Control of public expenditure on drug products in Bulgaria – Policies and outcomes

Aim: The aim of this study was to assess the economic performance of the application of the policy for negotiating discounts on drug products and agreements on the controlled access of patients in Bulgaria. Methods: The methodology involves comparison of the amounts of public spending on medicines in two periods – during the course of the analyzed drug policies (January 2007 – June 2009), and the period in which negotiations on the price of medicines and programs for the controlled access of the patients was discontinued (July 2009 – December 2012). Results: In Bulgaria, the government did not apply methods for controlling publicexpenditure on medicines bargaining price concessions from manufacturers andimplementing agreements on controlled access of patients after June 2009. This led to an annual increase in the expenditures on drug products for home treatment (on average, 17% for the period 2009-2012). Conclusion: This trend in Bulgaria will continue in the future since expenditure control only through price control by means of a reference system and the positive list of medicines is ineffective. There is a need for implementation of combined drug policies in Bulgaria in the form of negotiations on rebates with manufacturers and agreements on controlled access of patients and reference pricing

CHLAMYDIA TRACHOMATIS AND INFERTILITY

Almost one-quarter of 100 asymptomatic men under investigation for fertility has significant titres of lg-А antibodies (> 1:8) specific for Chlamydia trachomatis (CT) in seminal plasma. No clear association was evident between the presence of these antibodies and sperm quality. The female partners of men with consistently high serum or seminal plasma levels of Chlamydia-specific Ig A also exhibited a positive Ig-A reaction in serum without any clinical indications of infection. The study indicated that chronic asymptomatic infections with CT could be responsible for a large number of cases of infertility. It also implied that any men and women under investigation for infertility should be routinely screened with Chlamydial serology regardless of previous history and clinical finding

Public expenditure and drug policies in Bulgaria in 2014

Aim: The objective of this study was to provide an analysis of the factors which have a significant impact on the growth of public expenditure on medical products in Bulgaria. Methods: This research work consists of a critical analysis of the data reported by theNational Health Insurance Fund in Bulgaria on the stability of the healthcare insurance model and the implementation of the budget for 2014. Results: The results from the current analysis indicate that the growth of public expenditure is directly proportional to the number of reimbursed medical products and that the pattern of prescriptions including the innovative medical products mainly for the treatment of oncological and rare diseases has a significant impact on it. Conclusion: The reasons for the increase of public expenditure in Bulgaria include the non-transparent decisions in pricing and reimbursement of the products, the lack of guidelines for presenting pharmacological evidence and the lack of legislatively-defined drug policies for the management and control of the patterns of medical prescriptions

Local authorities, human rights and the reception and integration of forced migrants in Greece and Italy

This dissertation yields insights into two rather recent, quickly expanding, and closely related research areas: the role of municipalities in the reception and integration of forced migrants, and the rise and proliferation of human rights cities. It comprises of five stand-alone and at the same time interrelated treatises that highlight the way local authorities in Greece and Italy contributed to the protection and fulfilment of forced migrants’ fundamental rights amidst and after 2015’s ‘long summer of migration’. It presents the results of an interdisciplinary desk and empirical research, which integrates conceptual and theoretical insights from migration and refugee studies, international human rights law, leadership studies, local government studies, urban policy-making, and crisis management literature. Overall, the dissertation highlights municipal attempts to design and implement policies that facilitate the short-term reception and long-term integration of forced migrants into local communities in a human rights-conforming way. Several aspects stand out: a) the reasons that prompt local authorities to engage in migration governance matters that fall outside their institutional mandate (e.g. local pragmatism, opportunities for local development); b) the protagonists behind instances of municipal policy activism in the reception and integration of forced migrants (mayors, municipal officials); c) the strategies that local authorities apply to strengthen the protection of forced migrants’ human rights on the ground (e.g., collaboration with civil society, international organisations); d) the motives behind local authorities’ engagement with human rights as law, practice, and discourse in the field of migration governance (e.g., political conflicts with higher levels of government). The findings demonstrate that local authorities, even when situated within very restrictive institutional and financial contexts, have significant potential to directly influence the on-the-ground governance of forced migration. A good example in this respect is the ‘against-all-odds’ municipal policy activism of the Thessaloniki in Greece. In addition, the findings highlight the relevance of mayoral leadership to improving forced migrants' reception conditions and strengthening the protection of their fundamental rights. Lastly, the findings show that at times when legal and institutional frameworks at higher levels underdeliver, local authorities and their political leaders can step in and effectively address human rights deficits in the field of migration – as in the case of the Italian city of Bologna. In conclusion, the dissertation offers several lessons for local-level politicians and practitioners, which can assist them in overcoming structural constraints and developing human rights-based strategies for the reception and integration of forced migrants. Among these are: the proactive use of discretion on behalf of mayors in the field of migration governance; broad coalition-building with like-minded partners, locally and transnationally, to access know-how and external funding; and the timely institutionalisation of project-based initiatives

