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PUBLIC SECTOR FINANCING AND EXPENDITURE ON MEDICATIONS. PANAMA 2007-2011.
Beatriz Gómez1, Carlos Gordón1, Víctor Herrera Ballesteros1, Reina Roa1, Luis Ortega- Paz1, Manuel Pereira1
1 Instituto Conmemorativo Gorgas de Estudios de la Salud Fact Sheet: Republic of Panama
Background The economic and financial challenges that burden the global economy hinder the goal of universal access to essential medications in numerous countries. From an economic and sanitary standpoint, there is a need to evaluate the effectiveness of financing mechanisms and
Economic, Social, and Health Indicators of the Republic of Panama. 2010.
Age structure (%)
0- 14 years: 29.2 15- 64 years: 63.4 64 years and over: 7.4
Sex structure 101.1 men/ 100 women
Life expectancy at birth
Both sexes: 75.9 years
Estimated Proportional Mortality by Major Causes of Death in Panama According to Gender, 2001-2009.
Men Women
the public sector’s expense on medications. Some of the main issues faced by developing countries in this regard include the lack of integrated information systems, inadequate standardization of coding methodologies, and the use of outdated technologies. This problem is aggravated by insufficient training of the personnel in charge of keeping the records and
Population: 3,405,813 inhab.
Area: 75,510 km2
PIB: 20,862.9 millions US dollars
GDP per capita: 5,953 US dollars
Health expenditure per capita 2011: 616 US dollars
Public expenditure in medication as % GDP 2007- 2011: 0.67%
Annual % of growth: 7.5%
Population in poverty: 32%
Indigenous population (%): 12.3%
Afro population (%): 9.2%
Male: 73.3 years Women: 78.6
Mortality
Crude rate: 4.5/ 1,000 inhabts. Infant mortality rate: 12.2/ 1,000 inhabts
Source: INEC/ MINSA
gene Source: Life Events: Mortality, 2001 - 2009. INEC
gene
Global Medication Expense in Public Health Institutions
ultimately results in ineffective planning and decision making by the sanitary authorities in those countries.
Organization of Health Facilities. %
Attention and Complexity levels.
200,000,000.00
(MINSA - CSS) and as % GDP. Panama. 2007-2011.
0.76 0.8
Objectives To develop a financing and expenditure on medications information system for Panama’s public health institutions: the Ministry of Health (MINSA) and the Social Security (CSS), during the period 2007-2011.
Materials and Methods A database incorporating information of MINSA and
Sources of financing National Budget Regional Budget Extraordinary Credit Self-financing Donations
III LEVEL National Hosp.
Specialized Hosp
II LEVEL Regional Hospitals and
Clinics
I LEVEL Primary Health Care facilities
Society
Medications
The distribution and access is related to the health attention and complexity levels
180,000,000.00
160,000,000.00
140,000,000.00
120,000,000.00
100,000,000.00
80,000,000.00
60,000,000.00
40,000,000.00
20,000,000.00
CSS
MINSA TOTAL %GDP
0.59
101
76
25
0.62
105
87
71
34
0.71
138
94
51
0.71 176
150
104
72
55
0.7
0.6
0.5
0.4
0.3
0.2
0.1
CSS institutions by level of care was created. Economic and ATC (Anatomical, Therapeutic, Chemical Classification System) variables of the medications were registered. Data from the Vital Facts Registry 2001-
Health policy, regulation and vigilance
Provider of health services
.00 0 2007 2008 2009 2010 2011
Years
672,951,707.52 US dollars
2010, National Census 2010, Household Income and Expense 2007 survey, statistics from the Ministry of Health, and reports on the medication’s price increases published by the Consumer Protection and Competition Authority were also included in the analysis. A self-organizing map (SOM) was applied to the CSS and MINSA medication expenditure databases. Geographic Information Technologies were used and results were presented in a webmap format.
Global Medication Expense in Public Health Institutions (MINSA - CSS) by Pharmacologic Group. Panama. 2007-2011.
ANTINEOPLASTIC AGENT
GENERAL SYSTEMIC ANTIBIOTICS
BLOOD AND BLOOD DERIVATIVES
CARDIOVASCULAR SYSTEM
ALIMENTARY TRACT AND METABOLISM
MENTAL HEALTH
HIV
CENTRAL NERVOUS SYSTEM
RESPIRATORY SYSTEM
MUSCULOSKELETAL SYSTEM
DERMATOLOGIC PRODUCTS
SYSTEMIC HORMONES
GENITOURINARY SYSTEM
ORGANS OF SENSES
VARIOUS
Vaccine Expenditure by Health Region and by the 10 Vaccines of Greatest Expense. Panama. 2007-2011.
