I continued to surprise the media attention and state initiatives "naïve" of the Autonomous Communities on pharmaceutical management and lack of attention paid to an urgent debate on the financing of health care in the NHS. Let's see how long we take to follow the example of countries like UK, Germany, Holland and Sweden and submit the decision-making on health innovations to filter independent agencies and expert committees as a condition to defend the value of efficient and effective innovations and ensure that limited resources were allocated to treatments that are worth their cost.
The public health management and budgetary responsibility for the cost of appropriate care many years ago from all the Autonomous Communities. In times of severe economic downturn and cuts in public budgets can not escape that health is not only normal but necessary for those with responsibility for managing care and resources, including drugs, try to implement measures rationalization of spending the least possible impact the health of patients.
not be overlooked that it is questionable that anyone who manages attention, the Communities have to fit into your budget, without compensation, and without having had the opportunity to participate in the decision, recognized the prices of new drugs entering the market and public funding. This is most disturbing to say the least transparent, objective and based on cost-effectiveness criteria are these decisions with obvious budgetary impact. More questionable and inefficient would be that our public health managers are not capable of trying to buy the necessary resources to restore our health with the best quality possible and the lowest price. There is no justification for what managers do with any other remedy prostheses, for example, can not do with the purchase of medicines.
However, since some time ago is occurring continuously and disturbing and in my opinion a wrong interpretation or interested in the NHS territorial cohesion, equity and what some call the breakdown of the market. This concern has been saying repeatedly, and even blunt by providers not only affected but also of the Ministry, when communities seek to adopt simple measures of pharmaceutical benefit management that go beyond trying to buy a medicine the lowest possible cost effective where alternatives are available with prices different in the market. These are measures that use different tools in practice are basically this objective it is difficult to object when the quality of less expensive alternatives is warranted. In this group of proposals included measures like the "catalog" gallego, auctions for certain active ingredients of Andalusia, fewer opportunities for the prescription of certain brands, provided they have a higher price than the alternatives, by requiring justification therapy or delisting electronics, etc.
If the measures are designed to bring back prescription drugs equivalent to chemical (pharmacological and therapeutic equivalence should not be discarded before analysis in detail but, at least for now, is not the case) and a lower price, then you can claim to be efficient measures that have nothing to do with the references to inequity or alarmist assumptions and attacks on cohesion "nationalizing" the NHS. To the extent that ensure access to effective treatment, the budget manager has to have capacity and flexibility in making purchasing decisions (can not forget that the state already subtracted without further demonstrate capacity measures inclusion in the coverage and price innovation), otherwise, it would be logical decentralization of health management and budgetary responsibility of the Autonomous Communities.
The "cataloguiños" shorter lists in electronic prescribing and other measures should aim to promote the prescription of cheaper equivalent and give a clearer signal to the market that gives the current reference price system that The financier has to be very sensitive (an economist would say that is very elastic) to price differences between equivalent.
Another thing different would be if the measures were used to discriminate against price equal to the brands of the same active ingredient or a different approach to encourage lower prices. In this case we are considering a bill that flagrantly violates the principles of competition. It remains curious that this violation is grossly present in state regulation of a more favorable mandatory substitution of generics in certain cases despite not having a lower price and that, conversely, is the state that with simple measures management of regional shopping takes the ghost of market disruption and lack of cohesion. This is just the opposite, if these measures are designed properly, the effect they will have is to encourage price competition among producers with improved social welfare and contributing to the moderation in spending.
Equity in this context should rather be understood as equality of opportunity of access to effective care for the same need. From this point of view, equality and fairness is ensured if it is financed with the appropriate co-payment, how best to present the active ingredient prescribed by doctors to the patient. Equity, equality and cohesion have nothing to do with the brands or manufacturers whose products are prescribed, but with the quality and, more importantly, to the adequacy and effectiveness of prescription depending on the needs of the patient. What if attentive to the cohesion of the NHS and their own quality of care, for example, documented the high and inadequate prescription of antibiotics, antidepressants or medications for osteoporosis.
better idea than trying to step on and plug these initiatives that the regulator would ensure that multiple autonomous measures fit into the framework of the measures of competition and pilots were started each of the initiatives with an independent assessment of their impact.
On the other hand, we must be realistic and know that you can not expect big savings on public spending in the short term such measures. Its value lies more in the middle and even the long term and signals Dan is both producers as patients on a public demand that must be a very elastic products sustitutos ante.
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