RESUMO
The potential health and economic value of a vaccine for coronavirus disease (COVID-19) is self-evident given nearly 2 million deaths, "collateral" loss of life as other conditions go untreated, and massive economic damage. Results from the first licensed products are very encouraging; however, there are important reasons why we will likely need second and third generation vaccines. Dedicated incentives and funding focused explicitly on nurturing and advancing competing second and third generation vaccines are essential. This article proposes a collaborative, market-based financing mechanism for the world to incentivize and pay for the development of, and provide equitable access to, second and third generation COVID-19 vaccines. Specifically, we propose consideration of a Benefit-Based Advance Market Commitment (BBAMC). The BBAMC uses health technology assessment to determine value-based prices to guarantee overall market revenues, not revenue for any specific product or company. The poorest countries would not pay a value-based price but a discounted "tail-price." Innovators must agree to supply them at this tail price or to facilitate technology transfer to local licensees at low or zero cost to enable them to supply at this price. We expect these purchases to be paid for in full or large part by global donors. The BBAMC therefore sets prices in relation to value, protects intellectual property rights, encourages competition, and ensures all populations get access to vaccines, subject to agreed priority allocation rules.
Assuntos
COVID-19/prevenção & controle , Saúde Global/economia , Programas de Imunização/economia , COVID-19/economia , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/uso terapêutico , Defesa Civil/métodos , Defesa Civil/tendências , Competição Econômica/normas , Competição Econômica/tendências , Saúde Global/tendências , Humanos , Programas de Imunização/métodos , Tratamento Farmacológico da COVID-19RESUMO
Just as tariffs lead to economic distortions and provide incentives for corruption, so do patent monopolies on prescription drugs, except the impact is often an order of magnitude larger.
Assuntos
Comércio , Indústria Farmacêutica/economia , Patentes como Assunto , Medicamentos sob Prescrição/economia , Revelação/normas , Competição Econômica/normas , Apoio à Pesquisa como AssuntoRESUMO
We used 2010-16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.
Assuntos
Certificado de Necessidades/economia , Atenção à Saúde/métodos , Competição Econômica/normas , Agências de Assistência Domiciliar/economia , Certificado de Necessidades/tendências , Estudos de Coortes , Atenção à Saúde/normas , Atenção à Saúde/tendências , Competição Econômica/tendências , Agências de Assistência Domiciliar/organização & administração , Agências de Assistência Domiciliar/tendências , Humanos , Estados UnidosRESUMO
The cost of prescription drugs in the United States continues to be a source of concern for patients, caregivers, and policymakers. Drug prices typically decline rapidly once generic drugs receive US Food and Drug Administration (FDA) approval and enter the market, but the past decade has witnessed rising costs and shortages of generic drugs. We describe the strategies used by brand-name manufacturers to undermine generic competition and the reasons underlying the price increases of off-patent drugs, some of which continue to lack any competition from generic versions, and others that have increased in price despite having generic versions. We discuss the FDA's role in addressing drug prices and promoting competition, including recent agency policies to modify its process of reviewing generic drug applications and to prioritize applications for off-patent drugs with few competitors. We also examine proposed policy solutions and research areas that could help address the price increases of off-patent drugs.
Assuntos
Custos e Análise de Custo/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/normas , Competição Econômica/legislação & jurisprudência , Legislação de Medicamentos/tendências , Aprovação de Drogas/legislação & jurisprudência , Custos de Medicamentos/normas , Indústria Farmacêutica , Competição Econômica/normas , Humanos , Políticas , Medicamentos sob Prescrição/economia , Estados Unidos , United States Food and Drug AdministrationRESUMO
A lack of access to critical drugs in the USA, either due to exorbitant prices or shortages, has become a troubling norm that threatens the quality and safety of healthcare. In 2017, there were shortages of 146 commonly used drugs including electrolytes, chemotherapy, cardiovascular, and antibiotic agents. For example, there currently exists a shortage in intravenous fluids and injectable opioids (both in chronic short supply for years) that has been respectively ascribed to disruptions in pharmaceutical manufacturing by Hurricane Maria and manufacturing delays. These explanations, however, mask a more fundamental and avoidable cause: a lack of healthy competition in the generic drug market which is likely contributing to price hikes and shortages. By understanding this underlying cause, we hope to illuminate a pathway from our current state of complacency, where drug price hikes and shortages are routine, to a future state of effective action, where patients have reliable access to vital drugs. This article outlines a roadmap to influence incentives, regulations, new drug development, and ultimately stakeholder (i.e., patients, providers, and drug makers) behavior to enhance competition, with the ultimate aim of improving the quality and safety of healthcare for our patients.
