Biomedical Engineering Reference
In-Depth Information
innovations in health systems are influenced by factors such as the compatibility
of the innovation with the system, the value added by the innovation in compari-
son with existing products (Ruof et al. , 2002), the institutional or political context
within which the innovation is introduced, budgetary constraints, and clinicians'
behaviour (Ferlie et al. , 2000; Fitzgerald et al. , 2003). Building on earlier reviews,
we undertook a systematic review of 389 studies which fulfilled our quality criteria
for inclusion (from 74,981 published articles identified). These studies explored
how the characteristics of an innovation, behaviour of individual and organisational
adopters, the communication process (amongst adopters), factors relating to the
health system, and factors relating to the broad context influence the adoption and
diffusion of innovative medicines.
We analysed how the changes in health system elements (organisational struc-
ture, financing, resource allocation, provider payment systems, and service pro-
vision) and regulatory changes influence the uptake and diffusion of innovative
medicines (Atun et al. , 2005). We considered both new molecular entities (drugs
with active ingredients that have not already been approved by authorities) and drugs
which provide incremental therapeutic advances on active ingredients that have
already been approved for market use. These advances might include enhanced
compliance, improved safety profiles, and new benefits to patient subgroups. A
detailed review and the methodology are described elsewhere (Atun and Gurol-
Urganci, 2006).
The Regulatory Environment
An analysis of diffusion patterns of a new therapeutic class of drugs in 15 countries
showed developing countries 1 to have lower diffusion speeds than developed coun-
tries. Diffusion speeds were positively associated with per capita health expenditure
and negatively associated with price levels (Desiraju et al. , 2004).
Many countries have introduced cost containment policies for pharmaceuticals
(such as reference pricing, limiting number of prescriptions, withdrawing reim-
bursement, cost sharing, budgetary restrictions, delisting and restrictive drug for-
mularies) to change the behaviour of physicians and patients. These are explored in
what follows.
1 As defined by the World Bank, per capita income level less than $9,076. See, Global Economic
Prospects and the Developing Countries (2002), The World Bank, Washington, DC.
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