Colombia: Basic Insurance Plan is not enough..do you hear Chile??

Amid the discussion which is been carried out in Chile, regarding the likely changes of the private insurances model, it is worth to check what is happening in one of the paradigm models of private health in Latinamerica, which is Colombia.

This week the High Court (Corte Constitucional) in Colombia has ruled in favour of a mother and her son, who were rejected to receive the Pneumococcal vaccine because it is not included in the Compulsory Health Program (Programa Obligatorio de Salud – POS), which is used by Private Health Insurance Companies (EPS) to provide a minimum nest of health services, according to the story publish in the local El Tiempo. Moreover, the High Court officially stated that Pneumococcal vaccine must be extended to the entire population, as many other neighbour countries do. Pneumococcal vaccine is included in POS just for certain conditions, such as low weight at birth or pre term deliveries. Families with children’s without such conditions must assume extra cost if they want to obtain the vaccine.

Financing in the Colombian Health System is based on private insurance companies (Entidades Promocion de Salud). Even though the government has tried to diminish the risk of adverse selection and price discrimination through the implementation of the compulsory health program, still there are a great number of complaints and allegations from consumers against these organisations, which has given rise to legal disputes. This factor adds extra cost to the system, along with the adverse consequences in terms of the health of the population. It is worth noting that in this case the judicial power, the Corte Constitucional in Colombia, is recommending to the government the extension of the coverage of a vaccine highlighting the important prevalence of pneumococcal disease in the country. It will be important to see the reaction of the health authorities in an aspect that they must consider as part of their scope of decision.

However, despite of evidence published and practical examples such as this situation in Colombia, authorities in different countries, especially Chile, still aspirate to consolidate the subsistence of the private health insurance model. The case of the discrimination regarding the pneumococcal vaccine in Colombia, and the subsequent decision of the High Court, highlights that the Basic Health Plan, one of the flagships of the Health Minister in Chile,  even though is a good proposal, is not enough when we talk about eliminate the discrimination that is part of the private insurance business model.

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.

Brazil: Free Hypertension and Diabetes Drugs through Farmacia Popular

Yesterday the President of Brazil, Dilma Rousseff, launched the national programme Saúde Não Tem Preço ( translated as ` Health has no price ’ ) which mean pharmaceutical products to treat hypertension and diabetes are going to be distributed for free in the pharmacies that are part of the network Aqui Tem Farmácia Popular (“Popular” Pharmacies). The initiative will enter in force from the next February 14th and it was one of the promises made by the actual President during the presidential campaign, as part of the wide strategy focused on tackle extreme poverty in Brazil. However, since 2004, 107 drugs included hypertension and diabetes treatments are heavily subsidized by the government through this network of pharmacies, with a 90% of discount in the price, which mean in practical terms that vulnerable patients had to pay only 10% of the price of the drug.  Under the new measure, only hypertension and diabetes treatments will be provided free of cost and there will be a list of drugs available on each pharmacy specifying which are the drugs that can be obtained without cost on each of them, mainly generics.

Free medicines will be available to all Brazilians who have a doctor’s prescription, but the authorities say they expect the offer to be taken up mainly by poorer people who use the public health system. Throughout Brazil, the government said there are 15,000 pharmacies that are part of this agreement which mean to sell drugs under the government subsidy scheme. The official figures released outlined that the programme benefits 1,3 million people, of whom about 660,000 suffers from high blood pressure and 300,000 are diabetics. Besides patients with those illnesses, the Pharmacia Popular scheme offers drugs for treatment such as asthma, rhinitis, Parkinson’s disease, osteoporosis and glaucoma. The government’s budget for the Health Has No Price programme is US $ 280 million annually.

Free HIV drugs first and now Diabetes and Hypertension

Since 1996, Brazil has provided free anti-retroviral drugs to patients with HIV/Aids, an approach that has been widely praised. Following the same strategy the government wants to tackle the increase on the figures of Brazilian who have metabolic problems. Currently, about 33 million of Brazilians have high blood pressure, and more than seven million have diabetes. The Health Minister has pointed out that high blood pressure and diabetes caused 34% of deaths in Brazil in 2009 and these epidemiological facts were the main reason to take the decision of liberalise the provision of treatments.

What it does suppose to mean?

