Medicines and the New Economic Environment: II. THE REFORM OF HEALTH CARE SYSTEMS: II. 1. Cost Containment and Health care Reforms: the Impact on Pharmaceuticals: 3. LONG TERM SOLUTIONS: 3.2. Why are health care costs so explosive?

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:: Thèmes & Mots-clés

· Publications de l'OMS > Anglais > Medicine Access and Rational Use > Financing

· Mots-clés > health care
· Mots-clés > reform

Medicines and the New Economic Environment
(1998; 252 pages) [Spanish]

Table des matières

	THE AUTHORS
	PREFACE
	INTRODUCTION
	I. THE GLOBAL ECONOMIC ENVIRONMENT
		I.1. Opening Speech: Welfare State, Economic Policy and Health Services
			1. EVOLUTION AND PROBLEMS OF WELFARE PROGRAMS
			2. THE FUTURE OF THE WELFARE STATE: THE NEED FOR REFORM
			3. HEALTH CARE SERVICES: PROBLEMS AND REFORM LINES
			4. COMPETITION AND EFFICIENCY IN HEALTH CARE SYSTEMS
			5. COST OF HEALTH CARE TECHNOLOGY
			REFERENCES
		I.2. The Uruguay Round and Drugs
			1. INTRODUCTION
			2. PATENTS
				2.1. General principles
				2.2. Non-patentability: biotechnology-based drugs
				2.3. Non-discrimination clause
				2.4. Rights conferred: imports
				2.5. Rights conferred: protection of products through protection of the process
				2.6. Exceptions to exclusive rights
				2.7. Granting of compulsory licences
					2.7.1. Grounds for granting compulsory licences
					2.7.2. Conditions for granting compulsory licences
				2.8. Terms of protection
				2.9. Reversal of the burden of the proof
			3. UNDISCLOSED INFORMATION
			4. TRANSITIONAL PERIODS
				4.1. General grace period
				4.2. New patentable areas
				4.3. Protection of existing subject matter
				4.4. Prior compulsory licences and applications
				4.5. Pharmaceutical and agricultural chemical products
			5. ENFORCEMENT AND SETTLEMENT OF DISPUTES
			6. IMPLICATIONS FOR THE DEVELOPMENT, PRODUCTION AND MARKETING OF DRUGS
			7. CONCLUSIONS
			REFERENCES
		I.3. The Normalisation of the International Market for Pharmaceuticals: Future Impacts in Emerging Markets
			1. THE GLOBAL CONTEXT
			2. THE ESTABLISHMENT OF THE NORMS
				2.1. The drive towards normalisation
				2.2. The empirical framework
					2.2.1. The current structure of national markets
					2.2.2. Patents
					2.2.3. Prices
					2.2.4. The good manufacturing practices (GMP) and the quality of pharmaceuticals
					2.2.5. Generics
				2.3. The significance of the empirical information
			3. FUTURE TRENDS IN A NORMALISED WORLD
				3.1. Location of and control over production
					3.1.1. A synthesis of the structure of production
					3.1.2. What model is the international market heading for?
					3.1.3. Options for local producers in emerging countries
				3.2. International trade
			4. THE STEPS TO FOLLOW
			REFERENCES
	II. THE REFORM OF HEALTH CARE SYSTEMS
		II. 1. Cost Containment and Health care Reforms: the Impact on Pharmaceuticals
			1. INTRODUCTION
			2. COST CONTAINMENT MEASURES
				2.1. Cost-sharing
				2.2. Expenditure ceilings
				2.3. Limiting doctors and hospital beds
				2.4. Alternatives to in-patient care
				2.5. Influencing the resource use authorised by doctors
				2.6. Pharmaceutical prices
				2.7. A profit control system for Europe?
				2.8. The effectiveness of cost containment measures: potential for further action
			3. LONG TERM SOLUTIONS
				3.1. Systematic approaches to establishing priorities
				3.2. Why are health care costs so explosive?
				3.3. Technology assessment and pharmacoeconomics
				3.4. Methodological problems in economic evaluation
					3.4.1. Cost benefit analysis
					3.4.2. Cost-utility analysis
					3.4.3. International cooperation
				3.5. Making health services more efficient
					3.5.1. Evaluation of the reforms
				3.6. Necessary health care and outcomes measurement
			4. CONCLUSIONS
			REFERENCES
		II.2. Reform of Health Care Services in Developing Countries, Role of the State and Essential Drugs
			1. INTRODUCTION
			2. POLITICAL, ECONOMIC AND SOCIAL BACKGROUND, AND ROLE OF THE STATE
				2.1. The economic background
				2.2. Poverty
				2.3. The role of the state
			3. HEALTH CARE REFORMS IN LATIN AMERICA
				3.1. Financing of the health care sector
				3.2. Health care expenditure
				3.3. Coverage
				3.4. Adjustment policies in the sector
				3.5. Three practical experiences
					3.5.1. The Chilean reform
					3.5.2. Costa Rica
					3.5.3. The Colombian reform
					3.5.4. 1993: A change in direction?
			4. ESSENTIAL DRUGS
				4.1. Production
				4.2. Regulations and registration
				4.3. Prescription
				4.4. Marketing
				4.5. Drugs and the public sector
				4.6. Training
				4.7. Conclusions
			REFERENCES
		II.3. Regulation, Policies and Essential Drugs
			1. TWO MAJOR TRENDS
				1.1. The role of the state
					1.1.1. The state and the civil society: regulation and participation. State control vs. Privatization?
				1.2. Internationalization
