The floor of the pharmaceutical expenditure

Question

The floor of the pharmaceutical expenditure

Answer 1

Pharmaceutical expenditure (which pays for the administration of the subsidized drugs dispensed prescriptions) in May fell 12% over the same month last year. The note from the Ministry of Health collected with evident satisfaction a reduction in the disbursement of the communities and the same ministry, for the part that touches, namely Ceuta and Melilla. In November, the latest month data, this figure rose 4.8 % from the same month last year. In Health still satisfied. Not for this increase, which was not mentioned in the related press release, but because it was still 10.78 % less than two years earlier.

Communication issues aside, one thing is clear: neither the financing of Spanish public health was booming in May, and it was a disaster half year later. But the fact is that the Spanish health system has spent 20 years fighting to lower the number with partial success. At that time, there have been cuts prices (forcing the sale of generic medicines when they appear), excluding products of public funding (the first, in 1993, ruling Felipe González). But in the end, after each measurement, spend time down, but then inevitably picks up again. It's what happened after the most drastic change, modification copayment decided by the Health Minister Ana Mato. That measure, acting on a change in the reference price, determined by Leire Pajin (PSOE), reinforced the exclusion of 400 products for public funding has made three and a half years spending has gone from 12,000 million year to just under 9,000 million. But it is now up again.

And in this situation, a question arises. Is there a range of acceptable variation, manageable, healthy for the system?

To understand what this drug spending in the battered financial health systems, go to large numbers. In the past 12 months with data has added 9,000 million. The budgets of communities representing 50,000 million. That is, spending on drugs (pharmacy, not the hospital) accounts for 18 % of the total, much less, for example, the chapter staff (40%).

Given the need to incorporate new therapies and an increasingly aging population, some believe that the expense has already bottomed out. Logically, in this line are the laboratories. "Not everyone is the amount, we must also look at the recipes," says Pedro Luis Sánchez, director of studies Farmaindustria - an organization that monitors spending very closely every year for what it represents to them directly (measures of sales) and its implications (increasingly rising far the government imposes austerity measures turn) -. " The correction of the expenditure has been tremendous, almost 30%, and will continue on this soil many months," he predicts. For this, the responsible Farmaindustria study points to another factor directly related, but we usually do less case: the variation of the number of prescriptions.

This perspective does not satisfy the employer's laboratories. " The natural thing would be to grow at the pace of the economy. We find that nominal GDP [ -0.7 % year on data from INE closed the third quarter of 2013] brand very well the variation of public revenues, and that can not be falling every year. 9,000 million euros of pharmaceutical expenditure are clearly a ground. "

For laboratories - the sector that invests more in R & D in Spain, the 30% decline in three years of this game has had a clear detrimental effect, " although we have tried to maintain employment and research." But not only the sector has been affected by the cuts. "It is true that new drugs, innovative entering the funding system, are more expensive, but many do not come, and instead, at prices many reference [ the descent is decided when the patent expires and reaches generic ] " he says.

The principal consultant pharmaceutical market, IMS, also suggests that these are 9,000 million a floor. 2014 provides for an increase of 3.9% and 3.4% for 2015. "It should not be a worrying factor," says Sanchez.

The ultimate responsibility for drug policy, the Ministry of Health, shares much of this vision. The CEO of basic portfolio of services of the National Health and Pharmacy, AgustÃ_n Rivero also believes that " to lower margins are already very difficult." However, not close to the government may be forced to go further. "I understand that Farmaindustria would realize, to tell them: ' It's up to 9,000 million a year and see what happens from there ', but whether the EU is going to tighten more. Farmaindustria cries a lot, but there has been provision of the population with the copay, "said Rivero. "Right now our priority is to see how we can make innovations keep coming."

This view, however, is not shared by all experts in the field. "The position of Farmaindustria seems very smart. Under the guise of wisdom and austerity in line with the times, subliminally slip the notion that pharmaceutical expenditure should rise more than the CPI, "criticizes Beatriz González LÃ_pez- Valcárcel, Professor of Quantitative Methods in Economics and Management from the University Las Palmas. It refers to nominal GDP is a measure that does not discount the impact of inflation, so as soon as an increase in wealth of the country, it will rise more than prices.

