[02.13] Global Supply Chains V2.2.pdf

WHO Building Blocks

What are the requisites for a successful universal healthcare system, according to the WHO?

Static nature and conflicts of interest

What is a key critique of the WHO building blocks for health systems?

Adverse selection

What market failure occurs when private insurers only select people with less risk of getting sick to minimize utilization risk?

Overuse and high health cost inflation

What are the consequences of moral hazard in healthcare financing?

Obamacare

What US legislation aimed to remove adverse selection by requiring everyone to be covered upon enrollment regardless of condition?

Risk selection

What market failure is similar to adverse selection but focuses on identifying certain populations or areas insurers do not cover?

Pyramidal system

What system do some hospitals use where initial investors or pioneering doctors sell excess capital to second and third-tier doctors, which Dr. Mercado views negatively?

Non-diminishing

What is a characteristic of the value of public goods, unlike curative care?

Government

Who typically provides most public goods because private companies do not?

Inefficiency, poor quality, lack of innovation, unresponsiveness to users

What are the consequences of monopoly as a cause of government failure in healthcare?

Bureaucracy

What cause of government failure leads to rigid, inefficient, and low-quality services due to the use of bureaucratic rules?

Imperfect agency/Self-interest motivation (Public Choice Theory)

What cause of government failure involves government officials leveraging healthcare to perpetuate themselves, leading to misallocation of funds?

Regulatory capture and corruption

What cause of government failure results in laws and rules favoring strongly organized interest groups and directing public resources to them?

Lee Kuan Yew, prime minister of Singapore

Who decided that healthcare should primarily be the responsibility of the patients themselves, through individual savings funds?

The rich subsidize the poor

How does progressive taxation function in healthcare financing systems like those in the UK and Canada?

Biosocial Approach

What analytical approach in healthcare moves beyond biomedical factors to include social forces influencing health?

Unintended Consequences of Purposeful Action (Merton)

What concept suggests that policies can have unforeseen outcomes, often studied in implementation science?

More friction between mayors and governors

What was a consequence of devolving healthcare delivery to local government in the Philippines, according to the example of unintended consequences?

Social Construct of Reality (Berger and Luckmann)

What biosocial theory posits that the ones deciding what is applicable to an area should be the community itself?

Selective Primary Care

What approach, initially proposed by Harvard, limited primary care coverage to four basic areas like vaccination and malnutrition?

Not a holistic approach but affordable and cost-effective

What was the main characteristic of Selective Primary Care, despite its limitations?

Partners In Health

What social justice organization, founded by Paul Farmer, aims to provide a preferential option for the poor in healthcare?

Architecture of society that creates inequality

What is structural violence?

Biopower

What term describes the use of state power to affect health policies and determine which population segments benefit, such as in China's two-child policy example?

Control Knob Framework

What framework was created due to critiques of the WHO building blocks and biosocial concepts, primarily driving the implementation of UHC?

Organization, Financing, Payment, Regulation, Behavior

What are the five major policy instruments used in the Control Knob Framework and by UHC?

Quality, Access, Equity in Financing, Efficiency, Cost

What are the immediate outcomes targeted by the Control Knob Framework?

Health Status, Public Satisfaction, Financial Risk Protection

What are the performance goals of the Control Knob Framework?

Medical goods (29.1%)

What healthcare expenditure category constitutes the largest percentage of the total in the Philippines, according to 2022 data?

Hospitals and retail pharma

Where is the biggest chunk of current healthcare expenditure directed, according to Figure 4?

Ambulatory and Primary Care (3%)

What healthcare spending category accounted for only 3% of the total current health expenditure in the Philippines in 2022?

More than 50% is spent on primary care

Under what condition is the Universal Healthcare (UHC) program considered successful in terms of healthcare expenditure?

Thailand

What country is cited as an example of increasing average lifespan with less per capita spent compared to the US?

44.8%

What percentage do out-of-pocket components comprise of the total healthcare spend in the Philippines, according to Figure 5?

