Biomedical subjects

H Redwood

Publications and source records attributed to H Redwood.

4 recordsLinked to original sources

PubMed1998

Pharmaceutical cost containment and quality care. Conflict or compromise?

Existing methods of pharmaceutical cost containment are relatively primitive weapons of expenditure restraint. Their effectiveness is generally limited to short term savings. The conflict between cost containment and quality is epitomised by the 'Drug Budget', which conditions payers to regard pharmaceuticals solely as a cost input without considering the results of their use in terms of integrated health outcomes, crossing the budgetary boundaries between drugs, hospitals, ambulatory and other forms of healthcare. A further problem, also related to the separation of inputs from outcomes, is the contention by healthcare payers that, even if 'expensive' innovative drugs offer Value for Money, budget holders cannot afford the required Money for Value. The limits of affordability are real in poor countries. In rich industrialised nations, the affordability of quality is in essence a political rather than an economic issue. In making choices and determining priorities, elected governments are usually responsive to public opinion, which is coming to regard the issue of quality in healthcare as one of the highest social priorities. Pharmaceutical innovation has much to contribute to quality in healthcare. A compromise between pharmaceutical cost containment and quality is feasible, based on input/outcome considerations, rational drug pricing, and re-engineering decision-making by payers away from the simplistic notion that the cheapest drug budget is necessarily the best.

Cost Control↗

PubMed1998

Pharmaceutical reference prices. How do they work in practice?

Reference pricing systems are reimbursement ceilings set by payers in an effort to constrain pharmaceutical expenditure for a private or public drug benefit. In recent years, many governments have adopted reference pricing either as a replacement or in addition to product specific price controls. Programme administrators should consider whether these policies are providing the intended benefits or whether there may be a more effective method. This article provides a review of reference pricing in Europe, North America and other countries. There are many similarities in the reference price policies but the markets to which they apply are more likely to be different. The European experience gives a 'once-for-all' lowering effect on pharmaceutical expenditure, often at the expense of compromises on prescribing. In Germany and The Netherlands, reference pricing has been relatively ineffective in lowering expenditure which has led to a succession of other interventions to achieve expenditure control goals. The US also has reference pricing, but it occurs in a very competitive market which may be responsible (at least in part) for the relatively modest growth in expenditure compared with European countries. The review of countries with reference pricing policies suggests that such policies are less effective than competitive markets in moderating pharmaceutical expenditure. Nonetheless, governments continue to pursue reference pricing strategies.

Canada↗

PubMed1994

Public policy trends in drug pricing and reimbursement in the European Community.

In the European Community, the key issue of cost containment in healthcare (including pharmaceuticals) is dominated by three main background influences: The principle of 'solidarity' (society's responsibility for those who cannot afford to pay the full cost of healthcare); 'subsidiarity' (doing nationally what is best done nationally rather than at the Community level); and the 'pharmapolitics' of balancing the drug budget with the demands of patients in their capacity as voters. Pharmaceutical expenditure generally exceeded the rate of inflation during the 1980s despite legislation to contain costs. In the 1990s, more intensive efforts are being applied to oblige doctors to prescribe rationally and economically whilst putting even greater pressure on the pharmaceutical industry. Again with an eye on electoral repercussions, only limited attempts to make patients pay a higher proportion of total costs have so far been made.

Budgets↗

PubMed1989

The future for pharmaceuticals in a health care crisis.

When an industry reaches a turning point, everyone in it is drawn into the turmoil. Not that it happens frequently, but most industries pass more than one major turning point in the course of an executive career of average length. The experience is unsettling--especially if preceded by a general reluctance to anticipate it or its consequences. Corporate strategy is usually concerned above all with the competitive positioning of a company within an industry or, if diversified, in a number of industries. To this two-dimensional picture, which takes the company and its competitors as the main variables, we need to add the changing background of the industry itself: a third dimension that challenges the powers of adaptation of all the competitors. It compels them to acknowledge as real the forces that are unleashed by time as industries mature and society changes. This paper explores the turning points that have occurred during the past 30 years in one particular industry--pharmaceuticals--and seeks to distil from it a number of lessons that may be relevant to industrial strategy in a wider framework.

Australia↗