Chile/Latam: Otro post (no es) sobre Isapres y Seguros Privados

Today I want to share a post that I have published in a venture that I maintain with two more friends. This venture is called Matasanos, and it is a blog which is meant to be a platform for debate and ideas regarding healthcare in Chile and Latin America. The blog has been quite succesful, and we of course are very proud of it.

This is a post written in Spanish about the current changes and discussion that are being conducted mainly in Chile, but also incorporating examples from Argentina and Colombia, about the private insurance sector.  The lack of regulation, coupled with the constant abuses of the system, focused on prices increase, lack of coverage and discrimination by gender and sex, are fuelling concerns and calling for changes in those countries, where private insurances companies do not have an important share in the market, but, they maintain strong presence in terms of influence and lobby, driven by their economic power.

Al menos, es la intención. Durante la semana pasada – y lo que llevamos de ésta – hemos sido bombardeados por editoriales, columnas (incluido el conspicuo El Post), expertos por aquí, expertos por allá, reportajes y análisis sobre el famoso y tan esperado proyecto llamado Ley Corta de ISAPRES II  que el gobierno se decidió a presentar para su discusión en el congreso.

En Matasanos, en Junio del 2010 publicamos un post sobre la decisión del Tribunal Constitucional (TC) sobre la famosa tabla de factores de las Isapres (Click Aquí), donde en vez de derogarla por completo, el TC declaro inconstitucional algunos elementos de ella…..

You can read the post in www.matasanos.org clicking here

Mapping Vaccines Policies in Latin America

This is a extract of my first post published in Eyes For Pharma’s Website.

The vaccine industry is looking to expand into new geographies, and Latin America might offer attractive opportunities. The region’s increasing wealth and growing awareness of vaccinations, coupled with the political and economic stability achieved during recent years, creates an interesting market for the region as a whole.

However, obtaining an overview of the Latin American market is rather difficult, mainly due to the diversity within the region in terms of regulation and development as well as the difficulties of financing vaccination programs. The current situation in Latin America is characterized by a lack of standard decision making for incorporating new vaccines, a variability in national schedules, a lack of funding, and significant diversity in regulatory frameworks.

If you want to continue reading, please clik here…

 

A rap song in defense of the NHS UK

Moving out of my usual topics about Latin America and Spain, today I want to share something that I really think is extraordinary. The english rapper NxtGen (who was not well known indeed) has become a kind of celebrity after recording a track that certainly offers a “different sort of sound”. Eschewing the traditional hiphop themes of bling, booty and babes, NxtGen has recorded a caustic three-minute rap about the Department of Health’s white paper “Equity and Excellence: Liberating the NHS“, and dedicated it personally – highly personally, one might say – to the health minister himself.

The lyrics are an outstanding critique to the Health Reform that the coalition government wants to conduct, in my opinion, apart of few offensive words of course.

Sentences such as  “Andrew Lansley, greedy! Andrew Lansley, tosser!”, “The NHS is not for sale, you grey-haired manky codger!”

“So the budget of the PCTs, he wants to hand to the GPs / Oh please. Dumb geeks are gonna buy from any willing provider, / Get care from private companies.”

“we’ll become more like the US / and care will be farmed out to private companies, / who will sell their service to the NHS via the GPs / who will have more to do with service purchase arrangements / than anything to do with seeing their patients

How many of us would be willing to defense our health system like NxtGen…?

Source: The Guardian

Controversy Sparks Once Again Between Chilean MoH and Patients with Tyrosinemia

The bitter controversy between the Chilean health minister and parents of children suffering from Tyrosinemia has restarted during the last few weeks, after the latter announced that the public health system was running out of Orfadin (nitisinone), manufactured by Swedish Orphan International. The initial controversy started in March 2010, when the families of patients realised that the government had not renewed the agreement to supply the drug under special conditions to these patients (of whom there are no more than 10 in the country) due to the excessive cost of the orphan drug. After the problem was made public and fuelled political pressure, the government decided to re-initiate the purchase of the drug. Now the parents of those patients affected by the rare disease announced that once again they are having problems obtaining the drug in the Calvo Mackenna Hospital, amid versions that are a little unclear from the Ministry of Health and the Hospital’s Director, Osvaldo Artaza.

The Health Minister Jaime Mañalich pointed out in a press session that there is no such situation within the public health system, and that, “despite the efforts from the pharmaceutical industry charging overprices” the MoH will keep providing the essential drug to patients. In the same context, he called on journalists, “don’t be agents of the pharmaceutical companies”. Hereditary tyrosinemia type 1 is a serious but treatable disease that affects children. About one newborn child in 100,000 has the disorder, although geographical variation occurs. Children born with hereditary tyrosinemia type 1 lack the ability to break down the amino acid tyrosine. As a result, toxic substances build up in the blood, causing—among other things—liver failure, kidney dysfunction, and neurological crisis. Despite the rough comments expressed by the health minister about the pharmaceutical industry, the situation is explained by the total absent of policies outlined by the Chilean government regarding orphan drugs, which set the scenario for this controversy.

