Table 1.
ERP and its impact within countries: Summary of the analytical framework.
Source: The authors
| System-wide health policy objectives | Definition | Issues raised |
|---|---|---|
| Cost containment | Examines the extent to which ERP has the capacity to reduce or contain the rate of increase in pharmaceutical spending | ERP can lead to health care system savings |
| Extent of savings depends on the way ERP is implemented | ||
| Price levels | Assesses whether ERP leads or is able to secure reasonable prices for payers and healthcare systems | ERP secures low pharmaceutical prices |
| Pharmaceutical prices depend on ERP design | ||
| Pharmaceutical prices depend on market features | ||
| Drug use | Assesses whether ERP can manage excessive drug consumption | ERP impacts diffusion and use |
| Availability | The extent to which new pharmaceuticals are available in the market for which they are intended | ERP can lead to market withdrawal |
| ERP can lead to launch delays, launch sequencing or no launch | ||
| Affordability | The extent to which pharmaceutical prices are congruent with the purchasing ability of health care systems and/or patients | ERP leads to prices in line with the purchasing ability of health care systems and/or patients |
| ERP enhances the scope for affordability | ||
| Fairness/social welfare | The ability of ERP to promote equitable access to medicines | ERP has an impact on social welfare |
| ERP has an impact on health system priorities | ||
| Microeconomic efficiency | The extent to which ERP promotes health system efficiency and leads to optimal resource allocation | ERP has an impact on efficient drug expenditure |
| ERP is associated with a stable share of pharmaceutical expenditure on total health spend | ||
| ERP helps contain costs while guaranteeing access to medicines | ||
| Industrial policy | Assesses whether ERP promotes and/or is consistent with the objectives of industrial policy (attracting manufacturing, R&D and/or related activities) or it acts as a barrier to attracting these | ERP impacts innovation and investment in R&D |
| ERP influences manufacturing and/or R&D investment decisions | ||
| ERP can promote innovation |