title: Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova.
abstract: BACKGROUND
  To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova.
  
  
  METHODS
  Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability.
  
  
  RESULTS
  Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list.
  
  
  CONCLUSIONS
  If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine.
authors.affiliation: LSE Health, London School of Economics and Political Science, London WC2A 2AE, UK a.ferrario@lse.ac.uk.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrario
authors.affiliation: State University of Medicine and Pharmacy Nicolae Testemitanu, Testemitanu 22, 2025 Chisinau, Republic of Moldova.
authors.forename: Elena
authors.initials: E
authors.lastname: Chitan
authors.affiliation: Center for Health Policies and Studies, 99/1,V.Alexandri str., 2012 Chisinau, Republic of Moldova.
authors.forename: Rita
authors.initials: R
authors.lastname: Seicas
authors.affiliation: World Health Organization, Regional Office for Europe UN City, Marmorvej 51, 2100 Copenhagen Ø, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: Sautenkova
authors.affiliation: World Health Organization, Country Office for Moldova, Sfatul Tarii str. 29, 2012 Chisinau, Republic of Moldova.
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Bezverhni
authors.affiliation: World Health Organization, Regional Office for Europe UN City, Marmorvej 51, 2100 Copenhagen Ø, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Kluge
authors.affiliation: World Health Organization, Country Office for Moldova, Sfatul Tarii str. 29, 2012 Chisinau, Republic of Moldova.
authors.forename: Jarno
authors.initials: J
authors.lastname: Habicht
mesh_terms: D002908:Chronic Disease / Q000191:economics*; D003906:Developing Countries; D018954:Drugs, Essential / Q000191:economics*; D005251:Fees, Medical; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008966:Moldova; D009313:National Health Programs / Q000458:organization & administration*; D011203:Poverty / Q000191:economics
chemical_list: D018954:Drugs, Essential
keywords: Affordability; Republic of Moldova; mandatory health insurance; medicines; transition countries
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