This is the first major health announcement from the President Dilma Rousseff, who came in to office supported by the tremendous popularity of her predecessor Lula da Silva, providing an insight into potential principal aspects of her government’s policy measures with respect to the sector. The announcement regarding metabolic treatments such as diabetes and hypertension is part of her intention, first because it was a pledge in the presidential campaign and secondly, indirectly supporting her main commitment, which is to reduce extreme poverty in Brazil. Even though patients had to pay a small quantity in order to get access of those drugs, the abolition of the 10% co-payment in such drugs will have a positive impact in the vulnerable population. The measure has been granted as universal because every Brazilian registered in the public health system can obtain the benefit showing a prescription issued by a doctor. However, the 100% discount will only be available in certain pharmacies and for a reduced list of drugs, mainly generics produced locally, which are part of the programme called “Popular Pharmacies”. Having said that, and considering the geographic distribution of these pharmacies, is highly likely that this initiative will have a bigger impact in vulnerable population, rather than well off Brazilians. From the point of view of the industry, despite of the decrease on the sale profit, especially in the retailer sector, the increase in the volume of sales and the fact that more people will be attracted to come in stores and purchase products will mean an opportunity for the industry to recover the profits and even increase the revenues in sales.

Local Governments and Communities facing Disasters

Local governments play a central role in coordinating and sustaining a multi-level and multi-stakeholder platform to promote disaster reduction in their region. The active commitment and leadership of a local government is important for the implementation of any local disaster risk reduction measures to deal with different stakeholders and multiple layers of government.

In many cases, a comprehensive disaster risk reduction measure takes long time to fully implement, and the leadership of the local government is particularly crucial to ensure the political momentum and support among external stakeholders throughout the process. In the other hand they (Local Governments) effectively engage local communities and citizens with disaster risk reduction activities and link their concerns with government priorities.

As the most immediate public service provider and interface with citizens, local governments are naturally situated in the best position to raise citizens’ awareness of disaster risks and to listen to their concerns. Even the most sophisticated national disaster risk reduction measures (such as early warning systems) may fail, if communities are not properly informed and engaged. Likewise, community preparedness measures are sometimes as effective as costly public investments in reducing casualties from disasters, and local governments should play a central role in community education and training.

Finally local governments strengthen their own institutional capacities and implement practical disaster risk reduction actions by themselves. As the governmental body responsible for the long-term development and viability of its area, a local government is required to consider and institutionalize disaster risk reduction in its day-to-day operations, including development planning, land use control and the provision of public facilities and services. In terms of innovation, local government can devise and implement innovative tools and techniques for disaster risk reduction, which can be replicated elsewhere or scaled up nationwide. Because of its smaller scale and flexibility, a local government is better positioned than a national government to develop and experiment with various new tools and techniques, applying them to unique settings and policy priorities. (Local Government and Disaster Reduction 2010 Report)

WHO Agenda 2006-2015

Everybody knows about the World Health Organization.

Founded in 7 April , 1948 and part of the UN system, the WHO is the most  international recognized official entity in terms of public health. 

But…do you think the majority of people could answer this question : Which are the main points in the WHO Agenda during the next years?? I do not think so, and you want to know why ? Because I did not as well. Until today.

Making the preparation for my travel tomorrow to Geneva, in a kind of  “study trip” I started to revise regarding the WHO, objectives, main achievements, commitments , structure , organization, whatever.

I just realize there are a Director General (Margaret Chang) , a Deputy Director General , the Assistant Director Generals and a lot of Directors – definitely burocrasy is an important part of WHO - and also an Executive Board formed by 34 member who are proposed by the countries. One chilean is there, his name is Fernando Munoz.

Also I discovered today the budget of WHO is based in 1/4 by the ”compulsory” or standard contribution of the 193 associated members, and 3/4 for “voluntary” contributions. Can we imagine the influence that this “voluntary” contribution can buy??

But, maybe the most important thing I have discovered in this fast revision is the WHO Agenda for 2006 – 2015. We can find this Agenda in the document “Engaging for Health” Eleventh General Programme of Work”  in which are set out the main contents of WHO objectives during the next years.

And these point of the Agenda are:

1) Investing in Health to reduce poverty

2) Building individual and global health security

3)Promoting universal coverage, gender equality and health related human rights.

4)Tackling the determinants of Health

5) Strengthening health systems and equitable access

6) Harnessing knowledge, science and technology

7)Strengthening governance, leadership and accountability

When I come back from Geneva , I am going to write regarding my personal impression about how this Agenda is carried out in this big organization. Let me see what I can find there…

Looting after Chile’s Earthquake: Why?

