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Comparison of Health Care Systems in Latin America: Pharmaceuticals Villafuerte 2014

  1. 1. 2. Pharmaceutical Market Paraguay has in general no availability of breast/bowel cancer screening and cervical cytology at the primary health care level. Guatemala and Peru have in general no availability of of breast/bowel cancer screening at the primary health care level. 47% of the countries have no availability of cervical cytology at the primary health care level. Objective • Every country in the sample has an official list of essential medicines. • Smuggling is a problem particularly in Central America, Bolivia and Peru. For instance, in Bolivia a fifth of the commercialized drugs come from the smuggling of pharmaceutical products. • The highest proportion of the out-of pocket expenditures is for pharmaceutical products. 1. Health Systems Introduction Comparison of Health Care Systems in Latin America with a Focus on the Pharmaceutical System Karla Hernández-Villafuerte1 Latin America countries are usually classified as a unique group in terms of the characteristics of their healthcare system and pharmaceutical coverage. However, there are important differences between the countries with complicated structures of reimbursement. The objective is to compare the healthcare structures of the Latin American countries with special attention on the pharmaceutical system. 1Economist, Office of Health Economics, 105 Victoria Street, London SW1E 6QT. Tel: +44 20 7747 8886 • www.ohe.org • KHernandez-Villafuerte@ohe.org. 3. Formularies (HTA role) • A number of formal attempts to incorporate HTA in the priority setting process can be observed. For instance, CONITEC in Brazil, the CCA in Chile, CRES and IETS in Colombia, CENETEC in Mexico, CONETS in Venezuela, IECS in Argentina, among others. A central role of HTA analysis is the recommendation for the inclusion or exclusion of medicines in the essential medicine list or the reimbursement list. • Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Paraguay, Peru and Uruguay are members of REDETSA (Latin American Network of Health Technology Assessment). Conclusions: Inequality in access is the common factor that emerges from the comparison. Additionally, considerable attention has been given to establishing a formal structure of application of health technology assessment; however, the process of inclusion of medicines in the reimbursement lists requires further advances. First Step: A non-systematic literature review of published official sources and peer-review journals (English and Spanish). Analysis of quantitative information from official sources. Objective: Explore the characteristics of the health system and the pharmaceutical market in each country. Moreover, this is the preparatory work before the implementation in the second stage of a survey that will be applied to people involved in institutions involved in HTA and in the pharmaceutical market in their corresponding countries. Methodology: Two Stage Project Second Stage future research agenda: 1. Interviews with representatives of key government agencies responsible for the health sector in Latin America 2. Econometric models: cluster analysis Health Indicators: Coverage (UHC) Health Indicators: Financing Health Indicators: Inequality and Epidemiological Profile 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 0 50 100 150 200 250 300 350 Venezuela Argentina Chile CostaRica Brazil Panama Mexico Uruguay Ecuador ElSalvador Colombia R.Dominicana Nicaragua Honduras Peru Guatemala Paraguay Cuba Bolivia PHARMACEUTICAL SALES, US$ PER CAPITA (2011) PHARMACEUTICAL SALES, % OF HEALTH EXPENDITURE (2011) (secundary axis) Country Price Regulation in the Pharmaceutical Markets Paraguay Regulated: Through different coefficient depending if the product is produced in the country or imported. Ecuador Regulated: There is a limit on the profit margin. Honduras Regulated: There is a limit on the percentage of gross profits. Brazil Regulated: Price-fixing (Drug Market Regulation Council- CMED) Colombia Regulated but with different levels: 1) Direct regulation: Maximum price. 2) Regulated Freedom: There are established criteria and methodologies to determine the prices. Drug markets with high market concentration. 3) Freedom under Surveillance: The manufacturers define the price freely, but they must inform the authorities about any variation. Nicaragua Regulated Argentina No regulation. Sale prices are set according to market demands. Venezuela Mix System: Only the prices of the essential medicines are regulated (essential drugs accounted for around 35% of total pharmaceutical sales in 2010). Bolivia Freedom under Surveillance: the manufacturers and importers define the price freely, but they must inform the authorities. Chile Free Market Costa Rica Free Market El Salvador Free Market Guatemala Free Market Mexico Free Market Panama Free Market Peru Free Market DominicanR. Free Market Uruguay Free Market Pharmaceutical Sales 0.69 2 0.69 0.22 0.83 0.38 0.8 1 0.87 0.69 1.4 1.2 0.49 1 0.85 1.1 0.89 0.14 1.1 7.5 18.9 9.2 5.3 11.2 6.6 2.6 15 10.3 6.3 15.3 11.5 7.2 11.9 8.5 12.4 9.3 3.9 8.5 0 2 4 6 8 10 12 14 16 18 20 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Argentina Bolivia Brazil Chile Colombia CostaRica Cuba DominicanR. Ecuador ElSalvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru Uruguay Venezuela Maternal mortality ratio (per 1000 live births) (2010) (Second Axis) Neonatal mortality rate (per 1000 live births) (2012) (second axis) Immunization, measles (% of children ages 12-23 months) Births attended by skilled health staff (% of total) (Last Available Data) 0 200 400 600 800 1000 1200 1400 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Argentina Bolivia Brazil Chile Colombia CostaRica Cuba DominicanR. Ecuador ElSalvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru Uruguay Venezuela Out-of-pocket health expenditure (% of total expenditure on health) (2011) Health expenditure, public (% of total health expenditure) (2011) Health expenditure per capita (current US$) (2011) 0.0 10.0 20.0 30.0 40.0 50.0 60.0 0% 10% 20% 30% 40% 50% 60% Argentina Bolivia Brazil Chile Colombia CostaRica Cuba DominicanR. Ecuador ElSalvador Guatemala Honduras Mexico Nicaragua Panama Paraguay Peru Uruguay Venezuela Percentage of all NCD deaths occurring under age of 70: Male (2010) Cause of death, by communicable diseases and maternal, prenatal and nutrition conditions (% of total) (2008) Gini coefficient (last data available) (secondary axis)

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