Assuntos
Custos de Medicamentos/normas , Indústria Farmacêutica/normas , Medicamentos Genéricos/normas , Competição Econômica/normas , Qualidade da Assistência à Saúde/normas , Indústria Farmacêutica/economia , Medicamentos Genéricos/economia , Competição Econômica/economia , Humanos , Qualidade da Assistência à Saúde/economiaAssuntos
Competição Econômica/organização & administração , Pessoal de Saúde/organização & administração , Competição Econômica/economia , Competição Econômica/normas , Europa (Continente) , Custos de Cuidados de Saúde , Pessoal de Saúde/economia , Pessoal de Saúde/normas , Humanos , Qualidade da Assistência à SaúdeRESUMO
OBJECTIVE: To compare prices of medicines, both originators and generics, in New Zealand and 16 European countries. METHODS: Ex-factory price data as of December 2012 from New Zealand and 16 European countries were compared for a basket of 14 medicines, most of which were at least partially funded by the state in the 17 countries. Five medicines had, at least in some countries, generic versions on the market whose prices were also analyzed. Medicine price data for the 16 European countries were provided by the Pharma Price Information service. New Zealand medicine prices were retrieved from the New Zealand Pharmaceutical Schedule. Unit prices converted into euro were compared at the ex-factory price level. RESULTS: For the 14 medicines surveyed, considerable price differences at the ex-factory price level were identified. Within the European countries, prices in Greece, Portugal, the United Kingdom, and Spain ranked at the lower end, whereas prices in Switzerland, Germany, Denmark, and Sweden were at the upper end. The results for New Zealand compared with Europe were variable. New Zealand prices were found in the lowest quartile for five medicines and in the highest quartile for seven other products. Price differences between the originator products and generic versions ranged from 0% to 90% depending on the medicine and the country. CONCLUSIONS: Medicine prices varied considerably between European countries and New Zealand as well as among the European countries. These differences are likely to result from national pricing and reimbursement policies.
Assuntos
Custos de Medicamentos , Medicamentos Genéricos/economia , Competição Econômica/economia , Custos de Medicamentos/normas , Medicamentos Genéricos/normas , Competição Econômica/normas , Europa (Continente) , Humanos , Nova ZelândiaRESUMO
This short commentary on Oliver's review of incentives relates that review to four models of governance: Trust and Altruism (T&A), Choice and Competition (C&C), Naming and Shaming (N&S) and Targets and Terror (T&T).
Assuntos
Competição Econômica/organização & administração , Motivação , Qualidade da Assistência à Saúde/organização & administração , Confiança , Benchmarking , Competição Econômica/normas , Humanos , Qualidade da Assistência à Saúde/normas , Medicina Estatal , Reino UnidoAssuntos
Serviços de Saúde Comunitária/economia , Equipamentos e Provisões/economia , Setor Privado/economia , Medicina Estatal/economia , Comércio/economia , Comércio/legislação & jurisprudência , Serviços de Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/normas , Competição Econômica/legislação & jurisprudência , Competição Econômica/normas , Inglaterra , Equipamentos e Provisões/normas , Regulamentação Governamental , Humanos , Setor Privado/legislação & jurisprudência , Setor Privado/tendências , Medicina Estatal/legislação & jurisprudência , Medicina Estatal/normas , Integração de SistemasAssuntos
Serviços Comunitários de Farmácia/economia , Custos de Medicamentos/tendências , Indústria Farmacêutica/economia , Seguro de Serviços Farmacêuticos/economia , Honorários por Prescrição de Medicamentos/tendências , Atitude do Pessoal de Saúde , Indústria Farmacêutica/organização & administração , Competição Econômica/normas , Competição Econômica/tendências , Humanos , Estados UnidosRESUMO
The US hospital service price structures are complex and tend to be significantly higher than the actual cost to provide the service. Health care consumers have been given more authority to drive health care decisions. Transparency in health care is forcing hospitals to critically review and substantiate service prices. It is vital that US hospitals review their pricing strategies in order to continue as strong leaders in the health care market.
