ABSTRACT
This study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy-induced income losses. The results show that ophthalmologists substantially reduced their fees and rebates for services directly targeted by the benefit restriction compared to other medical specialists' fees and rebates. There is also some evidence that they increased their fees for services that were not targeted. High-fee charging ophthalmologists exhibited larger fee and rebate responses while the low-fee charging group raise their rebates to match the reference price provided by the policy environment.
Subject(s)
Ophthalmology , Physicians , Humans , United States , Insurance Benefits , Fees, Medical , Fees and ChargesABSTRACT
El derecho a la salud se hace efectivo, entre otros, a través de la garantía de acceso a los medicamentos, ya que estos contribuyen a prevenir, curar, o aliviar enfermedades, así como a corregir o reparar las secuelas provocadas por éstas. Así pues, en España, se reconoce el derecho de todos los ciudadanos a obtener medicamentos mediante las prestaciones farmacéuticas garantizadas por el Sistema Nacional de Salud, que es el modelo sanitario implantado para la garantía de la protección de la salud. Con el fin de garantizar la sostenibilidad del mismo, el Estado tiene la capacidad de regular las condiciones económicas de las prestaciones farmacéuticas, así como de normativizar el precio de los medicamentos.En el presente trabajo, se analiza la intervención administrativa sobre todas las cuestiones de índole económica y política que rodean al medicamento en su relación con la protección de la salud como son: la decisión de la financiación pública, es decir, inclusión del medicamento en la prestación farmacéutica de la Seguridad Social; y, la fijación del precio de financiación del medicamento con cargo a fondos estatales afectos a sanidad o de la Seguridad Social, que son realizadas en cada uno de los Estados miembros, y en España esta capacidad corresponde al Ministerio con competencias en sanidad. (AU)
The right to health is made effective, among others, through the guarantee of access to medicines, since these contribute to prevent, cure, or alleviate diseases and to correct or repair the aftermath caused by them. Thus, in Spain, the right of all citizens to obtain medicines through the pharmaceutical benefits guaranteed by the National Health System, which is the health model implemented to guarantee health protection, is recognized. To guarantee its sustainability, the State has the capacity to regulate the economic conditions of pharmaceutical services, as well as to standardize the price of medicines.In this paper, the administrative intervention on all the economic and political issues surrounding the medicine in its relationship with health protection is analyzed, such as: the decision of public financing, that is, inclusion of medicine in the pharmaceutical provision of Social Security, and the fixing of the price of financing the medicine from state funds related to health or Social Security, which are carried out in each of the Member States, and in Spain correspond to the Ministry with competences in health. (AU)
Subject(s)
Humans , Pharmaceutical Preparations , Commerce , National Health SystemsABSTRACT
El concepto de innovación incremental abarca las adaptaciones resultantes del análisis de la utilización de los medicamentos existentes, con el fin de incorporar una modificación o proponer un nuevo uso diseñado para beneficiar a los pacientes. Puede clasificarse en 6 distintas categorías, en función de la naturaleza o del objetivo de la innovación realizada.La innovación incremental puede resultar muy interesantes para los profesionales sanitarios porque estas variaciones aportan mejoras en el tratamiento, en la continuación de los tratamientos, en la disminución de efectos adversos o en la adherencia.La innovación incremental tiene también una excelente acogida desde la perspectiva del paciente, puesto que facilita el tratamiento y en muchos casos abre una expectativa terapéutica a determinados subgrupos, inexistente antes de la comercialización del medicamento.Es interesante asimismo para el Sistema Nacional de Salud, ya que determinados pacientes tratados con innovaciones incrementales obtienen mejores resultados en salud y requieren con menor frecuencia hacer uso de otros servicios sanitarios.Desde una perspectiva económica, muchas empresas farmacéuticas radicadas en nuestro país relevantes desde un punto de vista estratégico, podrían asimismo mejorar con este tipo de innovaciones el arsenal terapéutico aportando productos necesarios que, lamentablemente, no tienen en la actualidad las condiciones idóneas de viabilidad.Por todo ello, la promulgación de una normativa española que ampare y aporte seguridad jurídica a los titulares de la autorización de comercialización de este tipo de innovaciones parece necesaria. Esta futura normativa debería incluir un procedimiento para calificar las innovaciones incrementales de interés para el Sistema Nacional de Salud y tener efectos económicos para garantizar su comercialización efectiva. (AU)
The concept of incremental innovation encompasses adaptations resulting from the analysis of the use of existing medicinal products, in order to incorporate a modification or propose a new use designed to benefit patients. It can be classified into 6 different categories, depending on the nature or objective of the innovation carried out.Incremental innovation can be very interesting for health professionals because these variations provide improvements in treatment, in the continuation of treatments, in the reduction of adverse effects or in adherence.Incremental innovation is also very well received from the patients perspective, since it facilitates treatment and in many cases opens up a therapeutic expectation for certain subgroups that did not exist before the medicinal product was marketed.It is also interesting for the National Health System, since certain patients treated with incremental innovations obtain better health results and require less frequent use of other health services.From an economic perspective, many pharmaceutical companies established in our country and relevant from a strategic point of view, could also improve the therapeutic arsenal with this type of innovations by providing products of therapeutic interest that, unfortunately, do not currently have the ideal conditions for viability.For all these reasons, the promulgation of a Spanish regulation that protects and provides legal certainty to the marketing authorization holders of this type of innovations seems necessary. This future regulation should include a procedure to qualify incremental innovations of interest to the National Health System and have economic effects to guarantee their effective commercialization. (AU)
Subject(s)
Humans , Drug Repositioning , Treatment Adherence and Compliance , Patients , Commerce , TherapeuticsABSTRACT
International reference prices (IRP), also called external reference prices, are widely used across developed nations. IRP uses the prices paid in other countries to either inform negotiations with the pharmaceutical industry or as a cap on market prices. The authors review the application of IRP to cap the prices of negotiated outcomes in the context of US proposals for changing the way prescription drug prices are established for the Medicare program. They examine the economic, political, and administrative issues associated with the use of IRP, and they summarize the evidence on the impacts of IRP.