PHP 10,059.49

What is the average yearly out-of-pocket spending for healthcare by a Filipino?

20-25%

What is the general rule of thumb for out-of-pocket cost as a percentage of total healthcare spend to significantly decrease a person’s risk of financial bankruptcy?

Absorptive capacity of PhilHealth, local government, and HCPN

According to Dr. Mercado, what is the core problem hindering the effective deployment of PhilHealth funds, even if they are allocated?

Diagnosis Related Group (DRG)

What system is PhilHealth exploring to expand coverage, moving away from Relative Value Units (RVU), to cover multiple diseases in one confinement?

No clear protocol of treatment

What makes data mining difficult for PhilHealth in studying the expansion of its payments?

Healthcare Provider Network (HCPN)

What integrated system of primary care, level 1, 2, and 3 hospitals is usually under city and provincial networks and supposedly covered by PhilHealth?

Apex hospitals

What term describes referral multi-specialty hospitals like The Medical City and UP-Philippine General Hospital?

Fee-For-Service to a Prospective Payment System

Ideally, what shift in payment systems for healthcare is desired in the Philippines?

Philippines: 5.6% to 5.8%

What is the approximate percentage of the national budget allocated to healthcare financing in the Philippines?

Incentive to increase volume and profit

What is the main incentive for healthcare practitioners under a Fee-For-Service payment model?

Prospective Payment System (Capitation)

What payment system pays providers a fixed amount per member per year, incentivizing them to provide the right amount of healthcare service without over-utilization?

Value-based or outcome-based measurements

What is often included in prospective payment systems to protect patients from potential cost-cutting that might compromise beneficial services?

Medical missions are fundraisers with sources from the global north

What is a primary source of funding for many medical missions, leading to questions about government responsibility?

Local Government Code of 1991 (RA No. 7160)

What law prevents the recentralization of the Philippine healthcare system back under the national government without amendment?

Agriculture and health

According to studies, which sectors are generally better managed under nationalized systems?

Pooled pharmaceutical procurement

What centralized operating aspect, if implemented, could bring benefits like economies of scale and better negotiation power despite local government opposition?

Recoup expenses and incentivize research and development

What is the primary reason for granting pharmaceutical companies patent exclusivity for originator drugs?

12 years

What is the average duration of patent exclusivity for originator drugs, though it varies per country?

1995 WTO Agreements

What international agreements reinforced intellectual property protection and fair trade, granting signatory countries favorable trade terms?

TRIPs – Trade Related Aspects of Intellectual Property

What agreement, signed during the Doha Declaration of 2001, allows governments to seek generic options in national emergencies?

Parallel importation

What TRIPS flexibility involves utilizing lax patent rules of specific countries to get around patent restrictions?

Compulsory licensing

What TRIPS flexibility allows a government to purchase a license to manufacture a product for its citizens?

Philippines

Which country has thus far only conducted parallel importation rather than compulsory licensing, being wary of potential trade law infringement?

Evergreening

What strategy do pharmaceutical companies employ to extend patents by obtaining secondary patents for an innovator drug after making inconsequential changes?

Pay-for-delay settlements

What strategy involves a pharmaceutical company paying a generic competitor to delay market entry, as the cost is less than potential sole market profit?

Pharmaceutical companies

Which industrial sector had the biggest profit margins among five primary sectors in 2013?

20% for the first generic, 80-85% for multiple generics

How much can drug prices drop when the first generic drug enters the market, and with multiple generics?

Pharmacy benefit managers (PBMs)

What entities in the US negotiate with pharmaceutical suppliers for payors, often having a conflict of interest due to ownership by pharmaceutical companies?

Medicare and Medicaid

What two US government programs were recently allowed to negotiate directly with pharmaceutical companies due to public clamor?

PhilHealth

According to the UHC law in the Philippines, which entity will have negotiating power for healthcare providers networks (HCPNs)?

RA 8293: Intellectual Property Code of the Philippines

What Philippine law, passed in 1997, restricts the patentability of mere discoveries of new forms or properties of known substances without enhanced efficacy?

