Pharmacy in croatia - A short overview


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PharmaCon2007 Conference Dubrovnik Croatia

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Pharmacy in croatia - A short overview

  1. 2. FACTS ABOUT CROATIA <ul><li>4,400,000 inhabitants </li></ul><ul><li>area 56,600 km² </li></ul><ul><li>GDP: 7,706 € </li></ul><ul><li>state and private ownership </li></ul><ul><li>negotiations for EU membership opened 10/2005 </li></ul>
  2. 3. HISTORICAL FACTS <ul><li>1240 - pharmacy separated from medicine (beginning of pharmacy as independent profession, Edict of Frederick II) </li></ul><ul><li>first pharmacies in Croatia </li></ul><ul><li>- Trogir, 1271 </li></ul><ul><li>- Dubrovnik, Split, 1282 </li></ul><ul><li>- Zadar, 1289 </li></ul><ul><li>- Dubrovnik, 1317 ( Franciscan monastery of Little Brethren ; </li></ul><ul><li>uninterrupted operation from its opening to the present day) </li></ul><ul><li>- Dubrovnik, 1420 (charity home pharmacy Domus Christi , turned to hospital pharmacy in 1540) </li></ul>
  3. 4. GENERAL ECONOMIC SITUATION IN HEALTH CARE <ul><li>total health expenditure ≈ 8.0% of GDP </li></ul><ul><li>budget of the National Institute for Health Insurance within the state budget ≈ 15% </li></ul><ul><li>average spending on health care per capita ≈ 550 € </li></ul><ul><li>average spending on medicines per capita ≈ 150 € </li></ul>
  4. 5. HEALTH CARE INSURANCE <ul><li>National Institute for Health Insurance (NIHI) - state owned </li></ul><ul><li>basic insurance: 15.5% of each employee's salary </li></ul><ul><li>extra private insurance – not yet relevant </li></ul><ul><li>medicines on the basic positive list – free of charge </li></ul><ul><li>medicines on the additional list – patient's co-payment </li></ul>
  5. 6. REGULATION <ul><li>Revised acts </li></ul><ul><li> Health Care Act, 2003 </li></ul><ul><li> Health Insurance Act, 2004 </li></ul><ul><li>New acts, 2003 </li></ul><ul><li>Medicines and Medical Devices Act </li></ul><ul><li>Pharmacy Act </li></ul><ul><li>Medical Practice Act </li></ul><ul><li>Dental Practice Act </li></ul><ul><li>Medical Biochemistry Act ( laboratory practice ) </li></ul><ul><li>Nursing Practice Act </li></ul>
  6. 7. REGULATION <ul><li>Medicines and Medical Devices Act, 2003 </li></ul><ul><li>defines the demands on medicines, medical devices, and homeopathic products </li></ul><ul><li>defines the domain of the Agency for Medicines and Medical Devices (founded 10/ 2003 ) </li></ul>
  7. 8. REGULATION <ul><li>Pharmacy Act (first in recent history, 7/2003 ) in accordance with the European model </li></ul><ul><li>defines pharmaceutical activities community and hospital pharmacy, galenic laboratory and quality control laboratory </li></ul><ul><li>defines pharmaceutical profession rights and obligation s of pharmacists and pharmacy technicians </li></ul><ul><li>defines the domain of the Chamber of Pharmacists </li></ul>
  8. 9. PHARMACY NETWORK <ul><li>geographic criteria for the network </li></ul><ul><li>in cities >500,000 inh. min. distance = 200 m </li></ul><ul><li> 100,000-500,000 inh. min. distance = 300 m </li></ul><ul><li> <100,000 inh. min. distance = 500 m </li></ul><ul><li>demographic criteria for the network </li></ul><ul><li>1 pharmacy per 3,000 NIHI insurants, every subsequent pharmacy per 5000 insurants </li></ul><ul><li>Ownership: Single pharmacy – only pharmacist s </li></ul><ul><li>Pharmacy institution – all legal or </li></ul><ul><li>physical person s (2 or more pharmacies) </li></ul>
  9. 10. PHARMACY STAFFING AND OPERATING <ul><li>minimal staff required: 1 pharmacist per shift </li></ul><ul><li>½ pharmacy technician </li></ul><ul><li>licence: obligatory for pharmacist </li></ul><ul><li>issued by the Croatian Chamber of Pharmacists </li></ul><ul><li>(2002 - first renewal cycle) </li></ul><ul><li>POM dispensing : only by pharmacist </li></ul><ul><li>OTC dispensing : by pharmacist and pharmacy technician </li></ul>
  10. 11. PHARMACY NETWORK <ul><li>2300 pharmacists in health care system </li></ul><ul><li>(2180 in community ,120 in hospital pharmacies) </li></ul><ul><li>978 community pharmacies </li></ul><ul><li>23% state owned </li></ul><ul><li>63% private </li></ul><ul><li>14% under private lease </li></ul><ul><li>2/3 in pharmacy chains </li></ul><ul><li>2020 inhabitants / pharmacist </li></ul><ul><li>2.2 pharmacists / pharmacy </li></ul><ul><li>pharmacy network almost filled up </li></ul><ul><li>52 hospital pharmacies </li></ul>
