Waxing In Parlour By Spy Cam

Study of comparative effectiveness: more public funding Probabilities of hits and less favorable to the intervention. PATIENTS AND MORE

published in Clinical and Health Management 46, pg 108, 2011
http://www.iiss.es/gcs/

Hochman M, McCormick D
Characteristics of Published Comparative Effectiveness Studies of Medications. JAMA. 2010, 303:951-8.


Objective To analyze the characteristics of comparative effectiveness studies recently published in journals with high impact factor. Data and method


Systematic review of randomized clinical trials, case-control studies, cohort studies and meta-analysis published in 6 medical journals with higher impact factor (New England Journal of Medicine, Lancet, JAMA, Annals of Internal Medicine, BMJ and Archives of Internal Medicine) from June 2008 to September 2009. Were defined as those comparative effectiveness studies comparing an existing drug therapies against active (active comparator studies) rather than active therapy compared with inactive placebo control. Results


104 of 328 (31.7%) identified studies presented results of comparative effectiveness. Of these, 43% compared different prescription drugs and 11 non-pharmacological interventions. Comparative effectiveness studies were less likely than the rest to be financed privately only (87% of the studies were funded by nonprofit sources, 63% public funding). Only 2 of the 104 selected studies presented cost-effectiveness ratios. Between trials, the probability of statistically significant results in favor of the intervention being tested is significantly lower in the comparative effectiveness studies (39% vs. 63% in other studies). 24% of randomized clinical trials used active comparators aim to demonstrate non-inferiority. Conclusions


Only a third of the studies published in magazines "top" provides evidence of effectiveness compared, which are very rare compared with non-drug alternatives, or that safety or cost analysis. Funding is mostly by public and nonprofit organizations.

Funding: None stated; Conflict of interest: none declared; Correspondence: mhochman@usc.edu


comment on the comparative effectiveness or the extent to which an intervention contributes to improved health status for one or more alternative interventions (1). This is a concept similar to added therapeutic value (2), essential from the standpoint of the social value of innovations and a previous input, and essential for estimating the cost-effectiveness ratios (incremental cost per incremental unit of output is achieved with the intervention evaluated against their comparators).
The focus of the incremental cost-effectiveness is appropriate to the decisions of a certain treatment coverage by public insurance, the price you are willing to pay for it, and the clinical situations and patient groups in which recommended (ie, the formularies, software recommendations, and indicator systems prescription or not associated with incentives).
The measure of comparative effectiveness (achieving or not the estimated cost-effectiveness ratios) is a key factor in financing decisions taken by insurers to be efficient and help to maximize health improvement. Away from the unfortunate translation of the concepts of comparative effectiveness and cost-effectiveness ratio as a fourth barrier (after the "barriers" regulatory efficiency, safety and quality), research on the measurement of these concepts is the essential guarantee for the maximization of health objectives in the presence of financial constraints. Additionally, use this fourth "guarantee" in making decisions through independent agencies and committees of experts is able to defend the value of efficient and effective innovation policy "blind" to contain costs and ensure that limited resources available for health systems are intended to treatments are worth their cost (3).
The review published by Hochman and McCormick has a positive reading (almost a third of the studies published by the 6 major journals relating to similar effect) but also should serve to bring out the debate on the conditions of implementation and funding these studies. The measure of comparative effectiveness studies require less non-inferiority and superiority over studies, requiring more complex trials with more patients and more expensive. If the major regulatory authorities hold the attention away from the comparative effectiveness is issued a clear signal for the development of innovations in low value added and allowed therapeutic comparative effectiveness in the field of negotiation with donors. If you keep the status quo, innovators have little incentive to develop comparative effectiveness studies of high methodological quality and the production of this information will require government intervention or non-profit, especially when there is uncertainty about the efficacy / effectiveness innovation.
The example of the United Kingdom, Australia and Canada in the use of comparative effectiveness and cost-effectiveness ratio coverage decisions not only provides evidence that it is feasible for use in these decisions but they have encouraged the production of information Comparative efficacy by the market (4).


1. Eichler HG, Bloechl-Daum B, Abadie E, Barnett D, König F, Pearson S. Relative Efficacy of drugs: an Emerging Issues Between Regulatory Agencies and third-party Payers. Nature Reviews. 2010, 9:277-91.
2. Junoy Puig J, Peiró S. The usefulness of drugs added therapeutic value and cost-effectiveness. En Rev Public Health. 2009, 83: 59-70.
3. Mushlin AI, Ghomrawi H. Health Care Reform and the Need for Comparative-Effectiveness Research. N Engl J Med 2010; 362 (3): e6.
4. FM Clement, Harris A, Li JJ, Yong K, Lee KL, Manns BJ. Using Effectiveness and Cost-Effectiveness Decisions to Make Drug Coverage. JAMA, 302:1437-43.

EXPANSION

Pernicious Pathopysiology

GOBERNANTES jointly responsible

Article published in the September 27, 2010

Fortunately, for some time that citizens and taxpayers seem to be more aware of the weaknesses and strengths of the National Health System that most of the politicians and English rulers. The citizens believe that public health is the most widely used and better appreciated and more than justifies the tax. At the same time saying that it is also one of the worst making use of users and has the most room for improvement. One in four people believed to misuse of health (five times more than for the pensions of illness)!

citizens overwhelmingly expressed that health is the service that justifies the payment of taxes and the one most suited to the level of taxes paid. All that any politician or leader would know because it is being repeated continuously in the survey on opinions and attitudes of the English prosecutors of the Institute for Fiscal Studies (www.ief.es). Perhaps this point, to disbelief of many, that people would be willing to pay more taxes, public fees or co-payments are guaranteed if they are used to finance public health and improving their health center or hospital.

citizens and taxpayers are well aware that nothing is free or public health or any public service: attentive to the common sense of citizens who do not pay the health bill (Ministry of Health) each month to incorporate new drugs to finance public without evidence of cost-effectiveness of these and is at the same time he proposed disqualification apply impunity rates, prices or copayments (revenue) health finalists made some Autonomous Communities, which are precisely what make every effort to ensure that the health budget is the most valued public service.

However, it is inevitable that politicians make proposals on taxes, health co-payment rates or explicit details on the what, who, how, how and when the application of the same as the demon of these measures is in the details. And they are independent rating agencies in charge of public policies to inform and provide knowledge, over little political demagogues and stewards of their impact on the use equity, and health spending.

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SEPARATE PAYMENT TO THE PRICE OF INDUSTRIAL

Article published in medical journals on 14/09/2010

The aim of the recent working paper by Professor Adrian Hollis ("Generic drug pricing in Canada: components of the value-chain", Working Paper Department of Economics, University of Calgary. 2010; May 16) is to analyze the public policy implications that arise from trying to establish efficient prices related to the costs of generic drugs in Canada.

The paper uses economic concepts and Canadian case studies and experience in other countries to propose efficient alternatives cost charge for litigation, industrial production and distribution to help improve competition in the generics market. The case study illustrates the difficulties amlodipine generic entry through litigation between the brand and the first generic entrant and the brand's efforts to extend the exclusivity period. Calculate the cost of litigation and insurance savings for the public for 12 drugs.

costs of litigation necessary to challenge patents on active ingredients that are no longer valid involve risk and very high costs for the lab to start legal proceedings (up to $ 354 million Canadian case of Lipitor), while if it succeeds, the immediate benefit is not only the litigant but to all other generic competitors (spillover effect). Incentives for extension of patents are very high due to the significant revenue that generates the brand extension. On the other hand, if prices go down very quickly after the entry of generics, the benefits of litigation will stop more payers to laboratories. The costs and benefits of litigation are not aligned.

The rule that the generic price should be 25% (or any other fraction) of the price of the brand before the entry de genéricos no guarda ninguna relación con los costes de producción ya que esto sólo tendría sentido si el precio de las marcas fuera igual al un mismo múltiplo de los costes de producción.
Las farmacias gozan de un cierto poder de mercado y no compiten en precios. Las farmacias han capturado una parte importantes de las rentas de la competencia entre productores genéricos mediante descuentos ofrecidos por estos productores y que no se trasladan ni al tercer pagador ni al consumidor. El sistema de pago a las farmacias no debe basarse en los costes medios observados sino que debería utilizar tarifas prospectivas por servicio limitando el papel de lo descuentos.

