Pharmaceutical drug development: high drug prices and the hidden role of public funding.

In 2019, the record for the most expensive drug was broken at US$2.1 million per patient. The high costs of new drugs are justified by the pharmaceutical industry as the expense required for maintaining research and development (R&D) pipelines. However, this does not take into account that globally the public pays for between one to two-thirds of upfront R&D costs through taxpayers or charitable donations. Governments are effectively paying twice for medicines; first through R&D, and then paying the high prices upon approval. High drug prices distort research priorities, emphasising financial gains and not health gains. In this manuscript, issues surrounding the current patent-based drug development model, public funding of research and pharmaceutical lobbying will be addressed. Finally, innovations in drug development to improve public health needs and guaranteeing medication access to patients will be explored.

Does the New Rural Pension Scheme improve residents' livelihoods? Empirical evidence from Northwestern China.

The sustainable development of pension systems has been investigated from a financial perspective worldwide. However, the pension adequacy and its effect on the sustainability of a national pension system are still understudied. Using actual replacement rate and modified living standards replacement rate, this study empirically evaluates whether China's New Rural Pension Scheme (NRPS) grants enough livelihood protection for the rural residents in the Northwestern China. The results show that the NRPS fails to meet the basic needs of the elderly people (i.e., age of sixty years or older) or the middle-aged people (forty-five to fifty-nine years old), while it only provides limited protection for the young people (sixteen to forty-four years old). These findings suggest that the current NRPS benefits are very low in the Northwestern China and policy reforms should be further implemented to improve the sustainable development of the New Rural Pension Scheme.

The role of premium subsidies in crop insurance.

This study develops a novel framework of heterogeneous producer attitudes towards risk to analyze different, stated and revealed, roles of crop insurance premium subsidies and underlying policy objectives of the government. The analysis reveals a strong connection and a complementarity between the roles of premium subsidies in increasing producer participation in crop insurance, inducing a desired separating equilibrium in the presence of asymmetric information, and transferring income to agricultural producers participating in the program. Developing an alternative design of premium subsidies that can achieve the stated government objective of increased producer participation and induce any desired separating equilibrium at significantly reduced costs, our study rejects the idea that the income redistribution taking place under the current policy design is necessary for increasing producer participation in crop insurance. Indeed, the current policy design reveals that premium subsidies are either a means of income redistribution or a policy failure.

Contemporary Trends and End-Results of National Institutes of Health Grant Funding to Departments of Urology in the United States: A 10-year Analysis.

PURPOSE: We explored the patterns and distribution of National Institutes of Health grant funding for urological research in the United States. MATERIALS AND METHODS: The National Institutes of Health RePORTER database was queried for all grants awarded to urology departments between 2010 and 2019. Information regarding the value of the grant, funded institution, successful publication of the research, and the category of urological subspecialty were collected. Data on principal investigators were extracted from publicly available information. RESULTS: There were 509 grants awarded to Urology between 2010 and 2019 for a total value of $640,873,867, and a median per-project value of $675,484 (IQR 344,170-1,369,385). Over the study period, total funding decreased by 15.6% and was lower compared to other surgical subspecialties. Most grants were awarded by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases (85%) to Western or North Central institutions (52.5%), and had principal investigators specialized in urologic oncology (56.4%), followed by general urologists (21.5%). Female principal investigators led 21.6% of Urology grants and were more likely PhD basic scientists than males (64.4% vs 38.2%, p=0.001). In total, 10,404 publications linked to the 509 grants were produced, of which 28.5% were published in journals with an impact factor ≥10. CONCLUSIONS: Urology is underrepresented in National Institutes of Health grant funding compared to other surgical fields. During the past decade there was a further decrease in the total budget of National Institutes of Health grants to Urology.

Different impacts of the zero-markup drug policy on county general and traditional Chinese medicine hospitals: evidence from Shandong province, China.

BACKGROUND: As a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals. METHODS: We obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007-2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP. RESULTS: On average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20, 32.58 and 6.08% respectively, and up to 28.53, 63.89 and 17.94% after adoption, while government subsidies increased by around 170 to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals. CONCLUSION: The ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals' revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM.

