title: Foregoing medicines in the former Soviet Union: changes between 2001 and 2010.
abstract: Pharmaceutical costs dominate out-of-pocket payments in former Soviet countries, posing a severe threat to financial equity and access to health services. Nationally representative household survey data collected in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine were analysed to compare the level of population having to forego medicines in 2001 and 2010. Subgroup analysis was conducted to assess differences between populations of different economic status, and rural and urban populations. A substantial proportion of the population did forego medicines in 2010, from 29.2% in Belarus to 72.9% in Georgia. There was a decline in people foregoing medicines between 2001 and 2010; the greatest decline was seen in Moldova [rate ratio (RR)=0.67 (0.63; 0.71)] and Kyrgyzstan [RR=0.63 (0.60; 0.67)], while very little improvement took place in countries with a higher Gross National Income (GNI) per capita and greater GNI growth over the decade such as Armenia [RR=0.92 (0.87; 0.96)] and Georgia [RR=0.95 (0.92; 0.98)]. Wealthier, urban populations have benefited more than poorer, rural households in some countries. Countries experiencing the greatest improvement over the study period were those that have implemented policies such as price controls, expanded benefits packages, and encouragement of rational prescribing. Greater commitment to pharmaceutical reform is needed to ensure that people are not forced to forego medicines.
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Electronic address: katharine.footman@lshtm.ac.uk.
authors.forename: Katharine
authors.initials: K
authors.lastname: Footman
authors.affiliation: European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Erica
authors.initials: E
authors.lastname: Richardson
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Bayard
authors.initials: B
authors.lastname: Roberts
authors.affiliation: Center for Study of Public Opinion, 38 Pushkin Street, Almaty 050002, Kazakhstan.
authors.forename: Gulzhan
authors.initials: G
authors.lastname: Alimbekova
authors.affiliation: Georgian Opinion Research Business International, 34 Tashkenti Street, Tbilisi, Georgia.
authors.forename: Merab
authors.initials: M
authors.lastname: Pachulia
authors.affiliation: Center for Sociological and Political Research, Belarussian State University, 14 Leningradskaya, Minsk 20050, Belarus.
authors.forename: David
authors.initials: D
authors.lastname: Rotman
authors.affiliation: Centre for Sociological Studies, Moscow State University, Leninskie Gory, Moscow 119991, Russian Federation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gasparishvili
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D000293:Adolescent; D000328:Adult; D001136:Armenia; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D005846:Georgia (Republic); D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007623:Kazakhstan; D007707:Kyrgyzstan; D008297:Male; D008875:Middle Aged; D008966:Moldova; D055553:Prescription Drugs / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D002094:Republic of Belarus; D012426:Russia; D012959:Socioeconomic Factors; D014455:Ukraine; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: Access; Former Soviet countries; Pharmaceutical; Reform