Se propone establecer un mecanismo que financie por separado the three components of the generic chain: lawsuits, production and distribution / dispensing. Royalties payable to generic laboratories that achieve an end to patents that are no longer valid because it is inefficient to try to reduce prices without incentives for generic producers to incur high costs and uncertain litigation. The production must be financed through competitive mechanisms (eg through auctions). Governments should establish independent regulatory authorities agreed at rates to reward efficient pharmacy services.

When you end the exclusivity occurs over a monopoly to a competitive market, change that public funders should be adjusted.

An efficient financing of government purchases of generic payment mechanisms should be set different for each of the elements of the value chain. In countries with high legal costs to challenge a patent when the exclusivity period ends must devise ways to reward those laboratories that achieve win lawsuits. The design of this study requires reward: compensation to the laboratory has successfully challenged the patent on the number of starters and the starting price, a period of exclusivity at a price above the cost of production, etc. It required

information and case studies on these costs and legal proceedings in Spain similar to those presented in the text of Hollis. Needless to say, the competition authorities should act quickly and diligently to any suspicion of possible financial arrangements between brand and generic laboratories in order to delay market entry of generic versions of the drug.

Industrial prices should be based on the promotion of industry price competition in public procurement through market based instruments such as competitive auctions. The experience of the measures taken in recent years in Germany, Belgium, Netherlands, Norway and Sweden is a useful reference for countries like Spain, characterized by limited price competition from retail and high discounts to pharmacies.

If the efficiency of the English system of remuneration of pharmacies in Spain is more than questionable, the extension of the generic should accelerate its reform a system that more adequately recompense the costs of service. Reducing the profit margin per container as a result of the diffusion of generics and lower price software has been offset by increases in prescription volume (almost 33% in the last 6 years), the highest price of innovation and appropriation of part of the effect of competition on the wholesale price through discounts offered by laboratories and distributors to pharmacies.

A reward system based on the cost of the service requires, among other things, separate the real remuneration of industrial purchase price compensation for the service provided by the pharmacy to the patient. The copayment also should also separate the part that corresponds to the wholesale price of the remuneration to the pharmacy, may well create competition between pharmacies by allowing them to offer discounts on the patient copayment.

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called PHARMACEUTICALS IN PHARMACEUTICAL Copaga

Article published in THE JOURNAL September 8, 2010

Spain spends 1.8% of GDP to buy medicines and is the fourth country in pharmaceutical expenditure per person in the EU15, while health spending is third from bottom. Pharmaceutical costs are not high prices but by the amount of drugs consumed. Spain is the second greatest amount of drugs consumed among 14 developed countries, according to a recent study commissioned by the British health secretary. The number of prescriptions per person has increased by 21% in the last six years, while the real price fell by 10%.

responsible for this situation are multiple (prescribers, pharmacies, distributors, industry) and the solvency of the health system requires action on the incentives of all stakeholders without excluding patients. When it is clear that a policy is not working properly and worsens welfare, ethical and responsible is to change for the better. This is the case of pharmaceutical co-payment. It is unacceptable that the Ministry of Health is hide behind the defense of repetitive and unhelpful actions on prices (two royal decrees so far this year) not to reform the public subsidy to the drug.

Public health finances 60% of drugs and about 90% of some mostly for chronic treatment. For pensioners and their dependents grant is 100% (free). Public mutual funds in the grant is 70% without charge for anyone. On average, the group of patients has gone to pay more than 20 out of 100 euros in 1979 to pay only about 6 today. This system suffers from two serious problems that worsen with time: the burden of copayment is distributed quite unequally and promotes overconsumption.

Half copayment is concentrated in a small group of patients: it supports a 5% of users for which is a heavy load. The co-payment paid by non-pensioners is distributed between users down considerably so that an effort is higher for lower income individuals.
The extension of insurance from 60% to free the pensioner or their beneficiaries, at the age you are and regardless of economic and represents a significant increase in the number of prescriptions that would not have occurred without this change (moral hazard): the consumption individual increases about 25% in the first year free. The financial impact to the public (free over moral hazard) may increase spending by more than 100%.

How can we improve the current system of pharmaceutical co-payment? Here are three criteria inspired by economic theory and experience of the comparative system that would improve both equity and efficiency of the grant pharmaceutical compatible with any budget target. Delete

arbitrary distinction between active and retired, unbecoming of a national health system, applying the same level of subsidy to the pharmaceutical consumption of all patients in general. For example, a copayment of 40% of the price, or 30% combined with a fixed payment per prescription (1 euro). The level of public subsidy will depend on the policy objective that can range from pure rationalization of expenditure (adjusting the parameters of the copayment keeping the average percentage of grant) and the effect of tax collection (reducing the aggregate subsidy).

Reduce barriers to access to treatment necessary and effective for this system could mean for patients who concentrate a very high consumption (maximum quarterly or annual expenditure by the patient, for example, 60 euros per quarter) and for patients actually very low income (pension and gratuity lower unemployment benefits to a very low income, unemployed and without subsidy).

encourage the prescription of medicines needed, effective and most cost-effective (cost per year of quality-adjusted life years gained, QALYs) using differential copayments based on clinical criteria established by scientific evidence. For example, level of subsidy than the general (including 80 to 100% of the price) for the medications necessary, effective and less costly. Overall level of subsidy (for example, 60%) for preferred drugs, chosen among those with the same indication with greater efficiency and lower cost per QALY (eg, simvastatin the lowest price for lowering cholesterol). And grant low (less than 30%) without low-income exemption or copayment avoidable (pay 100% of the price difference on the therapeutic equivalent of the preferred list) for more expensive drugs declared non-preferred (eg price brands than generic, or atorvastatin for lowering cholesterol), with exemptions when clinical factors, the substitution is not applicable for the preferred drug.

Review article

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variability in the value of the QALYs Monetary

winner of the best scientific paper in health economics published in 2009 awarded by the Association of Health Economics in 2010.


The goal of rigorous and elaborate article by Pinto-Prades JL, Loomes G, Brey R in the Journal of Health Economics ( Monetary Trying to Estimate a value for the QALY . 2009; 28: 553-562) is to estimate the monetary value of years of quality-adjusted life-related health status (AVAC) and check the robustness of the conditions that would necessary to obtain a monetary value only from questions that involve different combinations of quality of life, duration and risk.

To achieve this goal using two questionnaires about willingness to pay applied to the general English population (n = 892). The first questionnaire was designed to analyze the stability of monetary value for variations in the severity of several diseases, the duration or permanence in each state of health and in reducing the risk of chronic diseases that pose a significant loss quality of life. This questionnaire presents eleven scenarios to respondents in the hypothetical case of developing a particular disease chronic, which differ in treatment, the cost, time until treatment takes effect, the duration of symptoms, severity of disease and the risk of the disease. The utilities of health states were obtained by the standard method called lottery. The willingness to pay is obtained by a process management card monthly payment for a certain period (eg 30 € for one year). The first questionnaire was applied to 7 groups of 80 persons (n \u200b\u200b= 560).

The second questionnaire was designed to clarify some results obtained in the first questionnaire and to assess health gains smaller. This questionnaire contains 6 stages and applied to 4 groups of 83 persons (n \u200b\u200b= 332). The format is multiple responses (5 choices) rather than binary (yes / no) as the first questionnaire.

The results of the first questionnaire showed that the monetary value of QALYs is quite sensitive to the order of the questions, the duration of the improvement in health status, method of obtaining the profit (direct versus chains) and the reduction risk. The results are, however, insensitive to the duration of payment. When you start giving the interviewee the smallest gain in health, the willingness to pay obtained is smaller. Volatility attributed to violations of procedure invariance (effect of order of questions, the effect of the payment period and effects of the procedure for obtaining profits) leads to monetary values \u200b\u200branging between 18,000 € and 112,000 €.