Current State and Future of Research in Nephrology.

The focus of this article is to review the available funding opportunities for the nephrology workforce at all career levels and review the current challenges involved in the career of a physician-scientist. While the scarcity of nephrology fellows for training programs is a continuing challenge, increased funding for the National Institutes of Health is encouraging particularly for early career investigators. In addition to National Institutes of Health funding, other funding sources are also discussed as they provide much needed bridge funding during key transition periods for young careers. Recent initiatives such as the Advancing American Kidney Health, KidneyX, and National Institute of Diabetes and Digestive and Kidney Diseases' Kidney Precision Medicine Project offer new research opportunities for bringing much needed innovation to improve lives of people with kidney diseases. The time is now for us to seize the opportunity and ensure that a strong workforce will be able to take advantage of these potential game changers for nephrology.

NIH funding trends to US medical schools from 2009 to 2018.

Total NIH funding dollars have increased from 2009-2018. We questioned whether this growth has occurred proportionately around the country and throughout allopathic medical schools. Therefore, we compared the trend in NIH grant funding from 2009 to 2018 for United States allopathic medical schools among historically top-funded schools, private and public schools, and by region of the country. Changes in both unadjusted and real funding dollars over time revealed a significant difference. Region was the only significant factor for mean percent change in funding from 2009-2018, with the Western region showing a 33.79% increase in purchasing power. The Northeastern region showed a -6.64% decrease in purchasing power while the Central and Southern regions reported changes of 2.46% and -6.08%, respectively. The mean percent increases were more proportional and nonsignificant in the public vs. private institutions comparison, at -3.41% and 4.75%, respectively. Likewise, the top-funded institutions vs. other institutions comparisons demonstrated modest, nonsignificant differences. However, although the relative changes might be proportional, the absolute increases evidence a pattern of growing cumulative advantage that favor the highest-funded institutions and private institutions. The potential consequences of this disproportionate increase include health science education, biomedical research, and patient access disparities in large parts of the country. The NIH and the scientific community should explore potential solutions in its funding models.

A social cost-benefit analysis of meat taxation and a fruit and vegetables subsidy for a healthy and sustainable food consumption in the Netherlands.

BACKGROUND: Implementation of food taxes or subsidies may promote healthier and a more sustainable diet in a society. This study estimates the effects of a tax (15% or 30%) on meat and a subsidy (10%) on fruit and vegetables (F&V) consumption in the Netherlands using a social cost-benefit analysis with a 30-year time horizon. METHODS: Calculations with the representative Dutch National Food Consumption Survey (2012-2014) served as the reference. Price elasticities were applied to calculate changes in consumption and consumer surplus. Future food consumption and health effects were estimated using the DYNAMO-HIA model and environmental impacts were estimated using Life Cycle Analysis. The time horizon of all calculations is 30 year. All effects were monetarized and discounted to 2018 euros. RESULTS: Over 30-years, a 15% or 30% meat tax or 10% F&V subsidy could result in reduced healthcare costs, increased quality of life, and higher productivity levels. Benefits to the environment of a meat tax are an estimated €3400 million or €6300 million in the 15% or 30% scenario respectively, whereas the increased F&V consumption could result in €100 million costs for the environment. While consumers benefit from a subsidy, a consumer surplus of €10,000 million, the tax scenarios demonstrate large experienced costs of respectively €21,000 and €41,000 million. Overall, a 15% or 30% price increase in meat could lead to a net benefit for society between €3100-7400 million or €4100-12,300 million over 30 years respectively. A 10% F&V subsidy could lead to a net benefit to society of €1800-3300 million. Sensitivity analyses did not change the main findings. CONCLUSIONS: The studied meat taxes and F&V subsidy showed net total welfare benefits for the Dutch society over a 30-year time horizon.

Prescribed Drug Spending in Canada, 2019: A Focus on Public Drug Programs.

