figure out the price difference of certain drugs between China and the other countries, especially the country where the drug was originally produced (origin country) and those countries neighbor to China.  Methods: Forty-eight drugs with highest unit price and procurement value in China were selected. Fourteen countries from Europe, Asia and North America were included as comparator countries. Price data came from IHS POLY database and China national drug supply information platform. Price ratio (China vs. origin country) was used for the price comparison between China and origin country, and median price ratio was used for the price comparison between China and those reference countries. Official exchange rate issued by the International Monetary Fund was used in cross-country drug price comparison.  Results: Among 39 imported drugs, 22 drugs had price ratio (China to origin country) higher than 1. The highest price ratio was about 16 while the lowest price ratio is only 0.32. Drugs having price ratio higher than 2 were imported from France, Canada and Italy. On the basis of the available drug price information of the 14 reference countries, around two thirds of drugs were found with median price ratio (China to median price of reference countries) between 1 and 2. Only 3 kinds of drugs had median price ratio lower than 1.  Conclusions: The empirical comparison of drug prices between China and origin countries showed contrast picture with some imported drugs are more expensive in China while some drugs much cheaper in China when compared with origin countries. Most of drugs from France and Canada had higher price in China. When compared with the other 14 reference countries, most drugs have similar price to China, except for some cancer drugs. PHP35 The First Indonesian Health-Related Quality of Life Valuation Study: An Eq-5d-5l Value Set

discrete choice data was used. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony.  Results: From 1056 participants who completed the interview, 2 met criteria that excluded them from the primary analyses. The characteristics of remaining 1054 respondents were very similar to those of the Indonesian population. Descriptive analysis showed that anxiety/depression and pain/discomfort are the two dimensions with most reported health problems. In the value set, values are ranged from -0.8506 for health state 55555 to 0,9426 for health state 11112. Mobility dimension affects most quality of life utility values, while Pain and Discomfort the least. Comparisons with healthy states values in other countries, and associations with demographic characteristics will be presented.  Conclusions: This is the first value set of the EQ-5D-5L for Indonesia, and Indonesian preference on health states. We expect our survey to promote and facilitate research on health economic evaluations in Indonesia. PHP36 Cost Variations of Inpatient, Daycare and Outpatient Hysteroscopy in A Tertiary-Care Hospital in Malaysia Shabaruddin FH, Chai BS, Woo YL, Dahlui M University of Malaya, Kuala Lumpur, Malaysia

Objectives: Hysteroscopy, a common gynaecological procedure, can be conducted in inpatient, daycare or outpatient setting. The costs of hysteroscopy conducted in the different settings vary between healthcare systems. This study aims to describe the cost of hysteroscopy in inpatient, daycare and outpatient settings in a tertiarycare hospital in Malaysia from the healthcare provider perspective.  Methods: Resource use data were collected from the medical records of patients who underwent hysteroscopy in 2014. Unit costs were estimated by combining top down (general overheads for hospital services) and bottom up (activity-based costing for clinic visits, hospitalisation, procedures and diagnostic investigations) approaches. The equipment costs of hysteroscopes were annualised based on the purchase price and number of users.  Results: Patients who met the inclusion criteria (n= 111) underwent hysteroscopy in daycare (n= 29) and inpatient (n= 65) settings with a rigid hysteroscope under anaesthesia while the outpatient (n= 17) setting used a flexible hysteroscope without anaesthesia. The average cost per patient in outpatient, daycare and inpatient settings were RM1547, RM1681 and RM1987 respectively (price year 2014). The main cost drivers were: equipment costs for outpatient setting (65% of total cost), operation theatre costs for daycare setting (33% of total cost) and ward costs for inpatient setting (40% of total cost). A hypothetical scenario analysis with equal number of patients undergoing hysteroscopy in each setting estimated the average cost per patient in outpatient (n= 50), daycare (n= 50) and inpatient settings (n= 50) would be RM874, RM1492 and RM2036 respectively.  Conclusions: Stratifying patients who are eligible for outpatient hysteroscopy and thus optimising its use could potentially be cost-saving to the Malaysian healthcare system while achieving similar diagnostic efficacy. PHP37 Spiralling Healthcare Expenditure in Malaysia: Is it Sustainable? Perumal AK, B Braun KL, Malaysia