Assuntos
Acesso à Informação/legislação & jurisprudência , Preços Hospitalares/legislação & jurisprudência , Medicare/legislação & jurisprudência , Competição Econômica/legislação & jurisprudência , Competição Econômica/normas , Competição Econômica/tendências , Preços Hospitalares/normas , Preços Hospitalares/tendências , Humanos , Medicare/economia , Medicare/tendências , Satisfação do Paciente , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/legislação & jurisprudência , Mecanismo de Reembolso/tendências , Estados UnidosAssuntos
Atenção à Saúde/economia , Competição Econômica/normas , Coalizão em Cuidados de Saúde/economia , Instalações de Saúde/economia , Marketing de Serviços de Saúde/normas , Aniversários e Eventos Especiais , Competição Econômica/tendências , Ética nos Negócios , Humanos , Marketing de Serviços de Saúde/economia , Marketing de Serviços de Saúde/tendênciasRESUMO
The specific aim of this analysis is to demonstrate how the trade-off between efficiency and equity policy approaches affects the ability of at-risk children to access quality health care services at the King/Drew Medical Center of Los Angeles County from 1980 to 2000. The concept of a second market phenomenon is used as a framework to illustrate how efficiency-seeking behaviors of federal, state, and local government actors affected government intervention efforts initiated to remedy health care access hardships created by market failure in low-income communities. A second market failure occurs when government failure results from the reintroduction of market protocols in an environment where the market had originally failed to facilitate the distribution of basic goods and services. The review suggest that financial austerity at the Los Angeles County Department of Health Services in the context of federal, state, and local government policies that emphasized allocative efficiencies, compromised equity values by undermining access to quality pediatric services at the King/Drew Medical Center which was a municipal academic medical center.
Assuntos
Centros Médicos Acadêmicos/economia , Serviços de Saúde da Criança/economia , Política de Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Qualidade da Assistência à Saúde/economia , Centros Médicos Acadêmicos/legislação & jurisprudência , Centros Médicos Acadêmicos/organização & administração , California , Criança , Serviços de Saúde da Criança/legislação & jurisprudência , Controle de Custos/normas , Competição Econômica/normas , Competição Econômica/tendências , Eficiência Organizacional , Administração Financeira de Hospitais , Financiamento Governamental/normas , Financiamento Governamental/tendências , Regulamentação Governamental , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Los Angeles , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Reembolso Diferenciado/economia , Reembolso Diferenciado/legislação & jurisprudência , Estados UnidosRESUMO
OBJECTIVES: To investigate whether market competition is a potential driver of hospital performance on the key evidence-based Joint Commission heart-failure (HF) quality indicators of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescribed, left ventricular function assessment, smoking-cessation counseling, and discharge instructions. STUDY DESIGN: Retrospective multivariate analysis. METHODS: Hospital performance data for HF was obtained from The Joint Commission's ORYX program from 2003 to 2006. The performance data were linked with hospital characteristics from the American Hospital Association Annual Survey and area-level sociodemographic information from the Area Resource File. Healthcare markets were defined as hospital referral regions (HRRs) and market competition intensity was defined by the Herfindahl-Hirschman Index. Hospital-level and HRR-level ordinary least squares fixed effects regression models were used to estimate the relationship between market competition and performance. RESULTS: A paired comparison indicated that there was a significant change in the mean hospital-level performance over time on all of the HF quality indicators. From the multivariate analyses, hospitals in the least competitive markets (Quintile 5) performed slightly better (2.9%) than the most competitive markets (Quintile 1) for left ventricular function assessment (P <.01). At the HRR level, however, the least competitive markets (Quintile 5) performed moderately worse (5.1%) on the discharge-instructions quality indicator compared with the most competitive markets (Quintile 1) (P = .05). CONCLUSIONS: Market competition intensity was associated with only small differences in hospital performance. The level of market competitiveness may produce only marginal incremental benefits to inpatient HF care.
