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.