Public drug program spending accounts for 43.1% of prescribed drug spending in Canada. This report provides an in-depth look at public drug program spending in Canada, using the Canadian Institute for Health Information's (CIHI) National Prescription Drug Utilization Information System. Public drug program spending does not include spending on drugs dispensed in hospitals or on those funded through cancer agencies and other special programs.

The Use of Ripple Effect Mapping to Understand Successes of the SC Pregnancy Assistance Fund: A Participatory Evaluation Approach.

OBJECTIVES: The South Carolina Pregnancy Assistance Fund (SCPAF) funded four counties to increase the amount, quality, and awareness of services for young parents; increase educational attainment among expectant and parenting youth; reduce the number of repeat teen pregnancies among youth; and improve parenting skills. The purpose of this paper is twofold: (1) to describe our application of the Ripple Effect Mapping (REM) technique as an innovative evaluation strategy to gather perspectives from SCPAF stakeholders and (2) to share key findings generated by participants in REM sessions on the perceived success of local SCPAF community collaboratives. METHODS: REM, an innovative evaluation strategy, was used to gather perspectives from SCPAF stakeholders. Five REM sessions were conducted with 52 participants. REM sessions included partner interviews and collective development of visual maps to illustrate stakeholder perspectives of program successes. Visual maps, as well as transcripts of discussions, were analyzed using an inductive approach. RESULTS: Stakeholders reported that the connections to resources, supports, and services provided through SCPAF had the potential to alter the life trajectories of expectant and parenting teens (EPT). Stakeholders also described that SCPAF fostered growth in collaboration among partners and reduced duplication of services in funded communities CONCLUSIONS FOR PRACTICE: This paper describes how an innovative evaluation strategy was used to provide a space for stakeholders to dialogue, synthesize their experiences, and construct a collective narrative of key program successes. This paper also illustrates how such approaches can be applied to complex community initiatives.

A "health in all policies" review of Canadian public finance.

RéSUMé: OBJECTIF: Il est démontré que la santé est principalement le fruit de ses déterminants sociaux, et comme de fait, la recherche sur les systèmes de santé montre que les dépenses publiques relatives aux programmes sociaux sont souvent plus fortement corrélées à la santé des populations que les investissements dans les soins médicaux. Notre étude vise à aider les Cabinets provinciaux et fédéraux du Canada à en prendre acte en introduisant le concept de « la santé dans toutes les politiques ¼ (Health in All Policies, ou HiAP) dans les débats budgétaires. MéTHODE: L'étude est descriptive; elle analyse des données secondaires accessibles au public sur les budgets fédéraux et provinciaux pour déterminer comment le financement public des investissements dans les déterminants sociaux de la santé (DSS) aux stades précoces (< 45 ans) et ultérieurs (65 ans et plus) du parcours de vie a évolué depuis 1976 par rapport aux investissements dans les soins médicaux. RéSULTATS: Les dépenses en soins médicaux ont augmenté de 3 983 $ par personne de 65 ans et plus depuis 1976. Cette augmentation dépasse de 45 % l'augmentation combinée des dépenses en services de garde, en congés parentaux, en aide au revenu familial, en éducation et en soins médicaux par personne pour les moins de 45 ans. De toutes les nouvelles dépenses pour les Canadiens plus jeunes, les soins médicaux ont reçu les investissements les plus importants. Alors que les dépenses médicales pour les retraités ont dépassé d'un peu plus de la moitié le rythme des dépenses en revenus de retraite, les dépenses médicales pour les Canadiens plus jeunes ont augmenté presque autant que les dépenses pour l'ensemble des politiques de DSS à leur endroit. CONCLUSION: Depuis 1976, il y a une plus grande concordance entre l'approche HiAP et le financement public du Canada pour les aînés que pour les Canadiens plus jeunes. Ces résultats offrent aux décideurs d'importantes informations rétrospectives pour évaluer les futurs investissements publics dans les soins médicaux et les déterminants sociaux de la santé pour tout le parcours de vie, ainsi que les plans de financement de ces investissements.