Cost sharing for provision of ART (Anti Retroviral Therapy)
In resource poor countries like India, although generic drugs are available, 93% PLHAS are deprived of access to antiretroviral therapy. (NACO, 2005) Considering this in mind, ARCON (AIDS Research and Control Centre) was established with the specific objective of ‘enhancing access to ART’ as per the GFATM (Global Fund to fight AIDS, TB and Malaria) Funding Round 2. There was a felt need for systematic and rational provision of ART services that would promote adherence to the drug regime. ARV drugs as it is well known, have numerous dangerous serious side effects that are the main hurdles in good adherence. The possible danger of drug resistance makes the life long continuation of these medications complicated, though necessary.
Hence ARCON sought to provide quality diagnostic, clinical, and counselling services for ensuring the rational use of ART. Understanding the significance of a multi-stakeholder approach, it has established linkages with private and public sector for enhancing access to ART. The cost price of the drugs is negotiated with the pharmaceutical companies and is nearly 40% less than the maximum retail price.
In order to make the programme self-sustainable, a graduated cost recovery program was envisaged at ARCON. Although it is recommended that ART be provided free of cost, in limited resource settings such as India there is an urgent need to enhance access to larger numbers of HIV infected people. With free ART the access in terms of number of patients is less, since there are several patients vying for them. However with a cost sharing mechanism, the scope of the patients reached is widened. So for instance if the cost of X medicine is Rs.100/unit and we have a budget of Rs.200 we will be able to provide only 2 doses of the medicine free of charge to one patient. If on the other hand we establish a cost sharing mechanism wherein the patient contributes for half the cost of the medication, the same Rs.200 can provide two patients with medications. Thus, with cost sharing there is enhanced access to treatment.
Any ART provision program must look at long-term sustainability, as the threat of possible drug resistance is very real. Cases of drug resistance in the dysfunctional health systems of African countries such as Malawi aren’t rare. While scaling up should be a definite priority in AIDS treatment, it must be ensured that the required health infrastructure is in place.
ARCON has a Tier system of co-payment where patients are categorised as per their willingness and ability to pay. Four tiers have been allotted wherein the patients pay 100%, 75%, 50% or 0% respectively; the fourth tier comprises of below the poverty line patients who are given ART free of cost.
There are other important aspects of this model such as social equity. Patients who can afford to pay for more than 60% of the cost of ART subsidise the cost for those with partial or no ability to pay. However the patients in the paying categories still get the treatment at a much a lower price than they would have paid in a private setting. Additionally, the concerns for privacy, confidentiality and inability to wait in long queues are also kept in mind. Though we cannot place a price tag on these they are vital pointers in health related decision-making, especially for patients with chronic diseases such as PLHAs.
Hence there is a need to revise some of the long held beliefs with respect to public health such as the felt necessity for “free health services”. Our own data has proved that people value a service much more when they pay for it (even partially); it also makes the service sustainable and accessible to larger numbers in the long run.
Hence ARCON sought to provide quality diagnostic, clinical, and counselling services for ensuring the rational use of ART. Understanding the significance of a multi-stakeholder approach, it has established linkages with private and public sector for enhancing access to ART. The cost price of the drugs is negotiated with the pharmaceutical companies and is nearly 40% less than the maximum retail price.
In order to make the programme self-sustainable, a graduated cost recovery program was envisaged at ARCON. Although it is recommended that ART be provided free of cost, in limited resource settings such as India there is an urgent need to enhance access to larger numbers of HIV infected people. With free ART the access in terms of number of patients is less, since there are several patients vying for them. However with a cost sharing mechanism, the scope of the patients reached is widened. So for instance if the cost of X medicine is Rs.100/unit and we have a budget of Rs.200 we will be able to provide only 2 doses of the medicine free of charge to one patient. If on the other hand we establish a cost sharing mechanism wherein the patient contributes for half the cost of the medication, the same Rs.200 can provide two patients with medications. Thus, with cost sharing there is enhanced access to treatment.
Any ART provision program must look at long-term sustainability, as the threat of possible drug resistance is very real. Cases of drug resistance in the dysfunctional health systems of African countries such as Malawi aren’t rare. While scaling up should be a definite priority in AIDS treatment, it must be ensured that the required health infrastructure is in place.
ARCON has a Tier system of co-payment where patients are categorised as per their willingness and ability to pay. Four tiers have been allotted wherein the patients pay 100%, 75%, 50% or 0% respectively; the fourth tier comprises of below the poverty line patients who are given ART free of cost.
There are other important aspects of this model such as social equity. Patients who can afford to pay for more than 60% of the cost of ART subsidise the cost for those with partial or no ability to pay. However the patients in the paying categories still get the treatment at a much a lower price than they would have paid in a private setting. Additionally, the concerns for privacy, confidentiality and inability to wait in long queues are also kept in mind. Though we cannot place a price tag on these they are vital pointers in health related decision-making, especially for patients with chronic diseases such as PLHAs.
Hence there is a need to revise some of the long held beliefs with respect to public health such as the felt necessity for “free health services”. Our own data has proved that people value a service much more when they pay for it (even partially); it also makes the service sustainable and accessible to larger numbers in the long run.
posted by The Red Ribbon @ 2:15 PM
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