  11. 12. PHARMACIES IN CROATIA 1991-2007
  12. 13. SUPPLY OF MEDICINES <ul><li>3700 registered medicines </li></ul><ul><li>620 generics in different dosage form s and packages </li></ul><ul><li>180 OTC medicines </li></ul><ul><li>dispensing of registered medicines: </li></ul><ul><li>medicines - only in pharmacies </li></ul><ul><li>some OTC - also in drugstores (under special </li></ul><ul><li>permission of the Ministry of Health) </li></ul><ul><li>dispensing of non-registered medicines: </li></ul><ul><li> import based on individual prescription allowed </li></ul><ul><li>~20 drug wholesalers </li></ul>
  13. 14. <ul><li>price s of reimbursed medicines: determined by the Ministry of Health and NIHI </li></ul><ul><li>tax: 0% for reimbursed medicines </li></ul><ul><li> 22% for non-reimbursed medicines </li></ul><ul><li>for reimbursed medicines - service fee (determined by NIHI; recalculated to 6-7% margin) </li></ul><ul><li>for non-reimbursed medicines - margin up to 35% (digressive principle) </li></ul>SUPPLY OF MEDICINES
  14. 15. REIMBURSEMENT SYSTEM <ul><li>National Institute for Health Insurance reimburses the pharmacy for medicine costs + service fee </li></ul><ul><li>Average reimbursement time is 250-280 days </li></ul><ul><li>patient co-payment for medicines on list B (additional list of NIHI) </li></ul>
  15. 16. <ul><li>Faculty of Pharmacy and Biochemistry, University of Zagreb – the only faculty in Croatia Since academic year 2004/05 – new five-year curriculum (adapted to the Bologna process) Graduate pharmacists –about 130 each year Specialisations in community and clinical pharmacy – under preparation. </li></ul>PHARMACY EDUCATION
  16. 17. PHARMACY EDUCATION <ul><li>since 1996 – licence for independent work of pharmacists is obligatory (issued by the Chamber of Pharmacists) </li></ul>FACULTY DIPLOMA (4Y) 1 YEAR TRAINEESHIP STATE EXAM LICENCE VALID 6 YEARS LICENCE RENEWAL
  17. 18. COMPULSORY CONTINUING EDUCATION <ul><li>Every 6 years – licence renewal </li></ul><ul><li>by collecting at least 30 points through following professional continuing education programs or </li></ul><ul><li>by passing an exam at the Chamber of Pharmacists </li></ul><ul><li>professional continuing education is organised mainly by </li></ul><ul><li>- CROATIAN PHARMACEUTICAL SOCIETY </li></ul><ul><li>- FACULTY OF PHARMACY AND BIOCHEMISTRY </li></ul>
  18. 19. CONTINUING EDUCATION <ul><li>Collecting points </li></ul><ul><li> active or passive participation in: </li></ul><ul><li>- congresses, symposia, seminars, conferences </li></ul><ul><li>- training courses </li></ul><ul><li>- annual professional meetings </li></ul><ul><li>- lectures </li></ul><ul><li>- scientific or professional publications - reporting medicine side effects , etc. </li></ul><ul><li>Points are assigned by the Commission for continuing </li></ul><ul><li>education set up by the Chamber of Pharmacists . </li></ul>
  19. 20. <ul><li>in case of insufficient number of points </li></ul><ul><li>- Taking an exam is required (Chamber's commission) </li></ul><ul><li>(exceptions: pregnancy, longer illness…) </li></ul><ul><li>Exam consists of written and oral part s </li></ul><ul><li>(subjects: pharmacotherapy, galenic and </li></ul><ul><li>extemporaneous preparations, POM and OTC </li></ul><ul><li>dispensing, legislation) </li></ul><ul><li>2002 was the first term for licence renewal ; only a few pharmacists had to take the exam </li></ul>CONTINUING EDUCATION
  20. 21. CONCLUDING REMARKS <ul><li>Main difficulties: </li></ul><ul><li>New pharmacy curriculum still in process of harmonisation </li></ul><ul><li>Incompleteness of legislative framework </li></ul><ul><li>Different pharmacy ownership – lack of unity </li></ul><ul><li>Concentration of pharmacies in cities, lack in rural area </li></ul><ul><li>Legislative framework not in line with competences of pharmacists </li></ul><ul><li>Delayed reimbursement by NIHI </li></ul><ul><li>Low service fee for dispensing medicines </li></ul><ul><li>Lack of partnership with MH and NIHI </li></ul><ul><li>Lack of monitoring and inspection </li></ul>
  21. 22. <ul><li>T H A N K Y O U ! </li></ul>