Objectives: The research hypothesis of this paper states that the present healthcare financing system in Malaysia is not sustainable in the long run. Three factors are acknowledged for this; ASEAN is undergoing an i. Epidemiological transition with higher disease burden from CDs to NCDs and is located within the hotspot of ii. Emerging & iii. Re-Emerging diseases. The specific objectives are, first, to determine trends of the following indicators: total health expenditure as a percentage of GDP (THE % GDP), General Government Health Expenditure as a percentage of General Government Expenditure (GGHE % GGE), out of pocket (OOP), per-capita spending on health (PCSH), per capita spending out of pocket (PC-OOP). Second, estimating future spending trajectories of the indicators above from 2013 – 2030.  Methods: Simple linear regression was used to conduct forecasts for 2013 – 2030 based on secondary data retrieved from Malaysia National Health Accounts report for the period of 1997 – 2012. This fulfills the three basic assumptions that projections should base on past information which is available, quantifiable and the assumption of continuity in the pattern.  Results: Every year, in the absence of cost containment policies, THE % GDP was predicted to grow at 9%, GGHE % GGE at 11% and OOP % GDP at 4%. In constant 2005 RM, THE was predicted to grow at RM1,916,000, PCSH at RM58.81 and PC-OOP at RM16.77 annually. The outlook, or projection, for 2013 – 2030 confirms continuity of uptrend via a linear regression model for all indicators.  Conclusions: In 2012, RM15.15 billion was allocated for healthcare spending, which was 11% higher than the allocated amount. This shows that technical inefficiencies and allocative inefficiency exist. The government should consider cost containment strategies. The findings presented in this research agrees the research hypothesis that Malaysia’s present healthcare financing system is not sustainable in the long run.

Purba FD1, Hunfeld J1, Iskandarsyah A2, Fitriana TS3, Sadarjoen SS2, Passchier J4, van Busschbach J1 1Erasmus MC, Rotterdam, The Netherlands, 2Padjadjaran University, Jatinangor, Indonesia, 3YARSI University, Jakarta, Indonesia, 4VU University, Amsterdam, The Netherlands

PHP38 Universal Health Coverage in Countries Across East and Southeast Asia – Associations Between Health Expenditure and Service Provision

Objectives: Indonesia has no previous value set of EQ-5D-3L or EQ-5D-5L. The objective of this study is to obtain social preferences and derive a value set from Indonesian general population using the EQ-5D-5L questionnaire.  Methods: A representative sample aged over 17 years old was recruited from Indonesian general population. We used multistage stratified quota method with respect to place of living, gender, age, level of education. Religion and ethnicity were determined from the sample level. Two elicitation techniques, the composite time trade-off (C-TTO) and discrete choice experiments (DCE), were applied. Interviews done by trained interviewers using computer-assisted face-to-face interviews in an EQ Valuation Technology (EQ-VT) software provided by EuroQoL Group. To estimate the potential value sets, a hybrid regression model combining C-TTO and DCE data composite time trade-off and

Evans JS, Wickstead RM, Hanman K, Steeves S Costello Medical Consulting Ltd, Cambridge, UK

Objectives: To investigate healthcare expenditure in 6 countries across East and Southeast Asia with established and developing universal health coverage (UHC) systems.  Methods: A pragmatic literature review was conducted using the snowball method through Google and Google Scholar. Eligible data sources included peerreviewed journal publications, reports and healthcare statistics databases. Analyses were performed to establish possible correlations between gross domestic product (GDP) per capita, total health expenditure (THE) and out-of-pocket expenditure (OOPE) in the different countries.  Results: Over 95% health coverage has been achieved in China, Japan, Singapore, Thailand and South Korea. Indonesia began