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.

 

Caribbean: Further Integration is Needed in Terms of Health Coverage

This week I have seen a news that raised my attention, about the caribbean health market.I decided to investigate because in general I do not have too much insight in such a fantastic place, mainly because due to the differences of language (predominate the english) in Latin America the caribbean are regarded as a “different” continent…

Triggered by the new policy  endorsed by Barbados regarding non-national citizens on healthcare and drugs, countries from the Caribbean Community (CARICOM)  are to discuss about difficulties combining regional integration and access to healthcare, in order to define a future policy as a group.

According to The Guyana Chronicle, the government of Barbados has begun the implementation of a new Health Care Act that restricts access to cost-free drugs/medical care to non-nationals who have neither Barbadian citizenship nor permanent residency status. In such  a context, unless proof of citizenship or permanent residency status could be established when seeking medical care, then non-nationals who lived in Barbados could be denied health benefits previously freely accessed. Driven by this decision, different member states that are part of CARICOM, such as Guyana, Jamaica, St. Kitts and Nevis and St. Vincent and the Grenadines, have expressed concerns about the application of the new Barbados Health Care law that would require clarifications.

CARICOM: The Caribbean Community and regional integration

In 1972, Commonwealth Caribbean leaders at the Seventh Heads of Government Conference decided to transform the Caribbean Free Trade Association (CARIFTA) into a Common Market and establish the Caribbean Community, signing the treaty establishing CARICOM July 4^th 1973, was a defining moment in the history of the Commonwealth Caribbean. The objectives of the Community were to improve standards of living and work, through economic and social policies within the region and among the different members. In 2001 it was created a new version of the Treaty, called formally, The Revised Treaty of Chaguaramas Establishing the Caribbean Community, including the CARICOM Single Market and Economy, which added new protocols, including the rights contingent on the free movement of persons and labour.

However, the treaty did not establish what it would happen with internal polices such as access to health and drugs. Now CARICOM governments need to collectively  move towards a common strategy for shared medical benefits by all nationals of member states that have signed on to the Community’s Single Market and Economy (CSME) project. It has been noted that implementation of the Barbados health care legislation, has come at a time when CARICOM is in the process of seeking to establish appropriate mechanisms consistent with arrangements for the CSME. These arrangements, which would facilitate more than the estimated nine categories of skilled nationals to have freedom to live and work in any of the participating CSME member states, relate to outstanding issues like contingent rights and creation of a regional health insurance scheme that’s applicable across the region.

Countries such as Trinidad and Tobago has a significant presence of nationals from other Community states, which makes rather important to officially set up a policy in relation to non-nationals accessing cost-free medical care and drugs. According to sources from Barbados, even citizen that hold valid work permits, Barbados ID card and are tax payers, are being classified as immigrant and are being left without access to care. This inconsistency in the legislation and the social problems that it brings is fuelling pressure in the Community, in order to prioritise arrangements for common approach in the provision of health care and reimbursement of drugs for all nationals of the Community, towards the evolution of a common health-care programme for Community nationals, including non-citizens who live and work there.

The Caribbean is formed by several small states, such as Antigua y Barbuda, Bahamas, Barbados, Belize, Guyana, Haiti, Jamaica, Surinam and Trinidad & Tobago. Together this  market  is characterised by a  health sector which is predominantly public, with important needs in terms of maternal and child care. From the point of view of the Healthcare & Pharmaceutical industry, opportunities for a more integral approach as a region can come with the definition of common approaches on healthcare programmes within the region, which is about to be discussed in the Inter-Sessional Meeting of CARICOM leaders.

CARICOM	Bahamas	Barbados	Guyana	Jamaica	Trinidad and Tobago
Total life expectancy at birth 2008 (years)	73.49	77.01	67.11	71.84	69.34
Infant mortality rate (IMR 2009)	8.50	9.80	28.90	25.90	31.10
Public health expenditure 2007 % GDP	3.71	4.45	7.18	2.36	2.69
Private health expenditure 2007 % GDP	3.56	2.51	1.01	2.33	2.11
Total health expenditure 2007 % GDP	7.27	6.96	8.18	4.68	4.80
Total population (Millions) 2009	0.34	0.26	0.76	2.70	1.34

Brazil: Sanofi Pasteur dengue vaccine might be marketed first in Brazil

Brazil might be the first country receiving the dengue vaccine manufactured by Sanofi-Pasteur, the vaccines division of French pharma giant Sanofi-Aventis, reported the Brazilian local press. According to the source, executives from the French pharmaceutical company have met with Brazilian health authorities in order to find out ways to speed up the authorisation process of the vaccine in the country, which is currently undergoing Phase III clinical studies after having demonstrated a balanced immune response against all four serotypes after three doses in Phase II.

The announcement came after the agreement signed by Sanofi-Aventis with the International Vaccine Institute (IVI) to support the recently launched Dengue Vaccine Initiative. Brazil offers a good opportunity to launch the vaccine first, because Dengue is endemic and  on the other hand, Brazilian health authorities  would have the resources and the will to launch  the vaccine as soon as possible.  Currently, there are two other vaccines in competition to Sanofi. This includes GSK and Fiocruz’s dengue vaccine as well as one developed by Instituto Butanta. However, the endeavours between GSK and the local Institute Fiocruz to develop  a similar vaccine  which is to be locally produced, in addition  to Instituto Butantã ’s product,  may prove to be difficult  for the aspirations of Sanofi-Aventis, which would be to launch the vaccine in Brazil before 2015.

Argentina announced inclusion of HPV vaccine in the national schedule: Really?

The Argentinean President, Cristina Fernandez, has announced yesterday that the government will incorporate the vaccine against human papilloma virus (HPV) in to the national immunization schedule established by the Ministry of Health, local press reported. The President announced the decision in the context of the launch of the National Institute of Tropical Medicine in Puerto Iguazu, pointing out that cervical cancer associated with HPV is the second leading cause of cancer deaths and kills about two thousand women per year. The vaccine will be indicated to girls of 11 years old  as part of the national schedule and it will be delivered free of charge.

That can be true? The announcement would represent a major breakthrough for the health of Argentinean woman in terms of cervical cancer prevention. However, there is a lack of information related to this announcement which might symbolize that its implementation is still  being worked out. At the moment,  the government has not been released information about which vaccine of the two available in the market (Gardasil/Merck – Cervarix/GSK) will be  included in the immunisation program and if there is a public tender ahead. In addition, even though the inclusion of the HPV was related to the national vaccination schedule, which means it is universal and will be provided free of charge, the President in the same speech has called  for the well off people to try to purchase th is  vaccine  from the private sector, in order to make sure enough coverage for the poorer sectors of the population. Further information will need to be disclosed  in order to assess this announcement  properly. Furthermore, it is interesting to note and understand why for Pneumococcal vaccine has not been included yet in the calendar, and HPV has been.