ABSTRACT
Background: A health system consists of people, institutions, and resources that provide health services to meet the health needs of the target population. Health systems in developed and developing countries have different characteristics from which some lessons can be learned. The aim of this study is to compare the two health systems of Portugal and Iran. Methods: The study was conducted in 2021 using a comparative study approach. The WHO's six building blocks framework was used for the comparison (i.e., governance and leadership, health financing, health workforce, health information system, medication, and service delivery). A six-step protocol was used to review the literature. International databases such as Medline / Pub Med and Scopus were searched. Policy briefs, reports, and dissertations were also reviewed. Results: In both countries, the Ministry of Health is centrally responsible for health system governance. Healthcare financing is 80% government-funded in Portugal and 55% in Iran. In both countries, Health systems are mixed (NHS, NHI, and out-of-pocket model) and the unbalanced regional distribution is a major problem for human resources. In Iran, generic drugs are used, while Portugal combines generic and branded systems. In both countries, there are some challenges in integrating health information systems for health centers and hospitals. Conclusion: In both countries, some autonomy should be delegated to the regions. In Iran, public sector investment in the health system in Iran should be increased to reduce the currently very high out-of-pocket payments in the health system. In both countries, the distribution of resources, especially human resources, should be modified by designing some incentives. Increasing the share of generic drugs in Portugal will have a positive impact on cost control in the drug sector. It seems necessary to develop programs to strengthen the health information system in both countries.
ABSTRACT
BACKGROUND: The use of generic medicines instead of branded, is one of the main policies to decrease the expenditures and provide access to affordable and essential medicines in low and middle-income countries. The present study aims to systematically create a comprehensive synthesis of demand-side policies, encouraging the use of generic medicines. METHODS: The study systematically searched and reviewed the articles in Medline, Scopus, Web of Science, and Embase from 1.1.2000 to 12.5.2019. A total of 6435 records were identified during this period of time (Medline (n=315), Scopus (n=4323), Web of Science (n=71) and Embase (n=1726)). All stages are conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyzed (PRISMA). RESULTS: The encouraging policies and practices were classified into four categories from 44 articles analyzed, including; Prescribing, Dispensing, Patients/consumers, and healthcare organizations. Subthemes were also explored in relation to each category as; education, financial incentives, generic substitution, advertising approaches, and enforcement. CONCLUSION: Various policies should be taken into consideration to encourage successful generic medication prescribing, dispensing, and consumption in both supply and demand-side. Economic, political, socio-cultural, technological, legal, and structural factors could as such accelerate the policies' effect. Studying the experience of successful countries can be helpful for policymakers.