Where Good Ideas Come From?

A very inspirational video about where good ideas come from…

I really like the concept that good ideas are part of the collision of hunches , and it takes at least a couple of years to develop good ideas. They need time to incubate, spending a lot of time under this “hunch” form.

Maybe that’s the reason why I do not like so much those people who always believe they have the “silver bullet” in case of complex problems, such as healthcare and reforms in general. I really do not believe there is a single straight answer or solution for the majority of the problems we are facing now within the sector. However, the question is, how in a society that force short-term results, we will be able to pass through this long process of innovation, hunches and merging different ideas?

It is the responsibility of managers, to provide proper environments for innovation, with long terms assessment instead short terms results? Perhaps we should have more time to let our imagination flow and embrace innovation..that’s the challenge

What do you think?

Chile: Government Still in Huge Debt with Pharmaceutical Companies

The past week, the Industrial Association of International Pharmaceutical Companies (Camara de Industria Farmaceutica, CIF), along with the organisation that represents the interest of local pharmaceutical companies (ASILFA) claimed that the government still maintains an important debt with them, not fulfilling its own pledge to terminate the long-term debt with the sector until 31 December 2010. According to the CIF, the Public Health Sector, which is managed on behalf of the government through CENABAST (National Warehouse and Central Drug Purchaser), it has a debt worth 31 billion Chilean pesos (USD64 million), with a delay of 270 days. In addition, the local pharmaceutical companies, grouped in ASILFA, has commented that CENABAST owes them CLP18 billion in 330 days.

The huge debt that the Chilean health sectors maintain with private entities, either private health providers or drug suppliers, has been the subject of huge controversy during recent years. Indeed, the Ministry of Health, on its annual account in 2010, announced that it had reduced the debt significantly, as one of its main achievements. However, pharmaceutical companies have released this declaration questioning what the government through CENABAST has been doing in terms of debt reduction. Apparently, pharmaceutical companies have decided to scale up the controversy, from CENABAST to the Ministry of Health, despite the fact that it is the former entity which is in charge of centralising the purchase of drugs. Even though it is highly unlikely that pharmaceutical companies will decide to take further radical measures, due to the purchasing power of the public sector, this fact sows doubt amongst the industry about the government’s commitment in terms of reducing the pharmaceutical debt.

Haiti: WHO and Partners Outline New Immunization Action Plan

Officials from Haiti’s Ministry of Public Health met with counterparts from the Pan American Health Organization/World Health Organization (PAHO/WHO) and UNICEF in order to outline their new plan to improve immunization services in Haiti over the next five years, including the introduction of three new vaccines.  The information, published on the website of PAHO, unveils that the so called “multi-year immunization plan for Haiti” is about to start this year, regarding rotavirus and pneumococcal vaccines as priorities.

According to the statement released, the new multi-year strategic plan for Haiti aims to improve vaccination coverage and vaccine management with the help of numerous donors and partners, including the US Centers for Disease Control and Prevention, the Canadian International Development Agency, UNICEF, USAID, the Bill and Melinda Gates Foundation, and others. The plan will cover routine vaccination, epidemiological surveillance, social mobilization and communication, training and management from 2011 through 2015, with detailed costs and plans for inclusion of pentavalent and other new vaccines, which represent an opportunity for pharmaceutical companies in terms of public private partnerships.

Chile: Private Health Centres charging higher prices, described as “abuse of the system”

The Chilean Free Competition Advocacy Authority (Fiscalia Nacional Economica – FNE) has opened an investigation in order to determine the condition on which health providers, especially private hospital, charge their patients in terms of drugs and medical devices, reported Estrategia. The head of the independent organisation, Felipe Irarrazabal, has pointed out that even though a current legislation exists which forces health providers to publish their prices in a list, this fact would not be enough to stop providers from charging consumers in excess of that price for drugs and procedures within their services.

The announcement made by the FNE came after lawsuits were initiated by patients who were subject to higher charges and what is being described as `abuse of the system’. This situation is caused because providers are not subject of prices regulation and nowadays they are part of health networks in connection with private insurances companies, a sort of informal Health Maintenance Organisation.  That situation determines that users of the private health system are not able to compare prices and they do not have free choice to decide which provider they want using market mechanisms, because they are caught within the health network of their insurance company.  The FNE will analyse the situation and will generate recommendations to the health authorities, in order to set out proper changes. However, due to the current scenario characterised by the important presence of the private health sector, is highly unlikely that important changes will be made.