That said, the professor states that there is a "healthy " margin of drug spending growth. From a budgetary point of view, the figure would be appropriate expenditure that meets the official forecast. But beyond this rather obvious explanation, González LÃ_pez- Valcárcel believes that we must change the way we measure this match. "We should look at more disaggregated data, see what drugs go up or down. And, from a health point of view, focus on recipes that health spending, and there has been a brutal rally. We need to know which recipes are because we do not have that information. "

Juan Gervás, professor at the National School of Health, is blunt: "The information given is painful in the sense that it focuses only on the pure control. You have to get into something that will not do neither the administration nor Farmaindustria: see where it goes. For example, studies say that spending on statins [ cholesterol lowering drugs ] is excessive, and would have to focus on simvastatin, which is the cheapest and safest, leaving many people who try do not. There is also clearly a wasteful anti-hypertensive drugs, but with the information given, there's no way of knowing. What we have is the certainty that there is an unnecessary expense. With these controls, the pocket drug would have to drop steadily, never more than 10%, but mostly have to change qualitatively. "

Javier Rey, director of the Alternatives Foundation, also sees scope for reduction " should be level with the surrounding countries, and we are 10 points higher," he says.

The former secretary general of the PSOE Health and current spokesman in committee of Congress, José MartÃ_nez Olmos, believes that " not everything can be savings." " What we demand is that these measures are taken with an assessment of the health impact." For MartÃ_nez Olmos, the difference between the above measures to reduce spending and that the current government has taken is that " just before a bearing on the prices, what now can affect health." MartÃ_nez Olmos refers to the change of the copayment and the exclusion of drugs " fewer prescriptions are issued and collected less medication." He has compared the data from two neighboring provinces that have " similar health conditionalities': Murcia and Granada. " And we have seen that in the Andalusian province with an electronic prescription system which ensures that retirees do not pay more than the limit fixed by the decree law (8, 16 or 64 euros per month depending on your income), these collected more medications, while in the other, for fear of disbursement, take less, which may affect their status, "he explains.

With the point of view of patients, Olmos can not agree to set a cap on nominal GDP as Farmaindustria proposed. " That's a business approach, not health. What programs do is to measure the impact of new products, monitoring of chronic patients with polypharmacy, which are the most abused. "

This group of people, older with various ailments, are always in the spotlight. Aging and the need to incorporate new drugs to the public system, which are almost more expensive than the existing definition above, are the two arguments to justify that unless concrete steps during a limited time, spending always seems to have to grow. Gervás think is not true. "They are operating the chainsaw health system, when what we need is microsurgery. 30 % of expenditure could be avoided while increasing health, " he says.

In fact, the need for more data is shared even by the representative of the ministry. "We are also working to give the hospital costs," said Rivero. This represents around 3,500 or 4,000 million, is calculated. " In hospitals, 100 drugs account for 80 % of expenditure, and there may be 10,000 in the market." The project is already well advanced, and there are 11 communities and prepared to give that information.

Beatriz González can not help but agree. " In hospitals, the price of new drugs is spectacular. For example, half of the 43 drugs for which you want to put copay cost more than 1,000 euros ", he says.

Rivero also indicates that also are testing methods to reduce this spending (funding based on outcomes, for example).

The second question then is: why this endeavor of Health to give a detailed record of something that might not have such significance?

A first response to this historic attachment to the figure. Communities have no choice but to calculate what to pharmacies every month to pay them. So it's the only data that occurs with this frequency. Vicente Ortún, dean of the Faculty of Economics at the University Pompeu Fabra, often ironic about the preponderance given to this issue: if the Catholic liturgy is said Thursday that three more shine than the sun, in economics there three facts that seem similar media brightness: CPI, unemployment and drug spending. Needless to add that the comparison between the weight of the first two in the life of citizens and the macroeconomy and the third is clearly disproportionate.

But in the end, that's what you get. And even when the Federation of Associations for the Defence of Public Health brought its report this year on healthcare budgets in 2014 (a decrease of 0.4% per person compared to 2013, accumulating more than 11% between 2010 2013) was made ​​the same case.

Javier Rey does not want to criticize this information policy. "At least it's a fact." " Maybe there would have to be aware of it every month, but year after year indicates a trend," he says. Pedro Luis Sanchez, is "somewhat agree " with that much detail can be overstated. " But at least they are data, and I prefer them," he says.

Beatriz Gonzalez gives an example of what happens: " What we do is look for the lost coin in the evening where the lamp illuminates, not where it has fallen to us. We need more streetlights. " While waiting for these outbreaks, politicians, businessmen and analysts [ and reporters ] will [ continue ] as before: focus on the only thing known for certain month.