Subject(s)
Drug Costs , Medicare , Aged , Humans , United States , Costs and Cost Analysis , Public Policy , Economic Competition , Drug IndustryABSTRACT
El derecho a la salud se hace efectivo, entre otros, a través de la garantía de acceso a los medicamentos, ya que estos contribuyen a prevenir, curar, o aliviar enfermedades, así como a corregir o reparar las secuelas provocadas por éstas. Así pues, en España, se reconoce el derecho de todos los ciudadanos a obtener medicamentos mediante las prestaciones farmacéuticas garantizadas por el Sistema Nacional de Salud, que es el modelo sanitario implantado para la garantía de la protección de la salud. Con el fin de garantizar la sostenibilidad del mismo, el Estado tiene la capacidad de regular las condiciones económicas de las prestaciones farmacéuticas, así como de normativizar el precio de los medicamentos. En el presente trabajo, se analiza la intervención administrativa sobre todas las cuestiones de índole económica y política que rodean al medicamento en su relación con la protección de la salud como son: la decisión de la financiación pública, es decir, inclusión del medicamento en la prestación farmacéutica de la Seguridad Social; y, la fijación del precio de financiación del medicamento con cargo a fondos estatales afectos a sanidad o de la Seguridad Social, que son realizadas en cada uno de los Estados miembros, y en España esta capacidad corresponde al Ministerio con competencias en sanidad.(AU)
The right to health is made effective, among others, through the guarantee of access to medicines, since these contribute to prevent, cure, or alleviate diseases and to correct or repair the aftermath caused by them. Thus, in Spain, the right of all citizens to obtain medicines through the pharmaceutical benefits guaranteed by the National Health System, which is the health model implemented to guarantee health protection, is recognized. To guarantee its sustainability, the State has the capacity to regulate the economic conditions of pharmaceutical services, as well as to standardize the price of medicines. In this paper, the administrative intervention on all the economic and political issues surrounding the medicine in its relationship with health protection is analyzed, such as: the decision of public financing, that is, inclusion of medicine in the pharmaceutical provision of Social Security, and the fixing of the price of financing the medicine from state funds related to health or Social Security, which are carried out in each of the Member States, and in Spain correspond to the Ministry with competences in health.(AU)
Subject(s)
Humans , Drug Costs , Industry , Pharmacies , Access to Essential Medicines and Health TechnologiesABSTRACT
El concepto de innovación incremental abarca las adaptaciones resultantes del análisis de la utilización de los medicamentos existentes, con el fin de incorporar una modificación o proponer un nuevo uso diseñado para beneficiar a los pacientes. Puede clasificarse en 6 distintas categorías, en función de la naturaleza o del objetivo de la innovación realizada. La innovación incremental puede resultar muy interesantes para los profesionales sanitarios porque estas variaciones aportan mejoras en el tratamiento, en la continuación de los tratamientos, en la disminución de efectos adversos o en la adherencia. La innovación incremental tiene también una excelente acogida desde la perspectiva del paciente, puesto que facilita el tratamiento y en muchos casos abre una expectativa terapéutica a determinados subgrupos, inexistente antes de la comercialización del medicamento. Es interesante asimismo para el Sistema Nacional de Salud, ya que determinados pacientes tratados con innovaciones incrementales obtienen mejores resultados en salud y requieren con menor frecuencia hacer uso de otros servicios sanitarios. Desde una perspectiva económica, muchas empresas farmacéuticas radicadas en nuestro país relevantes desde un punto de vista estratégico, podrían asimismo mejorar con este tipo de innovaciones el arsenal terapéutico aportando productos necesarios que, lamentablemente, no tienen en la actualidad las condiciones idóneas de viabilidad. Por todo ello, la promulgación de una normativa española que ampare y aporte seguridad jurídica a los titulares de la autorización de comercialización de este tipo de innovaciones parece necesaria. Esta futura normativa debería incluir un procedimiento para calificar las innovaciones incrementales de interés para el Sistema Nacional de Salud y tener efectos económicos para garantizar su comercialización efectiva.(AU)
