RESOURCES, CONSUMABLES, TECHNOLOGY AND COST-EFFECTIVENESS

Recovery of health and sickness⁸ prevention measures are undertaken through health system activities. What these activities have in common is the application of specialized human resources (health personnel) with the support of various consumables (equipment, medical supplies, pharmaceuticals and other materials) combined through specific technology (processes of diagnosis and treatment).

^8. The most important part of disease prevention is not carried out within the scope of the health system, but by means of healthy practices in the daily living of each individual and in each community, in such areas as culture, education, the environment, citizen safety, the organization of space, etc.

The interrelationship and combinations of human resources and consumables are offered in different technological environments that the health systems refer to as services: outside consultation and ambulatory care, basic and specialized diagnostic tests, hospital care of high and low complexity, rehabilitation, etc.

In health services, resources and consumables may be combined in different proportions, giving rise to modalities of greater or lesser effectiveness that are more or less costly.⁹ It is therefore said that there are health services and technologies that are more cost-effective than others.

^9. For the same disease, it is possible to choose between a pharmaceutical treatment and surgery, or between out-patient treatment and surgery with hospitalization, or between a curative process based on medicines and one centered on a change in the patient's habits, etc.

Health resources and consumables have their own markets. In each of these markets there are supply (suppliers), demand (purchasers and recipients) and a system of relationships between supply and demand (marketing rules and regulations). Quantities and prices depend on the commercial characteristics and practices of supply and demand, and on the manner in which supply and demand relate to each other.

Ordinarily, health technology (i.e., the combination of resources and consumables and the type of service) is decided by the doctors. This situation gives health markets a peculiar characteristic: the doctors, who are a part of the supply of services, usually have more decision-making capacity with regard to demand than the users. The decision of the doctors may be autonomous or it may be restricted by criteria established by the health system.

In the specific case of pharmaceuticals, the selection is made by the doctor or by the patient (self-medication and self-prescription), with safety implications in the treatment and cost-effectiveness analyzed below.

THE RIGHT TO HEALTH

The economic and political vision of health is based on a guarantee of the right to health. The right to health has three dimensions: individual, social and ethical.

• From the individual point of view: each individual should have access to the most effective combination of curative consumables and resources.

• From the social point of view: the least costly combination of curative consumables and resources must be found to guarantee universal access, given budgetary and resource limitations.

• From the ethical point of view: All must have access.

The challenge to a health system is therefore to achieve a reasonable balance among the individual, social and ethical dimensions of the right to health, i.e., to achieve full coverage with the greatest effectiveness at the minimum cost. In practice, this translates into achieving the combinations of resources and consumables that offer maximum coverage, efficacy and utility with the resources available. That, then, is the economic and political framework for the right to health.

It is for this reason that the pharmaceutical market must be examined in light of the efficacy of policy actions related to that market faced with the challenge of achieving maximum coverage and effectiveness at minimum cost.