Bulletin

Issue: September 2004

Global Health

Better pharmaceutical drug scheme for Croatia

La Trobe senior lecturer in Public Health, Dr Ken Harvey - a specialist in the design of public policy to optimise the use of antibiotics and other medicinal drugs - has played a major role in introducing a cost efficient pharmaceutical drug scheme in Croatia.

Dr Harvey was a member of an Australian Health Insurance Commission (HIC) team which won a World Bank contract to help the Croatian Ministry of Health and the Croatian Institute for Health Insurance reform the country's pharmaceutical sector. This followed Croatian government concern about the relatively high cost of drugs and inappropriate prescribing habits by physicians.

Through research, commissioned policy papers and his inaugural membership of the Commonwealth Pharmaceutical Health and Rational use of Medicines (PHARM) Committee, Dr Harvey has helped formulate Australian medicinal drug policy.

He has also worked in 12 Asian countries under the auspices of the World Health Organisation, AusAID and the Regional Office for Asia and the Pacific of Consumers International.

Dr Harvey said Australian medicinal drug policy was held in high regard internationally. In particular, he said Australia's 55-year-old Pharmaceutical Benefits Scheme was world renowned for subsidising most of the cost of around 600 drugs for Australian consumers and for using stringent pharmaco-economic analysis to negotiate drug prices two to three times lower that that paid in the USA.

'In addition, our 'Quality Use of Medicines' policy encourages rational prescribing and use by providing independent drug and therapeutic information, analysis and feedback of drug utilisation data, and educational programs run by the National Prescribing Service,' he said.

Dr Harvey spent three months in Croatia in 2003 and early 2004 helping devise a national policy which encouraged the use of pharmaco-economic principles in the selection and purchase of the Croatian national drug list.

The team with which he was working recommended new drug funding and reimbursement options, reviewed drug use data and developed prescribing guidelines and feedback systems to encourage physicians to practice in accord with the national guidelines.

In addition, it developed and conducted education programs in pharmaco-economics for personnel involved in drug selection and pricing, courses in rational prescribing for clinical pharmacologists and physicians, and reviewed plans for the establishment of a Croatian National Drug Agency. This culminated in an information campaign for the general public.

Specifically, Dr Harvey's role involved adapting and translating Australian therapeutic guidelines to suit local conditions, using insurance data to monitor doctors prescribing practice and devising performance indicators, linked to financial incentives, to encourage physicians to follow the guidelines.

The Croatian Institute for Health Insurance accepted his recommendations, resulting in performance indicators and financial incentives being written into new contracts for Croatian general practitioners this year.

Dr Harvey also worked with a primary health care information technology project which aims to incorporate the guidelines devised into prescribing software being piloted in Croatia. He also played a leading role in the educational program for clinical pharmacologists and physicians.

Many countries, he said, face similar problems to those experienced by Croatia. Neighbouring counties such as Bosnia, Montenegro and Serbia are very interested in the Croatian pharmaceutical project. The Australian HIC has won a similar contract in Jordan and Dr Harvey is soon to return to Jordan as part of the team.

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