Method of Stimulation of Pharmacy Workers Involved in the Government Program “Available Medicines”

The aim is to study the current state of the organization of work in pharmacies under the government program “Available medicines” and to create proposals for the improvement of material incentives to increase the motivation of workers of such pharmacies.Materials and methods. The research used the general methods of scientific knowledge: analysis and synthesis, analogy and comparison; method of questioning to determine the actual state and opinions of specialists on the organization of work in the conditions of pharmacy participation in the program "Available medicines".Results and discussion. In the course of the study, the problem of lack of incentives and motivation for the work of pharmacy workers under the Government program "Available medicines" has been highlighted. According to the results of the survey of specialists of three different forms of pharmacy' ownership, participating in the program of reimbursement of the cost of drugs, it was found that the volume and intensity of work of workers has significantly increased, and wages have remained at the same level. The number of operations performed by employees in such pharmacies has considerably increased, which is related to the registration and maintenance of recipes under the program "Available medicines". The questionnaire survey has showed that the best option for optimizing the organization of remuneration in the prevailing conditions would be to pay extra for work (overpays). It was found that the number of recipes taken by one pharmacist per day varies considerably in different pharmacies, and there are also differences in the duration of the work of pharmacies under the reimbursement program during the month. To increase the motivation of pharmacists to work in the prevailing conditions, the method of calculating the additional payment for work in the conditions of the program "Available medicines" for each chemist's worker is offered individually in accordance with the post based on a formula that takes into account the intensity of labor using the intensity coefficient and the percentage of the additional payment.Conclusions. The conducted researches have shown that the increased intensity of labor, which takes place in pharmacies working under the program "Available medicines", is the basis for the calculation of additional payments. The application of the system of material stimulation of the work of pharmacists based on the proposed methodology will allow compensating additional labor of specialists, taking into account the intensity of their work

АНАЛІЗ РІВНЯ КОНЦЕНТРАЦІЇ АПТЕЧНИХ ЗАКЛАДІВ В УКРАЇНІ

The aim of the work. To analyze the level of concentration of pharmacies in Ukraine by territorial and demographic characteristics and to identify trends in the competitive conditions of retail sales of drugs. Materials and Methods. To assess the level of concentration of pharmacies, based on the territorial location of pharmacies (by region), the method of grouping was used, which allowed to typologize administrative entities. The number of pharmacies (from the License Register for the production of medicines (in the pharmacy), wholesale and retail trade in medicines), population and area by regions of Ukraine (from the website of the State Statistics Service of Ukraine) were taken as initial indicators: the number of population per pharmacy and the number of pharmacies per 100 km2. The graphical method was used to build a circuit on the number of pharmacies included in the groups per 10 thousand people population and 100 km2. Results and Discussion. The analysis showed that when grouping pharmacies by demographics, more than half of the regions have a very high and high level of concentration of the pharmacy market. This means that the level of availability of pharmacies for the population in Ukraine is high, but there is extremely high competition. The grouping of pharmacies according to territorial distribution showed that about 50 % of regions of Ukraine have a low concentration of the pharmacy market per unit area, ie the physical availability of pharmacies and pharmaceutical care in them is quite low. Conclusions. There is a certain imbalance in two groups: demographically, in more than half of the regions there is a very high concentration of Pharmacies, that is, competition in the pharmacy market is extremely high, and on a territorial basis almost half of the regions – with low Pharmacies concentration. That is, areas with predominantly rural settlements have a low level of pharmaceutical supply. This only indicates that in the pharmacy segment the decisive factor is the influence of financial factors on the organization of pharmaceutical activities and commercialization.Мета роботи. Провести аналіз рівня концентрації аптечних закладів (АЗ) в Україні за територіальною та демографічною ознаками і виявити тенденції розвитку конкурентних умов ведення роздрібної реалізації лікарських засобів (ЛЗ). Матеріали і методи. Для оцінки рівня концентрації аптечних закладів, з огляду на територіальне розташування аптек (за областями), застосовували метод групувань, що дав можливість типологізувати адміністративні субʼєкти. Як вихідні показники було взято: кількість аптечних закладів (дані Ліцензійного реєстру з виробництва лікарських засобів (в умовах аптеки), оптової та роздрібної торгівлі лікарськими засобам), чисельність населення та площу по областях України (сайт Державної служби статистики України), як результативні вважали кількість населення на один аптечний заклад і кількість аптечних закладів на 100 км2. Для побудови контура за кількістю АЗ, що входять до груп у розрахунку на 10 тис. осіб і 100 км2 використано графічний метод. Результати й обговорення. Аналіз показав, що при групуванні аптечних закладів за демографічною ознакою більше половини областей мають дуже високий та високий рівень концентрації аптечного ринку. Це означає, що рівень доступності аптек для населення в Україні високий, проте має місце надзвичайно висока конкуренція. Групування аптечних закладів відповідно до територіального поширення показало, що близько 50 % областей України мають низьку концентрацію аптечного ринку в розрахунку на одиницю площі, тобто фізична доступність аптек та фармацевтичної допомоги в них є досить низькою. Висновки. Виявлено певний дисбаланс при двох групуваннях: за демографічною ознакою в більш ніж половині областей дуже висока концентрація аптечних закладів, тобто конкуренція в роздрібному сегменті фармацевтичного ринку вкрай висока, а за територіальною ознакою майже половина регіонів – з низьким рівнем концентрації аптечних закладів. Тобто області з переважно сільськими населеними пунктами мають низький рівень фармацевтичного забезпечення. Це свідчить лише про те, що в аптечному сегменті визначальним є вплив фінансових чинників на організацію фармацевтичної діяльності та комерціалізація