The second questionnaire shows that the estimated monetary values \u200b\u200bare systematically influenced by the choice of attributes and varying levels of each scenario and the magnitude of this variation.

The results indicate that it is doubtful that you can get a single monetary value of QALYs due to variations in the estimated monetary value of QALYs that violate the assumption that the provision to pay is proportional to QALYs and violate the invariance of the process to obtain monetary values. There

previous literature to the article by Pinto, Loomes and Brey, both theoretical and applied research, which highlights difficulties inherent in the procedures to obtain monetary values \u200b\u200bfor health gains as well as theoretical arguments against the existence of a value AVAC unique.

This article won the award for best paper in health economics awarded by the Association of Health Economics 2010, has the virtue of presenting rigorous empirical evidence on both the existence and magnitude of the variability of the monetary values \u200b\u200bassociated with attributes and levels of scenarios, as well as the lack of sensitivity of the estimated values \u200b\u200bfor levels of attributes for which should be sensitive (the duration of the payment, example). For the first time to quantify the variability (and insensitivity) of estimates of the monetary value of QALYs.

What are the implications of these findings for research in health economics and decision-making on technological innovations taking into account the social willingness to pay based on maximum monetary values \u200b\u200bof QALYs?

First, economic research must follow a path which we glimpse long enough, to allow separate variability derived from the method of estimating real variability of the willingness to pay of individuals for improvements in health status.

Secondly, it is essential to deepen the understanding of the mechanisms and magnitude of real variability, or whatever it may be obtained without violating the invariance of the procedure.

And thirdly, to move in a flexible yet objective and transparent application of limits on the maximum willingness to pay to the decision-making about adoption and degree of innovation funding health. Note that the estimated monetary value of QALYs is necessary to know whether the value of the health benefits of a technology or product is higher or lower social costs thereof. However, decisions of inclusion and degree of public coverage is not sufficient to know the value of the benefit exceeds the cost of innovation, this is a necessary condition for not exclude innovation, but not enough to ensure that public coverage 100% as this is also the opportunity cost of this decision and the budget constraint (which is the opportunity cost resulting from the treatments that displace the inclusion in public coverage as the budget currently available?).

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Is it necessary ESTABLECER Copaga THE HEALTH? Recipes

Debate on the copayment, which have participated Jaume Puig Junoy Professor, Center for Research in Economics and Health (CRES), Department of the University Pompeu Fabra and Dr. Albert J. Jovell, president of the English Patients Forum. This debate was broadcast on Channel 3 / 24 of Televisió de Catalunya, today May 28, 2010.


http://www.tv3.cat/videos/2933050/Cal-establir-el-copagament-sanitari

Shoe Manufacturer Qupid

AND DEFICIT PUBLIC: URGENT

Article published in the Journal, 1/6/2010, page 9
Nobody sensible
I doubt that the difficult situation of public finances for months now required extraordinary measures for deficit reduction. Finally, Royal Decree 8 / 2010 of 20 May put to work. The main measure is a deduction on the price of existing patent drugs (outside the reference price) of 7.5% in favor of public insurance.

unthinkable that public spending on health continues to grow exuberantly several points faster than GDP, as has happened in recent years, precisely when the GDP grew more rapidly. Public health expenditure has a high weight on public finances: one in six euros of spending is health. But the aging population, medical and pharmaceutical innovations instituted and the culture of "everything free for all" with a driving demand outside inertia declines in GDP and an urgent channel is essential to ensure the solvency of health.

Reduced prices of patented medicines have a limited or negligible contribution to the containment of the deficit. What drives today's pharmaceutical expenditure is the number of prescriptions that patients pick up in pharmacies and not prices. In the last year the number of prescriptions has increased by 4.7% while the price has been reduced by 0.3%. In the past 7 years the average number of prescriptions per person has increased by more than 4 per year, representing an increase of more than 25%.

the last ten years have repeatedly decreed unilateral price cuts that contributed only a small reduction in spending over the next 12 months and the effect of which subsequently faded. The expense depends on the type of drugs that are prescribed (more or less expensive) and the number of recipes. Economists find that when the government unilaterally reduced the price of drugs, after a few months the level of expenditure has been restored thanks to a larger number Prescription drugs and the shift to new and more expensive. A managers and prescribers must justify this trend.

Measures left intact the incentives of doctors, industry and patients. No one questions the inclusion in public insurance coverage for new drugs very high cost and low effectiveness compared with other cheaper for the same indication. Nor is it puts an end to the suppression of co-payment for those who become pensioners, including early retirement, and causes an increase in spending per person than 50%.

should not act on the silo mentality of pharmaceutical spending, but on the whole health expenditure (more expenditure on pharmaceuticals, for example, to improve compliance with treatment of chronic patients may in some cases reduce the patient's health spending). Positions to take effective measures to reduce drug spending growth, the best way to ensure the sustainability of this public service is acknowledging that "less (recipes) may be more (health)." I draw three lines of action viable and effective in the short term.

First, we must adopt explicit and transparent criteria as to what drugs are included and what price are they willing to pay for the NHS: do not pay more for the same (reference prices with pharmaceutical and therapeutic equivalence and avoidable copayment by the patient if you choose the cheaper drug); stop funding excessive prices to win a year of life in new drugs that are a small improvement over other available (relative ineffectiveness) and drive the price to variable cost as soon as possible upon expiration of the patent (generic).

Second, it is necessary to adopt measures that affect the behavior of patients (transparent information on the existence of lower-priced substitutes and no copay avoidable, and their character bioequivalent), the doctors (based incentives with the prescription using the proprietary name and prescription medicines at a lower price within the same therapeutic class or the same active ingredient) and pharmacies (replacement policies with minimal restrictions.)

And third, it must be accountable to patients with an urgent amendment of outdated copayment system: all are active or retired, should pay a price equal percentage (eg 30% as in the mutual officials) , with a maximum monthly pocket expenditure borne by the individual, combined with the application of a lower percentage for medicines more effectively and more cost-effective and low (leading to the exemption) for 10% of the population with lower income.

Define Collinear Antennadesign

REFERENCE PRICES WITH NO COMPROMISE AVOIDABLE COPAYMENTS

The results of a recent Belgian study find that there is no under-utilization of drugs under price equivalents (no copay avoidable) or lower prices by socioeconomic groups of lower income and lower educational level (Vrijens F, Van de Voorde C, Farfan-Portet MI, Polain M, Lohest O. The reference price system and Socioeconomic Differences in the use of low cost drugs. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE) . 2010. KCE reports 126C. D/20101/10.273/20).
www.kce.fgov.be/Download.aspx?ID=2157
The purpose of this report is to analyze the choice of drugs under the Belgian system of reference prices. The specific objectives are twofold: (i) what are the characteristics of physicians and patients in Belgium, are associated with the choice between presentations of the same active when there is a generic brand and lower price, and (ii of) the same characteristics associated with the choice of submitting the lowest price.

is a retrospective study analyzed all prescriptions for adult patients in 2008 covered by public insurance a sample of 10% of primary care physicians and 5% of the specialists. The sample includes 1.5 million prescriptions for 66 active ingredients, data linking individual patient and the prescriber. Information on income and education, not available at the individual level, is supplied by the average area of \u200b\u200bresidence. A logistic regression for each of the 12 groups of drugs.

Copayments avoidable or additional payment as a result of the difference between the reference price and the retail price of drugs prescribed and dispensed under public financing in Belgium in 2008 equivalent to 10.2% of the total copay by patients (co-payment and copayment required avoidable). 34% of this co-payment is for preventable cardiovascular drugs, 19% of nervous system drugs and 17% to drugs musculoskeletal system. 52.2% of prescriptions up to a drug charge no more than reference.

variables associated with the requirements of low price (price at or below the reference, no additional copayment preventable) are: (i) older patients are slightly less likely to use a low cost alternative; (ii) patients with avoidable copayment maximum does not use more brand-name drugs, (iii) patients areas with lower average level of education are more low-priced drugs, except for acetylcysteine, (iv) the existence of an integrated medical record is associated with increased use of low-priced drugs, and (v) the most influential variables are those of the doctor: in 7 of the 12 groups of medication, general practitioners prescribe more drugs to lower price than the specialists (the opposite occurs with quinolone, piroxicam, tramadol), also the global budget payment to the center is related to greater prescription of low price.

