The case of pharmacist prescribing policy in Israel.

Hila Yariv

doi:10.1186/s13584-015-0045-4

Abstract

Pharmacy prescribing policy in Israel has been negotiated and changed in recent years in order to improve patient treatment and access to medicines, and reduce national health insurance costs by allowing pharmacists to prescribe medications. Various stakeholders and institutions were involved in the formulation process, affecting the process while representing different motives. The complexity of pharmacy prescribing policy formulation is universal - any policy project needs, for strategic and tactical reasons, to acquire an inventory of institutions involved, identify the key players and explore potential support or opposition among them. This article uses the field (theory) of new institutional economics to explain the process of pharmaceutical institutional change and identifies the stakeholders who are involved in the reform.In the framework of pharmaceutical policies, seven models of prescribing practices are outlined, and the Canadian and British prescribing models are presented. The paper then focuses on the Israeli case and the main issues that concern decision-makers in the Israeli health system, such as inequality in access to health services and the erosion of the notion of universal health services. These concerns and the involvement of different stakeholders, such as The Israeli Medical Association (IMA) and health funds, influenced and directed the final Pharmacist Prescribing Law. After several rejections and amendments the law was passed, enabling experienced pharmacists to prescribe only to patients with a previous prescription given by a physician in the hope it would improve services to patients and reduce physicians’ workloads. Here, the topic of the new prescribing policy is introduced, using tools from the new institutional school in political economy.

Highlights

According to the literature in the field, governance in the health sector is difficult to define as governance operates at many different levels [1, 2]
The multilateral relationship among clients, regulators, payers and providers that exists in the health sector adds to the complexity of governance arrangements in the pharmaceutical sector [3]
The main aim of this paper is to explore what factors are at play in the Pharmacist Prescribing Policy process and to find out which actors were involved in the evolution of policy making, using the field of new institutional economics to explain the process of institutional change

Summary

Introduction

According to the literature in the field, governance in the health sector is difficult to define as governance operates at many different levels [1, 2]. Governance can be analyzed in terms of political actors who compete and collaborate to establish public policies [1]. Governance can be analyzed in terms of the forms of these specific public policies; the resulting rules, laws and institutions. The multilateral relationship among clients, regulators, payers and providers that exists in the health sector adds to the complexity of governance arrangements in the pharmaceutical sector [3]. The main focus of these arrangements is on transparency in the use of public funds for buying drugs, fair and equitable access to medicines, patients’ safety in the use of drugs, quality assurance throughout the supply chain and the cost effective use of drugs [3]. The United Nations proclaims that a country has good governance when its public sector acts

Objectives

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Conclusion