Influence of household demographic and socio-economic factors on household expenditure on tobacco in six New Independent States

<p>Abstract</p> <p>Background</p> <p>To identify demographic and socio-economic factors that are associated with household expenditure on tobacco in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, and Tajikistan.</p> <p>Methods</p> <p>Secondary analysis of the data available through the World Bank Living Standards Monitoring Survey conducted in aforementioned countries in 1995–2000. The role of different variables (e.g. mean age of household members, household area of residence, household size, share of adult males, share of members with high education) in determining household expenditure on tobacco (defined as tobacco expenditure share out of total monthly HH consumption) was assessed by using multiple regression analysis.</p> <p>Results</p> <p>Significant differences were found between mean expenditure on tobacco between rich and poor – in absolute terms the rich spend significantly more compared with the poor. Poor households devote significantly higher shares of their monthly HH consumption for tobacco products. Shares of adult males were significantly associated with the share of household consumption devoted for tobacco. There was a significant negative association between shares of persons with tertiary education within the HH and shares of monthly household consumption devoted for tobacco products. The correlation between household expenditures on tobacco and alcohol was found to be positive, rather weak, but statistically significant.</p> <p>Conclusion</p> <p>Given the high levels of poverty and high rates of smoking in the New Independent States, these findings have important policy implications. They indicate that the impact and opportunity costs of smoking on household finances are more significant for the poor than for the rich. Any reductions in smoking prevalence within poor households could have a positive economic impact.</p

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

<p>Abstract</p> <p>Background</p> <p>One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.</p> <p>Methods</p> <p>A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.</p> <p>Results</p> <p>The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.</p> <p>Conclusion</p> <p>Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.</p> <p>Abstract in Russian</p> <p>See the full article online for a translation of this abstract in Russian.</p

Healthcare utilization and expenditures for chronic and acute conditions in Georgia: does benefit package design matter?

BACKGROUND: In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. To better assess whether the effect of MIP varies according to different conditions, and to identify areas for improvement, we explored whether MIP differently affects utilization and costs among chronic patients compared to those with acute health needs. METHODS: Data were collected from two cross-sectional nationally representative household surveys conducted in 2007 and in 2010 that examined health care utilization rates and expenditures. Approximately 3,200 households were interviewed from each wave of both studies using a standardized survey questionnaire. Differences in health care utilization and expenditures between chronic and acute patients with and without MIP insurance were evaluated, using coarsened exact matching techniques. RESULTS: Among patients with chronic illnesses, MIP did not affect either health service utilization or expenditures for outpatient drugs and reduction in provider fees. For patients with acute illnesses MIP increased the odds (OR = 1.47) that they would use health services. MIP was also associated with a 20.16 Gel reduction in provider fees for those with acute illnesses (p = 0.003) and a 15.14 Gel reduction in outpatient drug expenditure (p = 0.013). Among those reporting a chronic illness with acute episode during the 30 days prior to the interview, MIP reduced expenditures on provider fees (B = -20.02 GEL) with marginal statistical significance. CONCLUSIONS: Our findings suggest that the MIP may have improved utilization and reduce costs incurred by patients with acute health needs, while chronic patients marginally benefit only during exacerbation of their illnesses. This suggests that the MIP did not adequately address the needs of the aging Georgian population where chronic illnesses are prevalent. Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved