(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
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