Use of generic medicines in Latvia : Awareness, opinions and experiences of the population

Funding Information: Funding was provided by EEA Financial Mechanism and Latvian state (award number 2012.EEZ/DAP/MIC/183). The project is financially supported by Iceland, Liechtenstein and Norway. Publisher Copyright: © 2019 The Author(s).Background: To stimulate use of generic medicines a combination of supply and demand side mechanisms are employed in the Latvian reimbursement system. It is reported that patients have high out-of-pocket pharmaceutical spending and that they overpay by not choosing generic medicines. Patient preferences may be an important obstacle in implementing generic policy. Objective of this study was to assess awareness, opinions and experience of the Latvian population regarding use of generic medicines. Methods: Survey of representative sample of the population of Latvia (n = 1005) aged 18-74 was conducted in March 2015. The survey was distributed in Latvian and Russian languages using Computer Assisted Web Interviews. Associations between experience with generic medicines, preference for medicines, and sociodemographic variables were tested with Pearson Chi-square statistics. Associations between the previous experience and information given by different sources versus choice between medicines were tested with Spearman's correlation test. Results: 72.3% of the population were informed about generic medicines. Men (66.9%) and respondents with primary or secondary education (58.3%; 69.3%) were less informed compared to total (72.3%). From those who recalled using generic medicines (n = 441), 94.4% evaluated their experience as positive or neutral. Despite this, only 21% of the population would opt for generic medicines. The strongest preference for brand-name medicines was in the age group > 55 (40.5%). Opinion of a physician was the most important factor when choosing between generic and brand-name medicines (88.7%). The more positive the information provided by general practitioners, physician specialists, pharmacists, family members, friends and internet is perceived, the more likely respondents are to choose generic medicines (p < 0.001). Conclusion: This study demonstrates that people in Latvia are aware of generic medicines but only a minority of the population would choose them when presented with a choice. It is therefore important that health care professionals provide objective and unbiased information about generic medicines to their patients. Interventions should aim to reach groups that are less informed and to improve providers' understanding and communication with patients about generics.publishersversionPeer reviewe

Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019 : a comparative analysis

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and East-ern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland,Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and(3) identify common trends, success factors and challenges for reforms. Methods applied involved fivestages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative datacharacterizing hospital sectors were compared; (3) a scoping review was performed to identify an initiallist of reforms per country; (4) the list was sent to national researchers who described the top threereforms based on a standardized questionnaire; (5) received questionnaires were analysed and vali-dated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet,reforms related to hospital sector governance and changes in purchasing and payment systems are muchmore frequent than reforms concerning relations with other providers. Most governance reforms aimedat transforming hospital infrastructure, improving financial management and/or improving quality ofcare, while purchasing and payment reforms focused on limiting hospital activities and/or on incen-tivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensiveapproach; unclear outcomes; and political influence. Given similar reform areas across countries, thereis considerable potential for shared learning