Philippines, India, and Colombia

What are the only three countries that have laws stipulating restrictions against new patents based on inconsequential formulary changes?

Voluntary Licensing for Access to Medicine (VLAM)

What organized way of patent use involves price protection and pricing mechanisms, also facilitating technology transfer?

Unequal access to drugs

What is a persistent cause of health disparities between the rich and poor, both between and within countries?

Essential Medicine List (started in 1977)

What WHO initiative identifies drugs considered most important, basic, indispensable, and necessary for population health needs?

Medicine Patent Pool

What WHO initiative signals potential volume/market to manufacturers, leading to substantial price drops, and requires pre-certification by the UN for good manufacturing practices?

Strengthen health systems

Beyond buying medicines, what expanded indication do funds from PEPFAR and global health funds now cover?

18-20%

What percentage of medicines in the Global South are estimated to be counterfeit?

Philippine FDA

Which Philippine agency does not monitor fake medicines in the country?

Certificates of Good Manufacturing Practice (GMP) and Certificate of Pharmaceutical Product (CPP)

What documents must manufacturers provide to be part of the patent pool?

Hedging on pricing, ordering cycles, and consolidating orders

How do financing agencies like the Global Fund and PEPFAR manage drug procurement to ensure supply?

Handheld spectrometers

What technology has the WHO developed for post-marketing surveillance to detect counterfeit drugs?

The supplier or distributor

Who is held liable for counterfeit products if the manufacturer cannot be identified?

Quality, Efficiency, Equity, Resiliency, Agility

What are the five key metrics in the supply chain assessment framework?

Management

What is considered the most important and overarching factor in the supply chain assessment framework?

Purchasing, Inventory, Warehousing, Transportation

What are the four simplified supply chain building blocks?

Financing

What is included under the "Purchasing" building block?

Forecasting

What is included under the "Inventory" building block?

Understand the whole process of the production of your product, not just the cost

Beyond just cost, what is very important to understand in the purchasing process?

Raw materials for vaccines (antigens, supplements), transport requisites (cold chain, shelf life), temperature measurement/maintenance

What are important purchasing questions to ask in relation to vaccines?

Russian Doll Model

What model represents finding out who your supplier’s supplier options are, and who their supplier’s options’ supplier options are?

At least 3 options: primary, secondary, and tertiary

What is the recommended number of supplier options to have, including main and sub-suppliers?

Pack and fill

What part of drug manufacturing is mostly done in the Philippines, rather than manufacturing down to raw materials?

China and the US closed their ports

What event during the COVID-19 pandemic highlighted the problem of the Philippines not having its own drug manufacturing industry?

Suez Canal blockage

What event highlighted the importance of knowing alternative suppliers when supplies from Germany were backed up by a month?

Historical data

What accounts for most of the forecasting for inventory quantities in the Philippines?

Future program plans and underlying patterns

What are considered more interpretive of actual needs for inventory forecasting, especially if disease incidence is known?

Push & Pull

What inventory forecasting concepts refer to predicted supply requirements based on patterns ("Push") versus national government decisions ("Pull")?

Inventory cost, warehouse cost, breakage, theft, obsolescence (expiration)

What are some consequences of having too much or too long inventory?

Lost sales, breach of contract, returned product, drop in market share, urgent freight costs

What are some consequences of having too little or the wrong kind of inventory?

Inventory is the art of the balance

What key principle guides effective inventory management?

Securely store materials, efficiently process materials, maximize space/human resources, leverage technology

What are the main goals of warehousing?

Heavy boxes on high shelves, no visible labels, inadequate ventilation, crowded, unorganized

What are some common failures observed in sample warehousing setups?

Advanced Notifications

What warehousing best practice emphasizes knowing rather than guessing, requiring lead time in delivery?

Automate Information

What warehousing best practice aims to reduce human errors and provide real-time inventory information?

Just in time inventory

What inventory strategy minimizes inventory in excess to avoid lost income opportunity, often seen in efficient systems like PGH's deliveries?