DR. DANIEL LÓPEZ-ACUÑA⁶

^6. Director of the Health Systems and Services Development Division - PAHO/WHO.

The study of Health Insurance Systems and Access to Medicines and its results, which are presented in this publication, constitute an important PAHO/WHO effort to examine preliminary attempts at health sector reforms introduced in various countries in the Region. These relate to changes in drug financing schemes.

After a decade of reforms that have been implemented to differing extents, results are mixed with regard to the definition of drug pricing policy. In only a few cases has the design of an integrated policy been achieved.

The economic impact of pharmaceuticals is considerable, as they represent the second largest health expenditure by governments, after personnel costs. Drugs account for close to 40% of the health budgets of some Latin American countries. Even in developing countries, between 50 and 90% of drug costs are paid from the consumer's pocket. In contrast, in high-income countries, two-thirds of drug expenditure is from government revenues and health insurance programs.

Since private markets do not always achieve the objectives of equity and solidarity in the health sector, the governments of the region play an important role in financing health services and the provision of pharmaceuticals. Levels of financing vary considerably from region to region and country to country, with national expenditures varying from US$2 to US$400 per capita per year. Universal health insurance, a characteristic of almost all health systems in developed economies, promotes equity, solidarity and access. In most low-income regions, however, the situation is quite different.

Drug financing is critical. Economic strategies must be drawn up to cover costs. Such strategies envisage a broad range of choices with regard to policy decisions that may be important to the design of a national drug policy. These Include the choice of appropriate financing mechanisms to ensure access to essential medicines. A careful choice of appropriate strategies allows the countries to make better use of resources within the health sector, including those for drugs, and ensure equity in access.

Different options to increase the availability of funds and their better utilization should be considered. The option chosen will largely depend on the country's economic situation, on how it finances the rest of the health sector, and on a number of other diverse factors. This study presents the experience of six countries in the region. Lessons learned will undoubtedly provide guidance in moving towards the achievement of such goals.