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Essential Medicines in a High Income Country: Essential to Whom?

Author

Listed:
  • Mai Duong
  • Rebekah J Moles
  • Betty Chaar
  • Timothy F Chen
  • World Hospital Pharmacy Research Consortium (WHoPReC)

Abstract

Objective: To explore the perspectives of a diverse group of stakeholders engaged in medicines decision making around what constitutes an “essential” medicine, and how the Essential Medicines List (EML) concept functions in a high income country context. Methods: In-depth qualitative semi-structured interviews were conducted with 32 Australian stakeholders, recognised as decision makers, leaders or advisors in the area of medicines reimbursement or supply chain management. Participants were recruited from government, pharmaceutical industry, pharmaceutical wholesale/distribution companies, medicines non-profit organisations, academic health disciplines, hospitals, and consumer groups. Perspectives on the definition and application of the EML concept in a high income country context were thematically analysed using grounded theory approach. Findings: Stakeholders found it challenging to describe the EML concept in the Australian context because many perceived it was generally used in resource scarce settings. Stakeholders were unable to distinguish whether nationally reimbursed medicines were essential medicines in Australia. Despite frequent generic drug shortages and high prices paid by consumers, many struggled to describe how the EML concept applied to Australia. Instead, broad inclusion of consumer needs, such as rare and high cost medicines, and consumer involvement in the decision making process, has led to expansive lists of nationally subsidised medicines. Therefore, improved communication and coordination is needed around shared interests between stakeholders regarding how medicines are prioritised and guaranteed in the supply chain. Conclusions: This study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines. Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the EML concept in their approach. The wide range of views of what stakeholders considered were essential medicines, challenges whether the EML concept is out-dated or underutilised in high income countries.

Suggested Citation

  • Mai Duong & Rebekah J Moles & Betty Chaar & Timothy F Chen & World Hospital Pharmacy Research Consortium (WHoPReC), 2015. "Essential Medicines in a High Income Country: Essential to Whom?," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-14, December.
  • Handle: RePEc:plo:pone00:0143654
    DOI: 10.1371/journal.pone.0143654
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    References listed on IDEAS

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    1. Michael Fletcher & Ben Guttermann, 2013. "Income Inequality in Australia," Economic Roundup, The Treasury, Australian Government, issue 2, pages 35-56, December.
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    3. Wagner, Anita K. & Graves, Amy Johnson & Reiss, Sheila K. & LeCates, Robert & Zhang, Fang & Ross-Degnan, Dennis, 2011. "Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey," Health Policy, Elsevier, vol. 100(2), pages 151-158.
    4. Antonia Jeličić Kadić & Maja Žanić & Nataša Škaričić & Ana Marušić, 2014. "Using the WHO Essential Medicines List to Assess the Appropriateness of Insurance Coverage Decisions: A Case Study of the Croatian National Medicine Reimbursement List," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
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    6. Kathleen Anne Holloway & David Henry, 2014. "WHO Essential Medicines Policies and Use in Developing and Transitional Countries: An Analysis of Reported Policy Implementation and Medicines Use Surveys," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-16, September.
    7. Millar, T.P. & Wong, S. & Odierna, D.H. & Bero, L.A., 2011. "Applying the essential medicines concept to us preferred drug lists," American Journal of Public Health, American Public Health Association, vol. 101(8), pages 1444-1448.
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    Cited by:

    1. Josephine Walker & Betty B Chaar & Numa Vera & Alvish S Pillai & Jessy S Lim & Lisa Bero & Rebekah J Moles, 2017. "Medicine shortages in Fiji: A qualitative exploration of stakeholders’ views," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-16, June.
    2. Jonathan Minh Phuong & Jonathan Penm & Betty Chaar & Lachlan Daniel Oldfield & Rebekah Moles, 2019. "The impacts of medication shortages on patient outcomes: A scoping review," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-17, May.

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