The concept of incremental innovation encompasses adaptations resulting from the analysis of the use of existing medicinal products, in order to incorporate a modification or propose a new use designed to benefit patients. It can be classified into 6 different categories, depending on the nature or objective of the innovation carried out. Incremental innovation can be very interesting for health professionals because these variations provide improvements in treatment, in the continuation of treatments, in the reduction of adverse effects or in adherence. Incremental innovation is also very well received from the patients perspective, since it facilitates treatment and in many cases opens up a therapeutic expectation for certain subgroups that did not exist before the medicinal product was marketed. It is also interesting for the National Health System, since certain patients treated with incremental innovations obtain better health results and require less frequent use of other health services. From an economic perspective, many pharmaceutical companies established in our country and relevant from a strategic point of view, could also improve the therapeutic arsenal with this type of innovations by providing products of therapeutic interest that, unfortunately, do not currently have the ideal conditions for viability. For all these reasons, the promulgation of a Spanish regulation that protects and provides legal certainty to the marketing authorization holders of this type of innovations seems necessary. This future regulation should include a procedure to qualify incremental innovations of interest to the National Health System and have economic effects to guarantee their effective commercialization.(AU)
Subject(s)
Humans , 50054 , Biopharmaceutics , Drug Repositioning , Treatment Adherence and Compliance , Pharmaceutical Trade , Drug PriceABSTRACT
BACKGROUND: High price is a major challenge limiting access to essential medicines especially among the poorest families in developing countries. The study aims to compare the prices of medicines used in the management of pain, diabetes, and cardiovascular diseases in private pharmacies and the National Health Insurance Fund (NHIF) in Tanzania. Pharmacy prices were also compared with the prices of medicines surveyed nationally by WHO/HAI in 2012. METHOD: This cross-sectional study was conducted in Dar es Salaam, Morogoro, Dodoma, and Kilimanjaro regions from February to April 2015. Data were collected from 33 private pharmacies, NHIF and, the HAI database. The study used the WHO/HAI methodology. The analysis was done using non-parametric Kruskal-Wallis and post-hoc pair-wise comparison Dunn test, while a possible change in prices between our survey and 2012 WHO/HAI national survey data was tested using a Sign test in Stata version 16.1. RESULTS: Twenty-eight essential medicines, of which 9 are used for management of pain, 7 for diabetes, and 12 for cardiovascular diseases were analyzed. There was a significant difference in the mean pharmacy prices of some medicines between the regions and between the pharmacies and NHIF reference prices. NHIF reference prices were higher than the pharmacy prices for 16 of the 28 medicines. There was a significant increase in the prices of 5 out of the 8 medicines that were also nationally surveyed by the WHO/HAI in 2012. CONCLUSION: The study found that medicine prices in private pharmacies vary a lot between the study regions, which raises equity concerns. Also, there was a significant difference between the pharmacy and the NHIF reimbursement prices, which may expose patients to fraudulent co-payments or hinder timely access to prescribed medicines. Therefore, effective price control policies and regulations for medicines are warranted in Tanzania.
Subject(s)
Cardiovascular Diseases/drug therapy , Diabetes Mellitus/drug therapy , Drugs, Essential/economics , National Health Programs , Pain/drug therapy , Pharmacies , Private Sector , Cross-Sectional Studies , Humans , Surveys and Questionnaires , TanzaniaABSTRACT
The United States relies primarily on market forces to determine prices for drugs, whereas most other industrialized countries use a variety of approaches to determine drug prices. Branded drug companies have patents and market exclusivity periods in most industrialized countries. During this period, pharmaceutical companies are allowed to set their list price as high as they prefer in the United States owing to the absence of government price control mechanisms that exist in other countries. Insured patients often pay a percentage of the list price, and cost sharing creates some pressure to lower the list price. Pharmacy benefit managers negotiate with drug companies for lower prices by offering the drug company favorable formulary placement and fewer utilization controls. However, these approaches appear to be less effective, compared with other countries' approaches to containing branded drug prices, because prices are substantially higher in the United States. Other industrialized countries employ various forms of rate setting and price regulation, such as external reference pricing, therapeutic valuation, and health technology assessment to determine the appropriate price.
