Gorgodze Tsotne, Zoidze Akaki, Gotsadze George
Curatio International Foundation, Tbilisi, Georgia.
School of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia.
Int J Equity Health. 2025 Jun 2;24(1):161. doi: 10.1186/s12939-025-02535-x.
Access to essential medicines is crucial for achieving the Sustainable Development Goals and Universal Health Coverage. In Georgia, as in many low- and middle-income countries, out-of-pocket payments (OOPs) for medicines remain a major financial burden, particularly for low-income households. Despite the launch of Georgia's Universal Health Coverage Program in 2013, medicines still constitute the largest share of OOP health expenditures, increasing the risk of impoverishment. This study, therefore, aims to assesses the impact of three pharmaceutical policy interventions introduced between 2017 and 2023 on monthly household drug expenditures.
The analysis utilizes pooled data from Georgia's Household Income and Expenditure Surveys (2015-2023), covering over 88,000 households. Interrupted Time Series (ITS) analysis was employed to evaluate the effects of three policy actions: the 2017 drug reimbursement plan, the 2022 introduction of parallel imports from Turkey, and the 2023 implementation of external reference pricing. Regression models accounted for seasonality and complex survey design, including weights and clustering. Monthly median drug expenditures were adjusted to January 2015 prices.
Only after the introduction of external reference pricing policy in 2023 a significant reduction was observed - an immediate drop of 6.96 GEL (2.51 USD) per household (p = 0.016) and a monthly decline of 1.28 GEL (0.46 USD) (p = 0.002), representing a 29% decrease and saving Georgian households approximately 43.3 million GEL (15.59 million USD) in 2023. The 2022 parallel import policy led to an initial decrease (2.26 GEL; p = 0.39) but was followed by a significant increase over time (coefficient = 1.43, p < 0.001).
Addition of external reference pricing policy significantly reduced household pharmaceutical spending and shows promise as a policy tool for other low- and middle-income countries. However, sustained impact requires continued monitoring and complementary measures to ensure equitable access and long-term benefits.
获取基本药物对于实现可持续发展目标和全民健康覆盖至关重要。在格鲁吉亚，与许多低收入和中等收入国家一样，药品的自付费用（OOP）仍然是一项重大财务负担，对低收入家庭而言尤其如此。尽管格鲁吉亚在2013年启动了全民健康覆盖计划，但药品在自付医疗支出中仍占最大份额，增加了贫困风险。因此，本研究旨在评估2017年至2023年期间实施的三项药品政策干预措施对家庭每月药品支出的影响。
该分析使用了格鲁吉亚家庭收入和支出调查（2015 - 2023年）的汇总数据，涵盖超过88,000个家庭。采用中断时间序列（ITS）分析来评估三项政策行动的效果：2017年的药品报销计划、2022年引入来自土耳其的平行进口药品以及2023年实施的外部参考定价。回归模型考虑了季节性和复杂的调查设计，包括权重和聚类。每月药品支出中位数已按2015年1月的价格进行调整。
仅在2023年实施外部参考定价政策后，才观察到显著下降——每户立即下降6.96格鲁吉亚拉里（2.51美元）（p = 0.016），每月下降1.28格鲁吉亚拉里（0.46美元）（p = 0.002），降幅达29%，2023年为格鲁吉亚家庭节省了约4330万格鲁吉亚拉里（1559万美元）。2022年的平行进口政策导致最初下降（2.26格鲁吉亚拉里；p = 0.39），但随后随着时间推移显著增加（系数 = 1.43，p < 0.001）。
引入外部参考定价政策显著降低了家庭药品支出，并有望成为其他低收入和中等收入国家的政策工具。然而，要持续产生影响，需要持续监测并采取补充措施，以确保公平获取和长期效益。
