Transcript PGEU - Portalfarma

Market demands and public health
objectives:
Can the pharmacy sector combine them?
Luís Matias - PGEU President
Cádiz, 6 October 2006
EU – Setting the scene
In March 2000, the European Council adopted a strategy to
make the EU “the most competitive and dynamic-based
economy in the world”…
… giving priority to the competition policy foreseen in the
EC Treaty and reinforcing the Internal Market.
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EU – Setting the scene
A proposal for a Directive on Services has been presented by the
European Commission as an important tool to drive this strategy
onto the services sector, including health.
After a comprehensive debate on liberalization of services, some
sectors were finally excluded from its scope due to their specificities.
Health services were one of them.
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EU – Setting the scene
In spite of this decision, the European Commission is currently
asking some Member States to revise their national legislation on
community pharmacies, requesting them to justify rules relating to:
•
pharmacy ownership;
•
and pharmacy establishment (demographic and geographic
criteria).
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EU – Setting the scene
Meanwhile, at the level of Member States, some reforms
have also been introduced through the implementation of
measures that go along the same lines…
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EU – Setting the scene

Pharmacy ownership has been liberalized in countries such as the
Netherlands and Norway, announced in Portugal, or changed in its
business structure in countries such as France, Germany and Italy;

Pharmacy establishment criteria have been changed in countries
such as the Netherlands, Ireland and Norway;
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Liberalization of the selling of NPMs (ex: Denmark, Norway,
Czech Republic, Portugal and Italy);
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Liberalization of the price of NPMs (ex: Denmark, Germany and
Italy);
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POM to NPM switch (ex: France, Germany, UK and announced in
Portugal).
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Pharmaceutical policy environment
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Pharmaceutical policy environment
The rising costs in health:
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In recent decades, the pharmaceuticals’ mean share of the GDP
has been 1.2% in OECD countries.
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Pharmaceuticals accounted for 15.4% of total health
expenditure, with public expenditure about half of this amount.

Since 1970, the average share of GDP for pharmaceuticals in
most countries has increased 1.5% more per year than GDP
growth.
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Pharmaceutical policy environment
Many are the factors that contribute to the rising costs:

Life expectancy is increasing, leading to the aging of
population;
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The prevalence of chronic diseases is growing fast and,
therefore, the demand of healthcare is also increasing with
direct impact on costs and on the health structures;

The improvement of the social-economic conditions will
correspond to a significant increase of diseases related with
lifestyles;

Citizens’ expectations and demands are higher in relation to
the services provided.
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Pharmaceutical policy environment

The pharmaceutical expenditure is subject to several
components, such as industry income, prescribing habits,
wholesaler intervention, pharmacy remuneration and taxes.

In addition, pharmaceutical expenditure analysis must take
into consideration other contexts such as the level of patient
adherence, waste of medicines and advertising of
pharmaceuticals.
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Pharmaceutical policy environment
The market rules and pro-competitive policies:
The focus of today’s legislative procedures in the pharmaceutical
policy is dominated by three policy inputs:
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public health policy;
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healthcare policy;
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and market policy.
The main professional roles of the pharmacy profession fit into
the health policy, but somehow they also touch features of market
policy.
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Pharmaceutical policy environment

Policymakers operate with two conflicting views of
pharmacy and pharmacists.

In the first view, policymakers see pharmacies as
commercial enterprises and pharmacists as business people.

Governments will most likely make decisions based on
cost and relegate to second plan the quality of services.
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Pharmaceutical policy environment

In the second view, policymakers view pharmacies as
part of the healthcare sector and pharmacists as
healthcare professionals providing a public service.

If this is the case, governments are inclined to regulate this
field as they do with other healthcare professionals and
healthcare services.
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Pharmaceutical policy environment
The competition issue:
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Competition brings to the spotlight a new concept: “Change”
For us, pharmacists:
“Change is not a problem; engagement is!”
“ The objective is not to get people to support change but to
give them responsibility for engendering change and some
control over they destiny”
Harvard Business Review
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Pharmaceutical policy environment
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A question remains: How can community pharmacies
ensure patient safety and quality of care and
simultaneously contribute to cost containment in the
healthcare sector?

To optimize medication management in order to produce
positive health-outcomes and generate savings to the
healthcare sector, we believe that it is essential to uphold
a clear regulatory framework for the pharmaceutical sector.
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What must be preserved?
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Pharmaceutical policy environment
What must be preserved?

Professional image of pharmacists, promoting trust and
honesty to the public through:
- A Patient-focused image that:
•
•
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Safeguards the public on issues of product safety, effectiveness
and costs
Allows Personalized Care
And promotes Professional Services
- Disease State Management
- Point of Service Lab screening
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Pharmaceutical policy environment
What must be preserved?

The Community Benefit that pharmacy gives to society
through:
- Public Health Initiatives
•
•
•
•
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HIV/AIDS, Needle Exchange, Methadone
Hypertension – Diabetes Screening
Poison Prevention
Paediatric dosing schemes
Accidental overdosing
- Partnership with Patient Advocacy Groups and other
stakeholders
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Pharmaceutical policy environment
Michael Porter and Elizabeth Teisberg point out:
“In healthy competition, relentless improvements in processes and
methods drive down costs. Product and service quality rise steadily.
Innovation leads to new and better approaches, which diffuse widely
and rapidly. Uncompetitive providers are restructured or go out of
business.
Value-adjusted prices fall, and the market expands. This is the
trajectory common to all well-functioning industries – computers,
mobile communications, banking and many others.
Healthcare could not be more different.”
Harvard Business Review
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Pharmaceutical policy environment
A recent study published by ÖBIG, an Austrian Health Economic
Institute, has assessed the consequences of deregulation in
the pharmacy sector, in six European countries, in terms of:
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accessibility, quality and expenditure.
According to the study, liberalization doesn’t necessarily lead to:
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increased competition;
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decrease of NPMs’ price;
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containment of public expenditure.
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Conclusions
1. Healthcare environment is complex, and perhaps the most
effective change may require a mix of approaches involving
competition and regulation to ensure patient safety and
quality of care.
2. The perspective of various interest groups (government,
healthcare providers, patients, the public) should be
incorporated in pharmaceutical policymaking, given their
common goal and objectives in public health.
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Conclusions
3. Community pharmacists are an integral part of the
healthcare system and, therefore, they contribute to the
overall objective of a better performance, efficiency and
effectiveness in the healthcare system;
4. International evidence strongly suggests that the involvement
of community pharmacists in areas such as generic
substitution, medicines information, health promotion,
disease prevention and disease management provides
cost savings. This is achieved through reduction in wastage
and inappropriate use, as well as under-use of medicines.
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Conclusions
5. Intervening simply to reduce pharmaceutical costs
without a broader public health perspective will be short-sighted
and potentially disastrous, as medicines cost is only one
component of healthcare expenditure.
6. While contributing to cost savings both by improving health
indicators of the population and by implementing cost
control mechanisms, community pharmacists are
contributing to the well-being of their country and to the
competitiveness of their national economies.
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Conclusions
A balanced approach is needed to market rules,
cost-containment and pro-competitive policies in
health, taking into account universal concepts such as
affordability, accessibility, quality, equity and equality.
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Conclusions
… Pharmacists will always be part of the solutions, as
important allies of governments and consumers in the
implementation of the health policies that better serve
the citizens’ interests.
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THANK YOU!
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