Assuntos
Competição Econômica/normas , Eficiência Organizacional/normas , Setor de Assistência à Saúde/normas , Insuficiência Cardíaca/tratamento farmacológico , Hospitais/normas , Qualidade da Assistência à Saúde/normas , Antagonistas de Receptores de Angiotensina/economia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Eficiência , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Insuficiência Cardíaca/economia , Hospitais/estatística & dados numéricos , Humanos , Modelos Organizacionais , Análise Multivariada , Análise de Regressão , Estudos Retrospectivos , Abandono do Hábito de Fumar , Estados UnidosRESUMO
PURPOSE: In 2000 the Skåne Region (a public authority) and a private contractor made a five-year agreement for the provision of both in-patient care and out-patient medical services to about 30,000 inhabitants in the south-east part of the region. The Skåne Region is the main provider of health care to about one million inhabitants in the south of Sweden and is responsible for all health care (private and public), including ten hospitals. This paper seeks to answer the question of how the Skåne Region can control and cooperate with a private contractor, entering into competition with the public health care providers in the region. DESIGN/METHODOLOGY/APPROACH: This is a longitudinal study conducted between 2001-2006. It is based on 28 taped interviews with employees responsible for the contracting process, participating observations and comprehensive secondary material. The study presents experiences made by the contractor and the public authority on how to work out and follow-up assignments within the health care sector regarding patient interest, public interest and professional medical interest. FINDINGS: Measurement within the frames of the balanced scorecard (BSC) made it possible to control both volumes and health care quality delivered by the private competing contractor. The political purchaser claims that the Skåne Region has established a cost-effective and successful control system based on trust and measurement. ORIGINALITY/VALUE: This paper reports on a control system, between public purchaser and a private provider within health care, that focuses on and follow-up not only health care production but also health care quality.
Assuntos
Serviços Contratados/organização & administração , Comportamento Cooperativo , Competição Econômica/organização & administração , Administração Hospitalar/métodos , Privatização/organização & administração , Medicina Estatal/organização & administração , Serviços Contratados/economia , Serviços Contratados/normas , Competição Econômica/economia , Competição Econômica/normas , Humanos , Estudos Longitudinais , Privatização/economia , Privatização/normas , Qualidade da Assistência à Saúde/organização & administração , Medicina Estatal/economia , Medicina Estatal/normas , SuéciaRESUMO
Over the last 20 years strategies introducing regulated competition have gradually been implemented in the corporatistically structured German healthcare system. In particular, this applies to the structure of health insurance organisation where the corporatively organised allocation system has deliberately been transformed to ensure health insurance choice. Accordingly, the laws governing membership, health insurance premiums and health benefits have been adapted and new rules for public finance including a risk structure compensation scheme encompassing the different kinds of health insurances have been established. The options for competition arising in the area of health service provision do not only affect the health insurance companies themselves, but also the relations to the providers of healthcare as well as their relationship with each other. This holds especially true of the role and function of the (regional) physicians' associations. The relation between collective agreements and individual contracts is still unclear. With the further development of strategies introducing regulated competition the possibilities and limitations of competition will have to be explored and many details--such as, for example, the implementation of the responsibility for ensuring the provision of healthcare services--need to be resolved.
Assuntos
Atenção à Saúde/legislação & jurisprudência , Política , Atenção à Saúde/normas , Competição Econômica/legislação & jurisprudência , Competição Econômica/normas , Alemanha , Humanos , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/normas , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/normasRESUMO
Economic sociologists have argued that financial markets should be analysed as uncertainty-processing social networks and intermediary groups. Networks and intermediaries alone cannot confer legitimacy upon financial actors and transactions. Status groups are a solution to this problem. They emphasize reputation, honour and good social behaviour as stabilizers of collective action, as means of social control and as indicators of legitimacy. I examine here the emergence and evolution of status groups of brokers in London, New York and Paris, and show how emphasis on honour was used to legitimize financial transactions. I argue that financial markets should be conceived as networks, intermediary and status groups. In global, automated financial markets status groups like securities analysts are gaining in prominence.
Assuntos
Comércio/história , Competição Econômica/economia , Organização do Financiamento/economia , Capitalismo , Comércio/legislação & jurisprudência , Comércio/tendências , Competição Econômica/normas , Organização do Financiamento/normas , Hierarquia Social , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Londres , New York , Paris , Classe Social , Apoio SocialRESUMO
The prevailing imbalance in the buyer-seller relationship is threatening access of innovative medical technologies to patients. Proposed steps to remedy the situation are outlined here.