72% of patients receiving the inhibitor of proton pump cheaper, a figure that is 60% in the case of statins and 66% by inhibitors of angiotensin converting enzyme (ACE) and the Sartano. The age of patients is also associated positively with the probability of using the cheaper drug. The general practitioners prescribe inhibitors and statins, proton pump less expensive more often than the specialists (the opposite occurs with the Sartano and ACE inhibitors).

These results suggest the lack of equity of access issues related to preventable copayments reference prices as the use of low-priced alternative is even slightly higher in disadvantaged population groups.

The application of reference prices chemical equivalence is widespread among European Union countries. In most countries apply a system of this kind (Spain being the exception) the patient pays the difference that may exist between the selling price of the drug dispensed and its reference price (copay avoidable).

Except for a study population of more than 65 years in Canada, the distributional impact by socioeconomic status of the population of avoidable copayments related to the reference prices as a system of public funding for drugs has received little attention in research so far published. This study provides outcomes of interest in the context of Europe of the distributional impact on the characteristics of the patient and the physician associated with the variability in prescribing according to price.

Although the English system of so-called reference price system prohibits copayment avoidable practice to exclude public funding drugs above the reference price, it is, without doubt, an obvious instrument utility. The copayment avoidable, unlike the exclusion of the public coverage, allows the brands they consider appropriate to maintain a price above the reference, thus giving a greater margin generics para la competencia de precios; a igualdad de precio entre marca y genérico, como tiende a ocurrir de manera forzada con la regulación española, los genéricos pierden su principal atractivo, un precio inferior para un medicamento bioequivalente. Por otro lado, la insensibilidad de los pacientes ante las diferencias de precio entre medicamentos equivalentes desaparece cuando deben enfrentarse a un copago evitable, lo cual favorece la competencia de precios entre laboratorios competidores y fuerza rápidamente el precio a la baja hasta alcanzar el coste marginal.

Una preocupación relativa a los copagos evitables, hasta ahora casi no verificada, reside en el hecho de que laboratorios, médicos y farmacias podrían “explotar” imperfect and asymmetric information available to the patient to make him pay the price difference for alleged different between drugs bioequivalent. The Belgian study results highlight two interesting facts about it: (i) the avoidable copayment paid by the less privileged socioeconomic groups is not higher than it is even lower than the rest of the population, so that, as copayment level of global avoidable, it does not act as a barrier to access differential between population groups according to income and education, and (ii) the level of copayment avoidable, and therefore the perception that the cheaper drug is not a good substitute, is uneven: is higher in some drugs than others (for example, cardiovascular disease) and is higher for certain drugs in primary care physicians and other drugs is higher for specialists.

Beyond the particular characteristics of the reference price system applied in each country, it is necessary to adopt measures that affect the behavior of patients (transparent information on the existence of lower-priced substitutes and no copay avoidable, as well as bioequivalent character), the doctors (incentives related to the prescription using the proprietary name and prescription lower-priced drugs within the same therapeutic class or the same active ingredient) and pharmacies (replacement policies with minimal restrictions.)

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EQUITY ADVANTAGES AND HAZARDS OF THE DEFICIT REDUCTION

The advantages and dangers of deficit reduction: the role of fiscal rules and budgetary institutions

Commentary on: Joaquin Ayuso-i-Casals, Servass Deroose, Elena Flores and Laurent Moulin (Editors), Policy Instruments for Sound Fiscal Policies. Fiscal Rules and Institutions, Palgrave MacMillan, Hampshire and New York, 2009
http://us.macmillan.com/policyinstrumentsforsoundfiscalpolicies


The tsunami of economic downturn is revealing a stunning decline in the English public finances: the government deficit has increased fivefold in a year, the deficit and more than two digits as a percentage of GDP and public debt will drag it to levels that can easily exceed the 60% of GDP.

budget in this changing context, marked by the asymmetric impact of the economic crisis in the European Union countries, it is convenient and useful to ask for the role they have played and should play in the future, both in terms of economic growth and crisis and recession, fiscal rules and institutions budget of each country and the common form taken by the EU.

The book edited by Joaquim Ayuso, Servaas Deroose, Elena Flores and Laurent Moulin, Directorate General for Economic and Financial Affairs European Commission) entitled "Policy Instruments for Sound Fiscal Policies", published by Palgrave Macmillan in late of 2009 provides an excellent opportunity to review the role of budgetary rules and institutions both from the standpoint of economic theory from the empirical point of view.

This book has its origins in the Workshop of the Directorate General for Economic and Financial Affairs of the EC held in Brussels on 24 November 2006. The time has not dulled the issues discussed in this workshop but have added today. Although at that time had not yet glimpsed the devastating impact of economic crisis on most public accounts of EU countries, the lessons to be learned from the experience in implementing fiscal rules and budgetary institutions is and will be essential to help the accounts of nation states to better manage the impact of the economic cycle.

The aim of this book consists of contributions that review the status of theoretical and applied knowledge on economic incentives related to (i) changes and reforms in the rules of the annual budget cycle, (ii) the application of numerical fiscal rules, permanent limitations of fiscal policy in terms of budget performance indicators-summary of macro-variables on public or deficit , expenditure, revenue or debt, and (iii) the creation or reform of national budgetary institutions through independent agencies that can take care of the macroeconomic projections for the purpose of estimating revenues and expenditures, or recommendations on fiscal policy .

The underlying concern in most chapters of the book lies in learning budgetary experience of the past characterized by the trend towards deficit and the pro-cyclical fiscal policy in order to improve understanding of the causes and strengthen the Treaty and the excessive deficit procedure. Or policy instruments to support the improvement of incentives in a sustainable budget management can be classified into two groups or approaches. One is the approach based on improving budgetary institutions-contract approach-(rules, procedures and institutional framework). The other is the approach that privileges the delegation of fiscal policy in independent instuticiones-delegation approach.

The book is structured in four different parts in its scope and ambition. In the first part, we analyze the causes of the trend of budget deficit and whether the extent of fiscal rules and budgetary institutions have been effective in encouraging fiscal discipline in each country. The second part of the book, marking a normative character, is devoted to the analysis of the desirable conditions that must follow the rules and institutions for efficient management of the deficit depending on the level of fiscal decentralization.

The third part of the book is intended to study the incentives of institutional reforms on the creation or modification of discretionary incentives public decision-makers in fiscal policy. In the latter part of the book presents two interesting case studies by analyzing the rules and institutions in Sweden and Belgium.

Krogstrup and Wyplosz (Chapter 2) to assess the risk that the deficit reduction policies of fiscal policy becoming pro-cyclical. These authors present a model in which the application of numerical fiscal rules applied to the unadjusted budget balance are not optimal and may even worsen the fiscal results in terms of welfare, and numerical restrictions may be socially optimal when combined institutions adequately budget that encourage productive spending. Consideration of the cyclically adjusted budget balance in the Stability and Growth Pact of 2005 and the consideration of the medium-term debt are on the appropriate line and reduce the risk of inducing pro-cyclical policies.

Broesens and Wierts (Chapter 4) show the existence of surpluses in the public accounts are related to a smaller number of spending ministries, political stability, strict fiscal rules and greater transparency in fiscal policy. In addition, the aging of the population helps to explain why some countries have a surplus and other no.

In the second part, Halleberg, Strauch and von Hagen (Chapter 6) analyzed empirically the impact of fiscal rules and budgetary procedures on public finances in the EU15 countries between 1985 and 2004. The results of these authors provide useful guidelines for assessing the effectiveness of the measures of contractual or based on delegation: a more centralized budget, lower debt, the delegation of decisions on the economy ministry contributes to lower government debt one-party or no political competition colaición, the contract rate approach measures that impose restrictions and contribute more multi-annual targets fiscal discipline in countries with coalition governments scattered and internal competition.

