Valérie Paris

Drivers of poor medical care

The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain.

Pharmaceutical Pricing and Reimbursement Policies in Switzerland

This paper examines aspects of the policy environment and market characteristics of the Swiss pharmaceutical sector, and assesses the degree to which Switzerland has achieved certain policy goals. In Switzerland, pharmaceutical spending has not been growing faster than health expenditure as a whole, as has been the case in many other OECD countries. Swiss pharmaceutical spending per capita and as a share of GDP is modest by OECD standards. This in part reflects relatively low levels of pharmaceutical consumption, given that public prices are among the highest in Europe and the Swiss tend to be early adopters of new pharmaceutical products. Switzerland’s regulation of prices for reimbursed drugs, based on referencing across countries and within the therapeutic class for products with comparators, appears to result in prices lower than what would be obtained absent regulation. Although ex-manufacturer prices are somewhat high relative to other European countries, recent reforms have reduced the differential. While costs are under control, Switzerland has scope to improve the cost-effectiveness of its expenditures in the pharmaceutical area. Generic penetration of the market is increasing but falls short of what has been achieved elsewhere and the prices of generic products are higher than what is found in other countries. Relatively high mark-ups over ex-factory prices suggest that the distribution chain is a source of further potential efficiencies, although high costs could also reflect characteristics of the Swiss economy... Ce document passe en revue differents aspects des politiques et des caracteristiques de marche du secteur pharmaceutique en Suisse et evalue l’atteinte des objectifs relatifs a la politique pharmaceutique suisse. En Suisse, les depenses pharmaceutiques n’ont pas augmente plus vite que l’ensemble des depenses de sante, contrairement ce qui s’est passe dans de nombreux autres pays de l’OCDE. Les depenses de medicaments par habitant, et en proportion du PIB, restent moderees par rapport a la moyenne des pays de l’OCDE. Cela tient en partie au niveau relativement faible de la consommation pharmaceutique, puisque les prix publics sont parmi les plus eleves en Europe et les Suisses enclins a adopter rapidement les nouveaux produits. La regulation des prix des prix des medicaments rembourses, basee sur des comparaisons internationales et, le cas echeant, sur les prix des comparateurs au sein d’une meme classe therapeutique, semble conduire a des niveaux de prix moins eleves que ce qu’ils seraient sans regulation. Meme si les prix fabricants sont relativement eleves par rapport a ce qu’ils sont dans d’autres pays europeens, les recentes reformes ont reduit l’ecart. Les couts sont certes maitrises mais la Suisse pourrait aller encore plus loin pour ameliorer l’efficience de ses depenses pharmaceutiques. Le taux de penetration des generiques sur le marche s’ameliore mais reste inferieur a ce qu’il est ailleurs et les prix des generiques sont plus eleves que dans d’autres pays. Les marges relativement elevees appliquees sur les prix fabricants donnent a penser que les circuits de distribution pourraient etre rationalises, meme si les couts eleves peuvent aussi refleter certaines caracteristiques de l’economie suisse...

How can pricing and reimbursement policies improve affordable access to medicines? Lessons learned from European countries

This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.

Pharmaceutical policies in a crisis? Challenges and solutions identified at the PPRI Conference

In October 2015, the third international Pharmaceutical Pricing and Reimbursement Information (PPRI) Conference was held in Vienna to foster discussion on challenges in pricing and reimbursement policies for medicines. The research presented highlighted that commonly used pharmaceutical pricing and reimbursement policies are not sufficiently effective to address current challenges. Conference participants called for fundamental reforms to ensure access to medicines, particularly to new and potentially more effective and/or safe medicines, while safeguarding the financial sustainability of health systems and working towards universal health coverage.

Data Rich, Information Poor: Can We Use Electronic Health Records to Create a Learning Healthcare System for Pharmaceuticals?

Judicious use of real‐world data (RWD) is expected to make all steps in the development and use of pharmaceuticals more effective and efficient, including research and development, regulatory decision making, health technology assessment, pricing, and reimbursement decisions and treatment. A “learning healthcare system” based on electronic health records and other routinely collected data will be required to harness the full potential of RWD to complement evidence based on randomized controlled trials. We describe and illustrate with examples the growing demand for a learning healthcare system; we contrast the exigencies of an efficient pharmaceutical ecosystem in the future with current deficiencies highlighted in recently published Organisation for Economic Co‐operation and Development (OECD) reports; and we reflect on the steps necessary to enable the transition from healthcare data to actionable information. A coordinated effort from all stakeholders and international cooperation will be required to increase the speed of implementation of the learning healthcare system, to everybodys benefit.

Política de salud

Durante los ultimos anos Mexico ha avanzado significativamente en el sector salud. Mediante su innovador programa Seguro Popular, Mexico ha practicamente logrado ya la cobertura universal para la poblacion, como sucede en la mayoria de los demas paises de la OCDE. No obstante, a pesar de las importantes mejoras en la esperanza de vida y la mortalidad infantil, permanece aun por debajo del promedio de la OCDE en lo que corresponde a los indicadores basicos del estado de la salud. Si bien el gasto total en salud (publico y privado) ha crecido mas rapidamente en la ultima decada, dicho gasto sigue siendo muy inferior al de otros paises de la OCDE. El nivel de gasto publico es especialmente bajo y el gasto de bolsillo de los particulares es muy elevado. Ademas, el sistema de salud esta fragmentado, lo que conduce al desperdicio en el gasto y a considerables disparidades en el acceso a la atencion de la salud de un estado a otro. Mejorar los servicios de salud del pais exigira atender los problemas de los estados mas pobres, privilegiar los servicios donde se pueda ofrecer la maxima relacion calidad-precio y mejorar la eficiencia de la atencion. Estos cambios permitiran que Mexico cumpla el compromiso establecido en el Pacto por Mexico para igualar la calidad y la cobertura entre los diferentes esquemas de servicios de salud. Tal aspiracion debera motivar nuevas reformas a fin de ampliar el acceso a estos, con politicas basadas en el establecimiento de metas tanto de la cobertura de los servicios como de la utilizacion efectiva de los mismos por parte de los diferentes grupos socioeconomicos y en las diversas regiones.