Chile: Pharmacies prices and Lack of Transparency – More Regulation!!

After the scandal that affected the Chilean drug retail sector in 2008, which is being heard in the country’s court, pharmaceutical companies and drug stores chains still have not fully implemented changes that could avoid a similar situation from occurring again. These conclusions were exposed in the context of the presentation of a study carried out by National Consumer’s Service (Servicio Nacional de Consumidor – SERNAC) and reported by Estrategia. They concluded that nearly three years after the scandal of alleged drug price collusion, the sector has resolved only some of the practices that led it to be under the scrutiny of the Chile’s competition watchdog. However, the study says, there are still several challenges to overcome in order to gain the trust of the consumers.

In fact, during 2009, SERNAC received nearly 2,000 complaints involving the drug market and pharmaceutical sector. During 2010, this figure dropped to almost 1,260 complaints. According to the report, the issues highlighted were unjustified fees, poor service quality, lack of information and breach of promotions and offers. Even though the total number of complaints was declining, the government is highlighting that drug stores still face the same kind of issues compared with 2008, when the scandal was unveiled. These results should be understood in the context of pharmacies which have not changed their approach to consumers, insisting on continuing with the same practices of the past. Many pharmacies still do not display the price list, whilst employees keep influencing the public by inducing them to prefer products recommended by the company which will be more expensive, in order to obtain monetary incentives as a reward.

Alleged Collusion in 2008

The turbulences in the Chilean retail drug sector emerged in December 2008, when Chile’s competition watchdog, the National Economic Prosecutor (Fiscalia Nacional Economica), initiated a lawsuit before the Free Competition Defense Court (FCDC), alleging that, between December 2007 and April 2008, three pharmacy chains (SalcoBrand, Cruz Verde and Farmacias Ahumada/FASA) had collaborated in raising the prices of more than 222 medicines, including contraceptives and drugs for treating diabetes and epilepsy. At that time, the FNE’s petition claimed that the three companies “have been guilty of the most serious crime that it is possible to conceive within the Free Competition Law: namely anti-competitive collusion. Together [the companies] fixed retail prices that they could not have fixed without collusion, thereby cheating the competition, defrauding consumers and acting against the public interest”

More Regulation!! When?

The lack of regulation and fairness in drug prices has been questioned in the context of the Chilean free market economy. Historically, the pharmacy sector has had monopolistic behaviour where indeed, three pharmacy retailers concentrate 80% of the market share in terms of drug sales in Santiago, the capital of Chile. This was observed with the drug price-fixing strategy carried out by executives of those companies, who may risk even jail.

The Chilean government is working on different aspects in order to force pharmacies to increase their transparency in terms of drug prices, in order to avoid a similar situation like that at 2008. The first is the white paper project regarding over the counter drugs (OTC), which in Chile currently are forbidden. The project is being discussed in preliminary stages in the Chilean parliament, and according to the government, if the project is approved, it will not be necessary that pharmacies have to exhibit prices lists, which also is not compulsory in legal terms. The rationale for that is because price list will be difficult to implement for small drug stores, and OTC offers a better solution for customer in terms to compare prices in shelves. Another measure is to implement a change in the regulation in order to increase access to drugs through small “pharmaceutical warehouses”, which will target rural areas and neighbourhoods where there is no pharmacies, tackling at the same time the informal commerce of drugs on the streets, which is common in vulnerable zones of the cities in Chile.

 

Ecuador will regulate prices of certain drugs

The Government of Ecuador is about to present the first draft of a project tending to regulate certain prices of drugs in the local market, reported the local media. The different criteria which will be incorporated were agreed between governmental authorities and representatives of the pharmaceutical industry the past February 18th. According to the governmental authorities, the new mechanisms will make it easier for the Ministry to regulate prices of certain products, taking into consideration competitive conditions of the market. He used the example of high-demand drugs which does not have competition or generic versions, where the government will attempt to reduce the price and increase access to the population.

According to the preliminary information disclosed by the authorities and pharmaceutical representatives, the new system will not mean the establishment of a internal reference price system like countries such Spain does. Price caps would be imposed in just few products , being the main component of the strategy the so called Libertad Vigilada (Free Pricing and Surveillance ), which in practical terms means that the government will monitor prices and margins in high demand drugs. That fact could leave open the door for further changes in the regulation in the future, in terms of price regulation. Further details will be disclosed once the project is presented, however, it is likely that this policy would have a negative impact in the international pharmaceutical companies, which might see their margins reduced in the future.