Local authorities, human rights and the reception and integration of forced migrants in Greece and Italy

This dissertation yields insights into two rather recent, quickly expanding, and closely related research areas: the role of municipalities in the reception and integration of forced migrants, and the rise and proliferation of human rights cities. It comprises of five stand-alone and at the same time interrelated treatises that highlight the way local authorities in Greece and Italy contributed to the protection and fulfilment of forced migrants’ fundamental rights amidst and after 2015’s ‘long summer of migration’. It presents the results of an interdisciplinary desk and empirical research, which integrates conceptual and theoretical insights from migration and refugee studies, international human rights law, leadership studies, local government studies, urban policy-making, and crisis management literature. Overall, the dissertation highlights municipal attempts to design and implement policies that facilitate the short-term reception and long-term integration of forced migrants into local communities in a human rights-conforming way. Several aspects stand out: a) the reasons that prompt local authorities to engage in migration governance matters that fall outside their institutional mandate (e.g. local pragmatism, opportunities for local development); b) the protagonists behind instances of municipal policy activism in the reception and integration of forced migrants (mayors, municipal officials); c) the strategies that local authorities apply to strengthen the protection of forced migrants’ human rights on the ground (e.g., collaboration with civil society, international organisations); d) the motives behind local authorities’ engagement with human rights as law, practice, and discourse in the field of migration governance (e.g., political conflicts with higher levels of government). The findings demonstrate that local authorities, even when situated within very restrictive institutional and financial contexts, have significant potential to directly influence the on-the-ground governance of forced migration. A good example in this respect is the ‘against-all-odds’ municipal policy activism of the Thessaloniki in Greece. In addition, the findings highlight the relevance of mayoral leadership to improving forced migrants' reception conditions and strengthening the protection of their fundamental rights. Lastly, the findings show that at times when legal and institutional frameworks at higher levels underdeliver, local authorities and their political leaders can step in and effectively address human rights deficits in the field of migration – as in the case of the Italian city of Bologna. In conclusion, the dissertation offers several lessons for local-level politicians and practitioners, which can assist them in overcoming structural constraints and developing human rights-based strategies for the reception and integration of forced migrants. Among these are: the proactive use of discretion on behalf of mayors in the field of migration governance; broad coalition-building with like-minded partners, locally and transnationally, to access know-how and external funding; and the timely institutionalisation of project-based initiatives

Control of public expenditure on drug products in Bulgaria – Policies and outcomes

Aim: The aim of this study was to assess the economic performance of the application of the policy for negotiating discounts on drug products and agreements on the controlled access of patients in Bulgaria.Methods: The methodology involves comparison of the amounts of public spending on medicines in two periods – during the course of the analyzed drug policies (January 2007 – June 2009), and the period in which negotiations on the price of medicines and programs for the controlled access of the patients was discontinued (July 2009 – December 2012).Results: In Bulgaria, the government did not apply methods for controlling publicexpenditure on medicines bargaining price concessions from manufacturers andimplementing agreements on controlled access of patients after June 2009. This led to an annual increase in the expenditures on drug products for home treatment (on average, 17% for the period 2009-2012).Conclusion: This trend in Bulgaria will continue in the future since expenditure control only through price control by means of a reference system and the positive list of medicines is ineffective. There is a need for implementation of combined drug policies in Bulgaria in the form of negotiations on rebates with manufacturers and agreements on controlled access of patients and reference pricing

Unravelling the biosynthesis of exopolysaccharides in Synechocystis sp. PCC 6803

Abstract not currently available

Public expenditure and drug policies in Bulgaria in 2014

Aim: The objective of this study was to provide an analysis of the factors which have a significant impact on the growth of public expenditure on medical products in Bulgaria.Methods: This research work consists of a critical analysis of the data reported by theNational Health Insurance Fund in Bulgaria on the stability of the healthcare insurance model and the implementation of the budget for 2014.Results: The results from the current analysis indicate that the growth of public expenditure is directly proportional to the number of reimbursed medical products and that the pattern of prescriptions including the innovative medical products mainly for the treatment of oncological and rare diseases has a significant impact on it.Conclusion: The reasons for the increase of public expenditure in Bulgaria include the non-transparent decisions in pricing and reimbursement of the products, the lack of guidelines for presenting pharmacological evidence and the lack of legislatively-defined drug policies for the management and control of the patterns of medical prescriptions