Hodson (Chapter 7) contradicts the observation that countries have taken steps to delegate are the worst compliant with the Stability and Growth Pact (SGP) compared with those who take contractual measures: all countries, both those of a type and the other, have failed to meet the medium-term objectives of the SGP, and also there is a trend to the adoption of numerical rules by all countries.

The third part of the book, Balassone, Franco and Zotteri (Chapter 9) discusses the suitability of the so-called "Rainy Day Funds (RDF)" employees in various states of the United States since the seventies to the EU countries. The RDF are simply accumulate in a fund surpluses in the boom years that can be stored for use in years of budget problems, while maintaining the balance BUDGETARY. The authors suggest that the RFD is not useful to change the incentives of the non-adherent PEC. RFD not yet being a good option for countries with high deficits, it could serve to mitigate the rigidity of the constraint of 3% of EU public deficits.

Chapter 10, Ayuso, González, Moulin and Turrini provide a description of the numerical fiscal rules (rules on stock and debt, expenses and income) applied in 25 EU countries and analyze their influence on budgetary outcomes. This chapter, which perhaps is the core of the contribution of the book, uses a proprietary database covering the period 1990-2005. The adoption of numerical fiscal rules has been a growing phenomenon in most countries: less than 20 rules in 1990 has spent nearly 70 in 2005, 30% of the rules applicable to other central and local governments 30% . Half of these rules are multiannual. However, it is still fairly small number of studies that have analyzed the effectiveness of these policies at national states. Lower deficits are associated with numerical fiscal rules that affect a larger proportion of public sector budget and the presence of control and punishment mechanisms of compliance also contribute to improved fiscal performance.

The fourth and last part of this book discuss in detail the advantages and disadvantages prespuestario Swedish model (Chapter 14) and the Belgian budget process (Chapter 15).

The main virtue of the book edited by Ayuso et al subject of this review is to provide a comprehensive review of state economic knowledge on the effects of the reforms in budget systems of EU countries based on the adoption of numerical fiscal rules and the delegation of certain criteria or tax decisions independent agencies helping to facilitate a more informed and rigorous discussion on necessary incentives for more efficient management and balanced medium to long term sustainability of public finances.

At one stage in the current economic downturn, spending more than you enter is used to help maintain economic activity and helps the drop in revenue is not higher. However, the high stimulus English tax is not the main source of fiscal imbalance in English: the European Commission has estimated that in 2009 the primary structural deficit (which will still be beating the recession) is 8.2%.

If public expenditure is used productively and efficiently, our children will be richer and have greater well-being. Then, they will have problems to deal with debt and this will represent a smaller proportion of their wealth. In the medium and long term, the cost of the deficit depends on the quality of spending: what is spent (composition), results are achieved (effectiveness) and the cost of achieving these performance (efficiency).

We have evidence that the composition of public expenditure is relevant to predict the effects of spending on growth: infrastructure and education, and partly health, promote growth. However, not enough direct spending productively, if expenditure is high and the results achieved are low, the efficiency of public spending is low and public finances are not sustainable in the long term. Herein lies the Achilles heel of the English public finances as their level of efficiency is the lowest in the eurozone.

A report by the European Commission last July says that the quality of English public spending in five of six categories of spending (education, R & D, infrastructure, public order and security and general services) is poor, being only good in health services. On average, the quality of English public spending is among the lowest in the eurozone countries. Public infrastructure have a high level of spending and poor results. In education, the level of spending is not the highest, but the results are poor. R & D spending is low but with very low efficiency. In universities, very poor results despite having a high number of staff, resulting in a significant inefficiency.

there is no time for excuses designed to further delay the urgent measures of independent evaluation of the efficiency of spending programs and reforms based on their results.

Lori Anne Scime Topless

PRICE OF GENERIC: LOW PRICE AND DISCOUNTS

(This article has been partially published in MAIL PHARMACEUTICAL, week of March 29, 2010)

The agreement Interterritorial Council of March 18 again includes a number of proposals of measures aimed primarily at reducing the price of generic drugs which preaches an alleged drug-expected savings of 1,500 million euros annually to the government budget that would add more than 100 million savings for the citizen's pocket.

star measures to achieve these savings are basically four: first, modify the calculation of the reference price (the maximum amount paid by the NHS) by an off-patent drug by setting it at the lowest price, and second, reduced by an average of 25% the price of generic drugs and increase the price reduction for generic drugs that are not in Spain but in other countries, third, setting maximum prices for medicines for minor ailments excluding public funding which overcome them (targeted funding) and, fourthly, to establish a ceiling the percentage of laboratories and wholesale discounts they can offer to community pharmacies (5% expandable up to 10% for generic drugs).

The English situation on the limited price competition at the level of retail prices in the generic market has a striking resemblance to that observed in other countries that have implemented reference pricing systems or maximum price regulation of generic.

In several European countries (Germany, France, Netherlands, Norway, United Kingdom, Sweden), when applied to the reference price system has witnessed the emergence of deep discounts to pharmacies on the price procurement of medicines that do not move the price to the consumer.
In some European countries have substantially reformed the regulatory systems of pricing and reimbursement of generic drugs through better policies aimed at promoting price competition from generics as a means of improving efficiency, and improving policies deepening the existing system design setting maximum reimbursement level, measures for monitoring the competitive prices in order to reimburse pharmacies only the actual costs of acquisition, and procurement based on market instruments such as auctions public.

The objective of efficient policies to promote price competition should be to progressively lead and before long the price of drugs, both the industrial selling price as the retail, to its marginal cost production and distribution when the period has expired and gone legal protection barriers of entry into the market.

price reduction up to the marginal cost will depend on both the level of the latter as the brand price level prior to the entry of generics. Thus, price reductions can and should be, with justification, be different both between active (And between different presentations of the same active ingredient) and between countries.

The measures taken by the Council on the price of generic point in the line of improving and deepening the reference price system, advocating minor changes rather than structural reform policy of promoting competition in this market . Although no doubt point in the right direction, there are many shadows that justify skepticism about the magnitude of the real impact of the measures announced.
today
What drives drug spending are not drug prices but the number of prescriptions per person. Reduce the price by decree is not the same as reducing spending. To the extent that the NHS is more interested in the impact of generic policies on the cost of insurance by the sheer impact on the price of generics, it is important to note that the reduction in selling price the public until the marginal cost (efficiency condition) does not guarantee the reduction of NHS pharmaceutical expenditure in the same proportion as the price (or, sometimes, the reduction of it) or guarantee either the efficiency of spending, as this also depends on changes in the appropriate and inappropriate use of medicines.

The existence of large discounts on purchases made generic pharmacies to laboratories, and not transferred to the retail price paid by the NHS and patients, reveals that it is urgent to reform the structure (and not only the details of calculation) of the reference price so that price competition moves to the bill paid by the NHS. Impose a ceiling on the percentage discount on the billing from the laboratory to the pharmacy is difficult to enforce when the incentives for such practices remain intact. On the other hand, is unjustified and may distort competition to set a ceiling on the lower discount rate for the same product when brand when a generic.
Taking as reference
the lowest price, rather than the average of the three lower prices, requires security of supply capacity at that price in order to prevent anti-competitive practices. A simple change in the calculation of the reference price will alter the level in the right direction but not sufficient, by itself, to change the incentives of the laboratories.

In other countries, lower prices of generics are achieved by liberalizing the price of generics with universal mandatory substitution by lower-priced product on the market automatically updated, either generic or brand (except where the patient prefer to pay the price difference; copayment avoidable).

The English system continues to focus on the hyper-regulation instead of price liberalization when there is competition, flee from preventable copayment for no reason beyond political panic "co" and more than a reference price system is a exclusion system of public funding based on the maximum price.

Given the asymmetry of information, it is difficult to imagine how the controller may be hit with an appropriate division of the unilaterally imposed price reductions for each generic, bringing it down to marginal cost without distorting competition. Keep in mind that the real marginal cost would not have anything to do with either the retail price or the current reference price.

The RDL 4 / 2010 of March 26 has chosen to impose a reduction in the wholesale price of drugs subject to reference pricing system that can reach 30%: the reduction is higher for products whose current difference between reference price and the RRP + VAT is lower. For example, a drug that has a RRP + VAT today as the reference price has a reduced price of 30% industrial, and other medications that now have an RRP + VAT 25% or more below the current reference price does not suffer cut one in industrial prices. From a static perspective (today), "this measure contributes to efficiency (the price closer to marginal cost? I think it's highly doubtful that even from the static point of view this division of the price reduction will contribute to closer to marginal cost.

The explanation is quite simple: there are drugs that have long been under the effect of generic competition and under the reference price system whose reference price may have already reached the production costs, as well , these will be imposed a price cut of no more than 30%! In contrast, other drugs only recently that the system is applied reference price and for which there are few generic, in this case to a drug with a lower VAT PVP + 25% over the reference price is not the price cuts, although you can still find very away from the cost of production. It is quite clear that the difficulty of driving prices to the efficient level through more and more regulation rather than deregulation once and for all the generics market is an illusion that distorts price competition. By

unilateral price cuts applied once the proposal in the agreements of March 18 for generics (and reflected in the RDL 4 / 2010 of March 26), can help mitigate but no garantíasde to eliminate the risk that in the near future or remain or reappear immediately large discounts to pharmacies or other equivalent forms of this practice.

From the dynamic point of view, "these measures favor price acercacimiento efficient price? Again, the answer is rather negative. This is a price cut now tax once it leaves intact the substantive dynamic problem: the effects of strong price competition between laboratories industrial PVP move the NHS and paid users. This cut price point allowing the PVP will not be reduced to the extent that industrial prices do for those drugs that are still run down until the cost of production.

Having opted for the imposition of limits on discounts to pharmacies no objective reasons why it is different for brands and generics. However, experience indicates that this is a measure will only be effective to the extent that incentives disappear as competition takes the form of discounts, rebates or other facilities and other services.

Be careful to exclude from public funding drugs for minor symptoms that do not match a price: the result may be, if no precautions are taken, an increase public expenditure are being replaced by more expensive drugs funded by the NHS. This is indicated by the experience of other countries and the previous English experience.

Although the agreements have prevented Interregional Council again addressed the necessary revision of the inequitable and inefficient system of co-payments current drugs, further highlights a very positive and the commitment to take into account the cost per life year gained to deciding which services should be in the future: better prices only those innovations that lead to a major increase in efficiency and lower cost per life-year gained.

Removing A 2010 Rear Lamp On A Vw Golf

PRIORITY PERFORMANCE AND NOT PAY MORE FOR THE SAME (Comments to agreements Interterritorial Council of 18 March 2010)

(This article has published on March 24, 2010 in The Economist, p. 6)

still have fairly good health outcomes although the level of public spending and investment per person in the English health system is more than 10% lower than be for us according to our level of income and demographics. It

remarkable political consensus achieved by the recent agreements on the quality and sustainability of the Inter-Territorial Council of the National Health System. The signal has value as an example for other government spending programs.

The agreement reached by the Inter-Territorial Council is positive and hopeful opens political agenda to be developed. However, the agreement is still partial and leaves out much of the real issues (incentives to encourage the integration of care and solving capacity indiscriminate adoption benefits regardless of cost, lack of financial responsibility of users, etc. .)

the list of measures included in the agreement as very positive highlights the commitment to take into account the cost per life year gained when deciding which services should be in the future: better prices only those innovations which involve a further increase efficiency and lower cost per life-year gained.

The agreement promises an airy drug savings of 1,500 million euros Annual public budget over 100 million savings for the city's pocket.

star measures to achieve these savings are threefold: first, set the reference price (the maximum amount paid by the NHS) by an unlicensed drug in the lowest, second, reduce by half the price 25% generic and, third, setting maximum prices for medicines for minor ailments excluding public funding that exceeds the (targeted funding).

Despite pointing in the right direction, there is every reason for skepticism about the real impact of the three measures.

What drives today pharmaceutical expenses are not prices medications many recipes but person. Reduce the price by decree is not the same as reducing spending.

The existence of large discounts on purchases of generic drugs to pharmacies engaged in laboratories, and not transferred to the retail price paid by the NHS and patients, reveals that it is urgent to reform the structure (and not only details of calculation) of the reference prices so that price competition is transferred to the invoice paid by the NHS. Taking as reference

lowest price guarantee required supply capacity at that price in order to prevent anti-competitive practices. In other countries, lower prices are achieved by liberalizing the price of generics with universal mandatory substitution by lower-priced product on the market automatically, either generic or brand (except if the patient prefers to pay the difference price; copayment avoidable). By

unilateral price cuts as proposed in the resolutions of March 18 for generics, is mitigated but not eliminated the risk that in the near future remain high discounts to pharmacies and the sale price generic public does not fall quickly to the price of production.

And fifth, we must be careful to exclude from public funding drugs for minor symptoms that do not match a price: the result may be, if no precautions are taken, an increase in public spending due to their replacement by more expensive drugs funded by the NHS.

is a pity that the Inter-Territorial Council has missed yet another opportunity to raise the need to seriously review the inequitable and inefficient system of current drug copayments.

Junoy Jaume Puig, Universitat Pompeu Fabra

Technischedaten Für Roland Mixer M24e

NOT PAY MORE FOR THE SAME OR PUNISH THE EFFICIENCY

(An excerpt of this text was published in the newspaper PUBLIC on 19/03/2010, page 27)

Public health expenditure in Spain is one of the few categories of public expenditure that are efficient (good results for the level of investment, which is still at least about 10% less than what we obtain in our level of income), education or infrastructure and even I + D have much lower levels of efficiency (more waste).

The population increase along with aging and the pace of technological innovation upward pressure on health spending is justified. Carry the weight of necessary and painful fiscal adjustment on health spending is wrong from the economic point of view. This is not an obstacle to improving the efficiency of the NHS, but not at the level of public spending! Strong health budgets specialization of the CCAA is what leads the current government line of trying to steal more money where instead of reducing inefficient and unnecessary spending.

public pharmaceutical expenditure accounts for more than a fifth of total health expenditure. Here also the temptation to steal where there is more money through unilateral cuts would be wrong price from the economic point of view for several reasons.

First, what is driving spending are not drug prices but the number of prescriptions per person, while the average price per prescription is stalled or downwards, the number of prescriptions continues to rise without the aging serve as an alibi. We must act on the quantity and not on price.

Second, unlike what happened a few years ago, the weight of new and expensive drugs on expenditure on medicines dispensed in pharmacies has been greatly reduced due to fewer innovations and their transfer to the hospital budgets. The proper and efficient would be to establish measures to prioritize funding and provide better prices to only those innovations that lead to a major increase in efficiency and greater cost-effectiveness (cost per year of life saved!).

Third, the existence of large discounts on purchases of generic drugs to pharmacies engaged in laboratories and not transferred to the retail price paid by the NHS and patients, reveals that it is urgent to reform the system called reference prices applied to drugs whose patent has expired so that price competition is transferred to the invoice paid by the NHS.

And fourth, the current co-payment system needs to be reformed or not to raise more to pay more than the user but make it more equitable (today it pay 40% of lone parents with very low income with children charge while giving pensioners free open bar for high income and / or wealth) and more efficient (the number of prescriptions increased by about 25% the day that is granted free of drugs by becoming a pensioner), the status of pensioner to provide access to free no sense (there is no reason why a voluntary early retirement should mean more expenditure on pharmaceuticals!).

financial sustainability problems of the NHS has more to do with a chronic infrapresupuestación, with the approval of government budgets that managers know a priori that they are unrealistic, with the indiscriminate adoption of medical innovations and farmnacológicas regardless of their contribution improving health and its cost-effectiveness, the absence of incentives for public health organizations and professionals, with the lack of fiscal responsibility of the CCAA and the lack of financial responsibility of the users.

