The study on Health Insurance Systems and Access to Drugs allows a review of the theoretical and practical issues related to the economics and politics of pharmaceuticals. From such a review it is clear that the characteristics of the pharmaceutical market are markedly different from other markets and products which means that there are recognized weaknesses in the way this market functions. It has been argued that to remedy these defects, the State should play a specific role in establishing controls and regulatory mechanisms designed to overcome information imbalance, moral risks and adverse choices, seeking to guarantee the right to health and access to the drugs required to ensure this.

In Chapter 2, a classification of health systems models and their components was presented, developing an ideal typology by which to evaluate the different national systems of financing and delivering pharmaceuticals considered in this study: social assistance; social insurance; social security; and private insurance.

In addition, the three basic components of any health system were defined: the management model; finance model; and the care model. Each of these was examined in regard to existing systems in the case study countries.

In the third chapter, the findings of the experts' surveys in the countries studied were brought together. Based on the surveys' results/findings it was possible to address the different methods of drug supply in the six countries, set out in accordance with the classification outlined in the previous chapter.

In addition to the data analyzed in the case studies presented in Chapter 3, it was possible to highlight some factors for success and obstacles in drug policy.

So, for example, in Argentina, rationalizing drug prescribing and changes in consumption patterns have been achieved, on the basis of the payment methods for drugs, resulting in improved control of expenditures, and changes to supply, with quality control standards. In Colombia, the major factor for success in the health system has been the inclusion of a drugs list in the Compulsory Health Plan, plus positive experience with bulk purchasing schemes by cooperatives and groups of health service providers, along with introduction of the use of generic drugs.

While the greatest accomplishment in Costa Rica was the establishment of a universal system, based on solidarity, equity and obligation, together with a pharmaceuticals policy based on the essential drugs concept, although generic drugs still lack credibility. Furthermore, a centralised purchasing system was put in place that allows for great savings in drug purchases. Meanwhile, in Chile the greatest success factor is the use of generic drugs.

The USA is outstanding for its effectiveness in regulating the market, having a limited formulary which clearly establishes which drugs must be available, favouring generic drugs which have a co-payment, US$ 5, while for brand name drugs it is US$ 10. Another positive element is in the form in which the drug is given to patients, not in commercial packaging but in individualized containers with dosage instructions clearly specified for the particular treatment. Nevertheless, it has been observed that the existence of a reimbursement mechanism for drug charges may limit the access of some low-income patients who find it difficult to make the necessary immediate payment. Moreover, per capita drug expenditure is significantly higher than in Costa Rica and one of the reasons could be the respective health systems adopted by these countries.

Finally, in Guatemala, one should highlight the introduction of single-dose packaging as the key of in-hospital drug management, as well as therapeutic committees to specify the dosage. As in Costa Rica, centralised purchasing has been one of the accomplishments, allowing buying at much lower prices than on the general market.

Based on the above observations, this chapter brings together the study's main conclusions and also offers some recommendations to be considered when drawing up policies.