Pharmaceuticals and Health Sector Reform in the Americas: An Economic Perspective: 2. CHANGING PUBLIC AND PRIVATE ROLES IN HEALTH AND PHARMACEUTICALS 1 : 2.8 RECOMMENDATIONS AND CONCLUSIONS

Pharmaceuticals and Health Sector Reform in the Americas: An Economic Perspective
(1998; 112 pages) [Spanish]

Table of Contents

	ACKNOWLEDGMENTS
	FOREWORD
	EXECUTIVE SUMMARY
	1. ESSENTIAL DRUGS IN CONTEXT: THE NEW SOCIOECONOMIC ENVIRONMENT AND HEALTH SECTOR REFORM
		1.1 SOCIOECONOMIC DEVELOPMENT
		1.2 REFORM OF HEALTH SYSTEMS
		1.3 PHARMACEUTICALS AND REFORM
		1.4 RECOMMENDATIONS AND CONCLUSIONS
	2. CHANGING PUBLIC AND PRIVATE ROLES IN HEALTH AND PHARMACEUTICALS¹
		2.1 REFORM AND CHANGING ROLES
		2.2 ORGANIZATION OF THE PHARMACEUTICAL SECTOR
		2.3 PERSPECTIVES ON “PRIVATIZATION”
		2.4 THE ROLE OF THE STATE IN HEALTH CARE MARKETS
		2.5 ESSENTIAL STATE FUNCTIONS
		2.6 THE PUBLIC-PRIVATE DUALITY
		2.7 DECENTRALIZATION
		2.8 RECOMMENDATIONS AND CONCLUSIONS
	3. DRUG FINANCING ALTERNATIVES
		3.1 HEALTH AND PHARMACEUTICAL EXPENDITURES
		3.2 FINANCE REFORM
		3.3 CONSIDERATIONS IN EVALUATING OPTIONS
		3.4 GOVERNMENT FINANCING FROM GENERAL REVENUE
		3.5 INSURANCE AND RELATED MECHANISMS
		3.6 USER FEES
		3.7 EXTERNAL SOURCES OF FINANCING
		3.8 RECOMMENDATIONS AND CONCLUSIONS
	4. DRUG PRICING POLICIES
		4.1 PRICE AND TRADE LIBERALIZATION AND HEALTH SECTOR REFORM
		4.2 PHARMACEUTICAL MARKETS
		4.3 GOVERNMENT INVOLVEMENT
		4.4 PRICE CONTROL OPTIONS
		4.5 RECOMMENDATIONS AND CONCLUSIONS
	5. DRUG GENERICS STRATEGIES
		5.1 GENERICS STRATEGIES IN THE CONTEXT OF REFORM
		5.2 CREATING SUCCESSFUL STRATEGIES
		5.3 EXPERIENCES WITH GENERICS STRATEGIES
		5.4 RECOMMENDATIONS AND CONCLUSIONS
	6. THE ECONOMIC IMPACT OF RATIONAL DRUG USE
		6.1 RATIONAL DRUG USE AND REFORM
		6.2 THE COST-BURDEN OF IRRATIONAL DRUG USE
		6.3 IMPROVING RATIONAL DRUG USE
		6.4 RECOMMENDATIONS AND CONCLUSIONS
	7. CONCLUDING REMARKS
	REFERENCES
	FURTHER READING
	ACRONYMS

2.8 RECOMMENDATIONS AND CONCLUSIONS

REFORM AND CHANGING ROLES

• Health sector reform should shape the mix of public-private, and central-local participation in health care so as to achieve maximum benefit for all.

PRIVATE ROLES

• Increasing the importance of the private sector or of competitive mechanisms within the public sector are options which can be undertaken within a reform process as part of a comprehensive effort to improve equity, quality, and efficiency in health systems.

PUBLIC ROLES

• Concerns about equity and as well as the information imbalance, failure of competition, and externalities in the pharmaceutical sector argue strongly for essential state roles in policy-making, regulating, assuring quality and access, and promoting rational drug use.

PUBLIC-PRIVATE DUALITY

• Public and private sectors should compete fairly, on equal grounds and the structures and procedures for business for both sectors should be transparent.

• Public-private roles in the pharmaceutical sector should be considered within the context of a national drug policy which aims to ensure access to and rational use of drugs which are safe, effective, and of high quality.

• A strong or increasing role of the private sector changes but does not reduce the responsibility of the government to oversee equity of access and quality of health services.

DECENTRALIZATION WITHIN THE PHARMACEUTICAL SECTOR

• Some responsibilities and activities within the sector may benefit from a decentralized approach, but certain essential functions (development of a national drug policy, drug registration, and standards for quality control) should remain the responsibility of central authorities.