					1.2.1. From the «Nation State» to the «nationalities»
					1.2.2. Regional blocks: community areas
			2. DRUGS
				2.1. The process of innovation
					2.1.1. The end of the innovation boom
					2.1.2. Privatization of research
					2.1.3. Greater cost in research
				2.2. The selection process
					2.2.1. Prevailing health criteria
					2.2.2. Regulatory approval: selecting the useful and safe
					2.2.3. Essential drugs: the best
					2.2.4. And what about quality?
				2.3. The expansion of markets
					2.3.1. Economic and social rationale of internationalization
					2.3.2. Processes of regional and sub-regional integration
					2.3.3. Repercussions on the health care sector
					2.3.4. The challenge to surveillance and control. «Liberalization»?
				2.4. The creation of common areas: harmonization
					2.4.1. Harmonization of marketing authorization procedures
					2.4.2. Harmonization of pharmacological standards
					2.4.3. Harmonization of good manufacturing practices (GMPs)
					2.4.4. Intellectual property
				2.5. Ongoing processes
					2.5.1. World Health Organization
					2.5.2. The International Conference for Drug Regulatory Authorities
					2.5.3. The International Conference on the Harmonization of Technical Requirements for the approval of medicinal products for humans (ICH)
					2.5.4. The European Community
					2.5.5. The Andean group
					2.5.6. Mercosur
					2.5.7. Central America
			3. CONCLUSIONS
	III. A CHANGING PHARMACEUTICAL INDUSTRY
		III.1. The New Structure of the Pharmaceutical Industry
			1. INTRODUCTION
			2. PHARMACEUTICAL RESEARCH AND DEVELOPMENT⁵
			3. THE REGULATION OF NEW DRUGS MARKETING
			4. RISING COSTS, DECLINING NEW PRODUCT INTRODUCTIONS
			5. DRUG TESTING AND INTERNATIONAL COMPETITIVENESS
			6. DRUG PRICES, PRICE CONTROLS, AND COMPETITION
			7. INDUSTRY RESTRUCTURING
			8. CONCLUSION
			REFERENCES
		III.2. Innovation and Regulation in the Pharmaceutical Market
			1. INTRODUCTION
			2. AN ERA OF EXPENSIVE DRUGS
				2.1. Expensive innovative drugs
				2.2. Innovation and the dynamic of drug markets
				2.3. The cost of innovation
			3. WHY ARE DRUGS EXPENSIVE?
				3.1. The R&D problem
				3.2. The nature of the market
			4. HOW TO REGULATE EXPENSIVE DRUGS?
				4.1. The ineffectiveness of direct price control
				4.2. Reinforced competition?
				4.3. Prescription control and pharmaco-economic assessment
			REFERENCES
		III.3. Change and Growth in Generic Markets in Developed and Developing Countries
			1. INTRODUCTION
			2. THE RESEARCH-BASED INDUSTRY FACES THE GENERICS
			3. SOME FIGURES FOR WESTERN COUNTRIES
			4. SOME FIGURES FOR NEW AND DEVELOPING COUNTRIES
			5. TRENDS IN GENERIC PRODUCTION
			6. THE PROTECTION OF RESEARCH (SCHERER, 1993)
			7. GENERICS BY THE YEAR 2000
			REFERENCES
	IV. SYNTHESIS AND FORECASTS
		Medicines and the New Economic Environment: Summary and Forecasts (*)
			1. THE ROLE OF THE STATE AND THE REFORM OF HEALTH CARE SYSTEMS
				1.1. Problems regarding the welfare state in Western Europe and changes in Health Care Systems
				1.2. The development of health systems in Latin America and the ways of reform
				1.3. Conclusions on perspectives for change in health systems
				1.4. Cooperation from banks of development as new participants in the field of health
			2. CHANGES IN THE INTERNATIONAL SCENE
				2.1. Globalization
				2.2. Regional integration
			3. CHANGES IN THE STRUCTURE OF THE PHARMACEUTICAL INDUSTRY
			4. CALENDAR FOR FUTURE RESEARCH AND COOPERATION
	BIBLIOTECA CIVITAS ECONOMÍA Y EMPRESA
	BACK COVER

3.2. Why are health care costs so explosive?

Much has been published about the effects of the aging population. For example it has been shown that medical expenses in France and Belgium are over three times greater for men aged 65 to 74 than for men aged 15 to 44. Expenses double for men over age 75 compared with the age group 65 to 75 (SANDIER, 1987). But the average annual effect of demographic change in Britain has been calculated as less than 0.3 per cent for the next 35 years (COSTAIN and WOLFSON, 1994). The Department of Health in the UK has also estimated the components of growth of the UK drugs bill. The demographic factor accounted for 0.3 per cent of the growth between 1982 and 1992 (Table 11).

In the past also, the effect has been far too small to account for more than a small part of the rising costs of health care in the developed world. The large and common feature throughout the world is the rising cost of new technology, particularly in the US.

TABLE 11. - Components of annual growth of U.K. drugs bill between 1982-1992 and 1991-1992

Components	1982-1992 %	1991-1992 %
Pure Demography	0.3	0.3
Scripts per capita (volume)	2.7	4.3
Quantity per script	1.1	2.8
Price of basket of existing drugs	1.4	0.4
Product mix (new products)	5.5	5.5

Source: United Kingdom Department of Health.

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