BBC. – Chile’s president has appealed for calm in the earthquake-ravaged city of Concepcion, vowing a stern response to any renewal of looting and violence. Michelle Bachelet says 14,000 troops are now in the region, after dozens of people were arrested on Monday. A BBC reporter in Concepcion says police are now posted on street corners in the city centre, but says that aid convoys are yet to reach the needy. The death toll from the 8.8-magnitude quake now stands at 795, officials say.

Chile is a well-known country in terms of natural disasters. Also the “sense of solidarity” of Chileans in this sort of situation represents for us something close to be called a national proud.

But, what is happening after the 8.8-magnitude quake in Chile? An overwhelming sensation over the whole population is installed. Dozens of images from the devastated city of Concepcion and terrible information from other damaged cities confirm that looting and violence are taking control over the destroyed cities, threatening the security of the people.

Why this effect in the population is happening? Are there such lacks of food and supplies that people desperate need to do this? Or might be another reasons, rather than the evident?

I think there are two main factors playing in this situation. One is structural and the other is functional.

We have to understand that in the Chilean society we can find a lot of inequality. Despite the development, the OECD membership, the GDP growing and country status in the worldwide context, Chile still has a lot of work in terms of decreasing the widespread differences and the lack of fairness. Those facts configure a “substrate” that allows in this case – disaster, lack of electricity, overwhelmed security forces and of course lack of food and water – this sort of social outbreak. I am not justifying that action, but we have to recognize the existence of this “basement”.

The other factor is related with the government’s performance during the current situation. Given the substrate we have defined before, was very easy to think this situation could occurs. President Bachelet has decided just yesterday the curfew, 48 hours after the onset of the disaster, and soldiers finally have taken the control of Concepcion’s city today. This decision was correct, but it was too late.

I do not know whether the “symbolic” image related with the soldiers on the streets – maybe remembering the Pinochet’s Military Government – played a role delaying the decision. But in the end was clear the decision was necessary, at all. Now the next President Pinera – who enter in the office 11th March –  knows he has not only the mission of reconstruct the country, also he and his cabinet must definitive became Chile a country where the social justice is present.

US Health Care Reform for Beginners

At Christmas’s eve, the United States Senate passed their version of the Health Reform Bill. After that fact, 30 of the 46 millions people without health insurance in the US are seeing how their chances to obtain a better health and quality of life are closer than ever.  At November the House of Representants did their job passing their own version. Now the last step before to send the final proposal to President Obama’s signature is the reconciliation of both bills.

The US Health Reform is mainly focused in the financial provision of healthcare. In the context of the US health organisation – health market based by private insurances companies – this reform attempt to improve the regulation of these companies, decrease the number of US citizens without health insurance and reduce the trend of increasing costs in the health industry.

But, it is a matter of fact that exist uncertainty in the success of the most important campaign idea of President Obama. Three weeks ago, the republican Scott Brown was elected Senator of Massachusetts, taking Ted Kennedy’s seat, who died in August 2009. His victory means that Democrats will no longer have the 60/40 majority in the senate that they need to pass the final – reconciled – bill and prevent the filibuster action of the Republican Party (Bill to death).

So what are the main issues of this reform, and why the Republicans and some Democrats are not quite convinced?

The first issue is the so called Public Insurance Option, that means the government would run its own health insurance plan changing the conditions of the market. This proposal is only considered in the House of Representant bill, not in the Senate bill and is likely to be dropped. The second issue is abortion, which has been highly contentious during the debate. Finally, the third main issue is regarding how to pay the bill. The Senate calls for an increase in the payroll tax that people pay for Medicare and places a new tax on high cost plans like “Cadillac”. The House would tax individuals who earn more than $500.000 a year and couples who earn more than $1 million. Remember both bills estimated the increase in the health care expenditure by nearly $900 billions the senate and over 1 trillion the House.

In a desperate movement in order to save the reform,  President Obama has invited the Republican and Democratic leaders of Congress to meet near the White House to work on health care reform legislation. Based on the bill of the Senate (no more Public Insurance Option) he is trying to obtain some sort of “collective” support for both parties in a final attempt to became this reform real (or part of it at least).

We will see the discussion the next days. For the health of  the US citizen, I hope some sort of final agreement must be done.