Independent evaluations of the impact of the current reference pricing system for days to come and emphasizing that the system has been useful to reduce prices but not the expense. Spending on drugs subject to reference prices has not been reduced since the price reductions have been many times more than offset by the increase in the number of prescriptions per person. Prices have fallen, but not the way you should have done if he had encouraged price competition among laboratories.

Today this competition is manifested more in the form of discounts to pharmacies that lowered the retail price paid by the NHS and patients. The economic evidence indicates that it is more efficient the liberalization of prices of medicines whose patents have expired NHS combined with actions designed to cover only the lowest-priced drugs: this can be achieved by funding only the price of cheaper equivalent drug (being by the patient the difference if you prefer an equivalent but more expensive)-substitution by cheaper at any moment, or by conducting competitive auction for the award of preferred drug status (he who pays the NHS) as they have begun to do and several European countries.

For drugs whose patent has not expired, how efficient is the application of an identical level of funding for drugs to be different active ingredients are very similar therapeutic effect (reference prices with drug or therapeutic equivalence) as the difference price, if not choose the reference price, by the patient (copayment avoidable). It would also be appropriate copayments higher for drugs with a worse cost-effectiveness and more low or no cost to the most necessary and effective would be a much more efficient than the current system, combined with exclusions for low income individuals (regardless of your age!).

Gaybetween Dad And Son

ALTERNATIVES TO PATENT MEDICINES PHARMACEUTICAL SPENDING

Article published in HUMANITAS ONLINE No 48 March 2010
http://www.fundacionmhm.org/revista.html

Promoting research and innovation has traditionally used different instruments. Patents are one of these instruments and, perhaps, the most widespread, but not unique.

instruments for the promotion of innovation used in many economies throughout history have been:
1. Public funding of research. The national funding of medical research of basic nature are a good example of this instrument.
2. AWARDS AND PURCHASE OF PATENTS. For example, in 1714, after a maritime accident caused the death of 2,000 sailors on the coast of England, the British government established a reward of ₤ 20,000 for the invention of a method for determining longitude at sea. This award led to the development of the chronometer.
3. PATENTS, such as those that currently protect the new drugs in many countries.

Any patent creates a legal monopoly, the laboratory ensures innovator the exclusive right to use and sell the innovation for a fixed period of years. During the period of validity of the patent nobody else can make and sell the product protected by patent, unless to do so with your permission. Thus, it is during this period of protection of the jurisdiction conferred upon the patent for which the laboratory must recover fixed and sunk costs relating to expenditure on innovation and development (R & D) of the product. Once you have completed this period of protection obtained legally through the patent, any competitor can copy and produce the same drug, so it is possible that the innovator faces then a large number of competitors and the costs of market entry have virtually disappeared (open access to information on innovation).

However, being necessary and essential to encourage pharmaceutical innovation, patents, despite its large size and outreach, policy is far from perfect from the standpoint of social welfare.

An alternative to patents as an instrument to support research is the public funding of research through institutions like the National Institutes of Health U.S. or the Instituto de Salud Carlos III in Spain.

Put yourself in the Instead of a private company that managed to find the information needed to produce a new active substance. If the use of this information there is no possibility of exclusion (no other use could prevent the information at no cost to bring to market new active ingredient) and no rivalry in use (anyone can use the same information), you never have invested in getting the discovery.

Since the private sector will not invest for innovations that after discovered immediately become public property, a policy to encourage the development of such innovations is to make the public sector finances R & D.

How efficient is public funding and policy to promote innovation? The public sector has difficulty in selecting research projects with greater social and motivate researchers to direct their efforts towards the development of viable projects.

Until the first half of the nineteenth century, the awards were widely used as an alternative to patents and public funding to create incentives for innovation. For example, when Napoleon was faced with the need to find a new way to deliver food to his troops established a prize or reward that led to the development of tins. During the first half of the nineteenth century, when rewards or awards patents and share the territory of the incentives for innovation, we can find a very interesting example that combines both systems through the purchase of a patent: the case of the daguerreotype.

The incentives for the development of new vaccines, especially against malaria, tuberculosis and AIDS, offers a useful example for discussion on alternatives to patents. The reality seems to indicate that in the case of some diseases like the above patents have not been enough to get incentives, at least for several years, research in keeping with the high social and economic costs malaria, tuberculosis and HIV / AIDS.

Private research in vaccines such as those that could be developed against these diseases is limited not only by the poverty of potential customers, but also by the inability of innovators to obtain appropriate the value of the benefits that produce vaccines.

addition, governments use the purchasing power, regulation and intellectual property rights to maintain low prices for vaccines. Several governments are striving to reduce the price of vaccines and limit intellectual property rights applied to vaccines by producing or importing generic drugs. This strategy is useful in ensuring that the high prices associated with patents fall but discourages investment in R & D and delays the discovery of new vaccines.

If private investment and patents are insufficient to encourage discovery of new vaccines that affect a large number of people living in poverty and if we are to avoid the inefficiency associated with public research, what can you do to promote these innovations?

Michael Kremer (professor of economics at Harvard University) has released the initial proposal of commitments to purchase a certain quantity of vaccine at a price. The idea is simple in theory and based on the creation market incentives, although probably more difficult to implement in practice.

The government (or a private foundation) may make public a commitment to purchase a certain amount of a vaccine to a certain price, in the event that it was invented. The commitment could take the form of a contract (number of vaccines and price per person immunized, not per dose of vaccine) through which prospective adopting a commitment to purchase an innovative future to develop a vaccine that meets a set of requirements (eg approval by the Food and Drug Administration-FDA-American and a minimum efficiency of 80%). The buyer could vaccine available to less developed countries in exchange for a small co-related with income level.

research programs funded by the public sector may be suitable for basic research, but more applied stages of research, called Kremer and by pull programs "are more appropriate. These provide researchers and pharmaceutical companies strong incentives to self-select projects that are reasonably likely to be able to develop a useful product, and to focus on the development of a vaccine or medicine feasible instead to pursue other objectives. Finally, Pull programs "designed properly can help ensure that if new products are developed, they reach those most in need.

To purchase commitments that encourage innovation, potential producers should be confident that the sponsor will not try to renegotiate the agreement once it has developed the desired product and has incurred sunk costs. The courts consider that such liabilities are legal contracts that are enforceable. Assuming proper legal wording, the determinant of credibility will be more eligibility criteria and prices that financial funds are physically placed in separate accounts. The credibility of the purchase commitment can be increased by specifying the criteria for who is eligible (eligibility) and pricing of vaccines in advance and isolating those who must interpret the criteria of political influence.

What Shirt To Wear With Black And Pink Yoga Pants

Article published in THE GLOBAL 1 al 7 February 2010

In the United States there is a real growth slowdown in drug spending in 2003 being the 2007 rate of 1.6%, the lowest since 1974 .

A recent study published in Health Affairs indicates that the causes of this change of trend in the United States are, according to researchers, on three factors. First, the reduction in market entry of new molecules has reduced the weight in the cost of new and more expensive products in the prescription outside the hospital.

Secondly, increased competition between brands and generics, and between active ingredients brand of the same therapeutic subgroup, and this competition has been strongly encouraged by the copayment differentials (the most common: $ 6 for generics, $ 29 for preferred brand drugs and $ 40 for non-preferred brands). As a result, the proportion of generic prescriptions increased from 51% in 2002 to 67% in 2007: no increase in the penetration rate Generic the 2007 expenditure had been a 22% higher.

And thirdly, the case of statins, illustrates the fact that competition from a generic drug (simvastatin) even manages to reduce sales of other brands under patent statins (eg atorvastatin).

