(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!).
0 comments:
Post a Comment