PubMed · 16792215
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Claudia Wallis. 2006-06-12. Decoding the grocery store.. https://pubmed.ncbi.nlm.nih.gov/16792215/
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The rising demand and increasing scarcity of donor oocytes in developed countries have led to some fertility clinics sourcing oocyte donors from abroad, particularly from poorer countries, in what is referred to as 'transnational' or 'international' oocyte donation. In a further new 'twist' to this scheme, frozen sperm of the recipient's male partner is exported abroad through courier mail and is used to fertilise donor oocytes in a foreign clinic to produce embryos, which are then cryopreserved and imported back by mail for transfer to the woman. There are numerous ethical concerns with regards to such means of procuring donor oocytes. First, there is an issue of exploiting economically underprivileged women in poorer countries and disproportionate gains on the part of medical doctors and fertility clinics. Second, there is a question of abdication of responsibility for the donor's welfare on the part of the fertility doctor who takes charge of the recipient's treatment abroad if oocyte donors were to develop severe ovarian hyperstimulation syndrome. Third, the issue of responsibility and accountability becomes even more contentious if congenital defects were to appear in offsprings born from transnational oocyte donation or in the case of transmission of communicable diseases such as hepatitis B, syphilis and AIDS to the recipient. Last, cost savings from the lower prescription price of fertility drugs in economically less-developed countries may not be passed down to the oocyte recipient but instead be exploited to boost the already substantial profit margin of fertility clinics and doctors.
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In contrast to other EU countries, Cyprus lacks comprehensive health care coverage for its population, thus a significant portion of the population lacks insurance for medicines. Due to the small size of the country and small indigenous pharmaceutical industry, pharmaceuticals are mainly imported. Prices in the private sector are determined based on the ex-factory price from the country of origin. Distribution margins are calculated as a percentage of the import price, which creates perverse incentives for wholesalers to import products from high price countries, or import very expensive products, to maximize their income. In this article, we compare pharmaceutical prices in Cyprus to other EU counties with higher or similar GDP per capita and found Cyprus to be a high price country. We then propose a new pricing system to change wholesaler incentives, which would encourage them to shop around for the best buy in Europe. Prices can be set based on average prices from a basket of European countries, and adjusted to reflect the GDP per capita level in Cyprus. This will establish the wholesale price that the government will accept, and wholesalers can procure products from any country at a lower rate. Thus, wholesalers would be encouraged to go for the lowest prices and the authorities would be indifferent to the actual price they obtain, so long as the necessary criteria (good manufacturing practice, safety, effectiveness and efficacy) are met. Our proposal has implications for low and middle income countries where this system of pharmaceutical pricing and wholesaler incentives can be used.