Despite the reduction in the rate of increase in spending on medicines prescribed in primary care especially, is notorious for continued strong growth of the drugs prescribed in secondary care ("inflection or shift spending?).
However, this has yet turning a small translation on a market regulated with a small co-payment such as English.
First, in Spain the growth rates of current drug spending for prescriptions dispensed in pharmacies has slowed sharply from the year 2004, although growth has rebounded to 7.2% in 2008 (4 and 5% annually, respectively, when adjusted for population).
Secondly, the entry of generic drugs has led to lower prices for a growing share of extra-hospital use English, and will be even more in coming years as they expiring patents, although the rate of penetration of drugs lower price for the same active substance is lower than in other countries and that, unlike the U.S., sales of active ingredients in the same group under patent are not affected by price competition.
And thirdly, the key differential spending growth-of-hospital first in Spain is the increase in the number of prescriptions continues to be inflexible downwards and that more than offset price reductions when off patent (4 , 6 recipes per person from 2000 to 2008).

Alopecia Areta Barbae

BEND NO RESULTS IN THE ASSESSMENT OF RISK SHARING

Article published in medical journals
26/01/2010
When you set a fixed price for a new drug-funded public health insurance, all the risk posed by uncertainty about the effectiveness and costs of treatment lies in the Insurance: more or less effective, or not produce expected savings in other resources, all spending is in charge of insurance.
venture contracts are designed to distribute the risk between the insurer and the pharmaceutical industry where there is high uncertainty about the effectiveness of treatment or the cost per year of life gained (quality-adjusted cost-effectiveness): the price of medicine is not fixed but is variable and subject to some measure of the expected results.
In February 2002 the British NHS, after an unfavorable report from NICE, agreed to include within coverage of the treatment of multiple sclerosis with beta interferon (Avonex, Betaferon and Rebif) and glatiramer acetate (Copaxone) conditional on a joint venture contract.
The agreement for the treatment of multiple sclerosis has many characteristics that are far from what could be a typical pattern of risk sharing: patients should continue treatment for an unusually long, ten years. The treatment is funded by the NHS until it considers that it is effective. The price paid will decrease if not met improvement targets set until this price is equivalent to a maximum cost-effectiveness of 36,000 pounds per year of life adjusted for quality.
A preliminary assessment at 2 years of initiation of treatment recently published in the British Medical Journal indicates that there is no improvement in the effectiveness (delay in disease progression) of patients treated with the drugs under contract venture . Possibly, the longer-term evaluations will be less sensitive to short-term changes in disease and important methodological issues must be resolved highlighted in this first evaluation.

So, if these results are maintained in the longer term, the absence of incremental effectiveness is sufficient to make decisions without taking into account incremental cost. Despite the study's scientific advisory board considers it premature to take decisions on prices before they have longer-term results, holding the preliminary results for further analysis, following the logic of the agreement, the entire financial risk could reach lie with the pharmaceutical companies.

This preliminary assessment and highlights, as one might predict, the difficulties in assessing an agreement of this kind that looks more like a large clinical trial on its effectiveness to a financing agreement of drugs.

A treatment for a disease whose effects can only be long-term monitoring and which can not have a control group is not exactly the best candidate for a joint venture contract. It seems advisable, therefore, very limited use and more appropriate conditions of such contracts.

Midnighthotvedios.com

GENERIC COMPETITION AND PROMOTION OF QUALITY

Article published in 26/01/2010 PHARMACEUTICAL MAIL

health spending needs are independent of the recession because they depend on the pace of adoption of medical and pharmaceutical innovation and the evolution of the population covered and their aging. In this context, the proper design of a generic policy can contribute to more efficient financing of the health system thanks to the effect of competition on the price of drugs whose term has ended allows more space to cover financial innovations with adequate health cost-effectiveness.

Since that 1997 allowed the entry of generic drugs in the English market, generics have become increasingly important due to the reduction of prices for the product brand as well as the growing market share in units (about 22% in 2008). Although the overall share is still comparatively small and is still a very broad sweep upwards taking into account the products whose term ends short term, this market share is significantly higher for drugs subject to reference pricing system (about 55%).

The current design of the so-called reference price system (PR) has served to gradually reduce and remarkable price of drugs for which there are generic and in this regard, it has been a measure to assess very positive. However, this policy has been very positive thanks to the absence of other measures to sensitize patients and prescribers of price differences and the need to prescribe and dispense lower-cost equivalent drugs, ie, was positive only because we have not known any better.

The current system of PR have some important limitations that may even limit the bet in the medium and long term generic. In this sense, the difficulties remain the responsibility of ex-factory prices between laboratories are passed on to retail prices, setting the lower price does not respect the condition to demonstrate ability to meet a certain market share by producers who offer that price, the exclusion of the public financing of products with a higher price point and the elimination of avoidable copayment charged to the user makes generic pay "the price of being a reference", etc..

The report from the General for Competition of the European Commission published in July last year warned of the budgetary consequences of delays in generic entry after the loss of patent exclusivity due to multiple strategic and innovative industry input protected line extensions a new patent that rapidly cannibalize the market for traditional presentation, litigation, advertising campaigns questioning the quality of generics as well as the unacceptable delays due to regulatory process itself (in appearance, Spain has much to improve).

addition, the Commission's report provides evidence that the systems themselves price regulation and public funding can erect barriers to a firm commitment to generics. It was observed that the price regulation policies reduce competition, the price is stagnating at a level higher than you would in the absence of regulation. On the other hand, the study notes that the frequent adjustment of the reference price, the mandatory replacement for the equivalent of a lower price, the maximum reimbursement based on the lowest price and to a lesser extent, the differential co-payments, contributing to a greater reduction price and faster and greater market share of generics.

take decisive action is necessary to promote competition in retail prices in this market, which would be far more useful than continue to base generic policy regulating its retail price of their redemption price and the alleged prohibition of discounts the selling price of lab, except the real volume discounts.

Careful observation and without prejudice to the successful outcome of the experience of the measures taken in recent years in some European countries can provide valuable lessons for the reform of the regulation of generic drugs in Spain: the Norwegian experience with abandonment PR system with the deepening of fixing the maximum reimbursement level referenced as a percentage of PVP from the mark before the expiry of the patent which can reach 85% after one year of the first generic entry, the case of Sweden, which also abolished the PR, and replaced by mandatory substitution and reimbursement of cheaper equivalent product combined with a co-preventable by the patient, and cases of Holland and Germany with the onset of selective employment experiences of competitive auctions to determine preferred laboratory, separating the pharmacy reimbursement price laboratory.

My Baby Has Blue Ring Around Iris

Article published in 21/01/2010
EXPANSION
The tsunami of economic recession is uncovering a striking deterioration in public finances. Will our children pay the debt we are leaving a legacy?
In a recession, spending more than you enter is used to help maintain economic activity and helps the drop in revenue is not higher. However, the large fiscal stimulus English is the main source of fiscal imbalance in English: the European Commission estimates that in 2009 the primary structural deficit is 8.2%!
If public expenditure is used productively and efficiently, our children will be richer and have greater well-being. Then, they will have problems to deal with debt and this will represent a smaller proportion of their wealth. In the medium and long term, the cost of the deficit depends on the quality of spending: what is spent (composition), results are achieved (effectiveness) and the cost of achieving those results (efficiency).
We have evidence that the composition of public expenditure is relevant to predict the effects of spending on growth: infrastructure and education, and health, promote growth. However, not enough direct spending productively, if expenditure is high and results obtained are low, the efficiency of public spending is low and the government accounts will not be sustainable in the long term. Herein lies the Achilles heel of the English public finances as their level of efficiency is the lowest in the eurozone.
A report by the European Commission in July last year indicates that the quality of English public spending in five of six categories of spending (education, R & D, infrastructure, public order and security and general services) is poor, with only good in health services. On average, the quality of English public spending is among the lowest in the eurozone countries. In public infrastructure have a high level of spending and poor results. In education, the level of spending is not the highest, but the results are poor. R & D spending is low but with very low efficiency. In universities, very poor results despite having a high number of staff, resulting in a significant inefficiency.
there is no time for excuses designed to further delay the urgent measures of independent evaluation of the efficiency of spending programs and reforms based on their results.