10,000,000.00 9,000,000.00 Results
An increase in Panama’s public sector medication expenditure was observed, from US$ 101.6 million in 2007 to US$ 176.8 million in 2011. The groups of medications representing the greatest expense (millions of US$) in descending order include: antineoplastic and
ANTIPARASITICS
SERUMS AND IMMUNOGLOBULINS IMMUNOSUPRESSORS
TOBACCO CESSATION
TOTAL PARENTERAL NUTRITION
ANTISEPTICS
0
50000000
Amount (US dollars)
100000000
MINSA CSS
150000000
8,000,000.00
7,000,000.00
6,000,000.00
5,000,000.00
4,000,000.00
3,000,000.00
2,000,000.00
1,000,000.00
0.00
63,250,060.73 US dollars
PNEUMOCOCCAL ADULT INF.TRIVALENTE INF.H1N1 PENTAVALENT ROTAVIRUS
Vaccines
HEPATITIS A DPAT ADACEL. INFLUENZA PED.Y ADULT
PAPILOMA V V-PREV
immunologic agents US$ 134.3, systemic antiinfectives US$ 85.9, blood and blood derivatives US$ 71.3, and
Medication Expenditure in National Hospitals of CSS and MINSA. Panama. 2007- 2011
Children´s Hospital
Per Capita Medication Expenditure of Health Institutions (MINSA-CSS) by Health Region. Panama. 2007-2011.
cardiovascular drugs US$ 64.6 million. The six Panamá. 2007- 2011
3,044,400.41 8,923,936.01 MINSA
National Institute for Mental Health specialized national hospitals had a total medication
expense of US$ 249.5 millions, which was higher than the rest of the country’s public health network. Spending on vaccines increased, a fact which can be explained by the inclusion of new vaccines in the vaccination schemes. SOM analysis revealed that the CSS segment corresponding to the Metropolitan Hospital was composed of specialized and costly medication purchases, in contrast to MINSA, CSS
32,735,575.69
18,117,772.20
9,342,421
National Oncologic Institute
Santo Tomas Hospital
Children´s Hospital CSS
CSS Metropolitan Hospital
177,324,526.01 120
100
80
60
40
Per capita (annual average) 38 US dollars
104
5
0 52
27 36 regional hospitals, and CSS polyclinics who appeared to be more focused on chronic and infectious diseases. The per capita medication expense was greater in areas with more urban development. This suggests that national
249,448,630 US dollars 20
0
18 7 13 16
Panamá Oeste Panamá Este San Miguelito Ngäbe Buglé
19 20 22 24
Guna Yala Colón Darién Bocas del Toro
Health region
24
Coclé Veraguas Chiriquí
Herrera Metro Los Santos
hospitals, which are located in the metropolitan area, are concentrating specialized healthcare versus regional hospitals.
Conclusions The reasons that may explain the increase in the public sector’s medication expenditure include: an increase in life expectancy, the epidemiologic profile of the country, the expanded health coverage of the CSS, the public sector’s organizational model for the provision of health services, and asymmetries in the national market. The State should develop national medication accounts, which would allow a better understanding of how the expenditure is structured; evaluate alternatives for optimizing medication expense; and improve the social and geographic access to medications.
Principal Medication Expense Segments in CSS. 2007- 2011. Self Organizing Map Analysis
Panamá. 2007- 2011
Segment 1 Segment 2 Segment 3
Segment 1: cardiovascular system (21%), central nervous system (14%), and mental health (14%). Segment 2: antineoplastics (28%), blood and blood derivatives (12%), alimentary tract and metabolism (9.5%), cardiovascular, and nervous system (8 and 9% respectively) Segment 3: Cardiovascular system (15%), general systemic antibiotics (14%), and nervous system (12%).
Principal Medication Expense Segments in MINSA. 2007-2011. Self Organizing Map Analysis
Panamá. 2007- 2011
Segment 1 Segment 2 Segment 3 Segment 4
Segment 1: respiratory system (14%), cardiovascular system (12%), blood and blood derivatives (10%), and HIV (10%). Segment 2: blood and blood derivatives (18%), cardiovascular system (13%), and respiratory system (15%) Segment 3: general systemic antibiotics (100%) Segment 4: alimentary tract and metabolism (100%)
Department of Research and Assessment in Health
Technology
ICGES. Panamá, Ave. Justo Arosemena y calle 35. Tel.: (507) 527 - 4811 Fax: (507) 527 - 4889 Apartado Postal: Nº 0816 - 02593. Panamá, República de Panamá.
Email: [email protected]; [email protected] http://www.gorgas.gob.pa/SIGMED/Home1.htm
