Boston University School of Medicine, Department of Family Medicine; One Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA.
Int J Equity Health. 2009 Dec 14;8:43. doi: 10.1186/1475-9276-8-43.
A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.
We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition.
Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price.
The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means of achieving their goal. Evaluations of interventions to increase rural access to medicines should include impact assessment on both formal and informal pharmaceutical markets.
一个旨在增加吉尔吉斯斯坦农村地区药品可及性的农村药房计划（RPI）在 12 个以前没有药房的村庄建立了一个由 12 家药房组成的网络，该网络使用循环药品基金机制。本研究的目的是确定 RPI 的建立是否导致了该地区现有（非 RPI）私营药房中意想不到的药品价格竞争加剧。
我们对 2003 年 10 月至 2007 年 12 月期间，来自吉尔吉斯斯坦强制性健康保险基金的纳伦省 Jumgal 区的医疗保险索赔数据进行了描述性和多变量分析。我们比较了 RPI 于 2004 年 10 月推出前后竞争对手药房每季度的平均药品价格，以确定 RPI 对价格竞争的影响。
描述性分析表明，竞争对手对 30 种药品中的 21 种（70%）做出了反应。在 RPI 推出前一个季度到研究结束期间，30 种药品中有 17 种（57%）的药品价格下降，30 种药品中有 4 种（13%）的药品价格上升，30 种药品中有 9 种（30%）的药品价格保持不变。在价格不变的 9 种竞争药品中，有 5 种最初价格下降，但后来又恢复到基线价格。对符合样本量标准的 19 种药品进行的多变量分析证实了这一发现。在这 19 种药品中，有 14 种（74%）的竞争药品的价格在 RPI 推出前一个季度到推出后一个季度之间发生了显著变化，其中 9 种（47%）的药品价格下降，5 种（26%）的药品价格上升。
RPI 充当了市场驱动力，刺激了竞争对手药店的药品价格竞争，即使这些药店位于不同的村庄。在发展中国家和转型期国家的农村地区设计旨在增加药品公平获取的计划时，应考虑利用药品价格竞争作为实现目标的一种手段。评估增加农村地区获取药品的干预措施应包括对正规和非正规药品市场的影响评估。
