The reiteration of the quo vadis analyzes of the medicine sector in our country surely indicates the interest of the topic, but also the difficulty of diagnosis, and especially of its prognosis. The undersigned is not a fan of big bangs, no matter how much glamor great visions usually generate. I am not revealing anything by saying that the sector has many aspects, from industrial production, exports, research, technological advances for health and well-being, and the momentum with which health spending moves. With such complexity of interests in aligning the purposes of the market with those of well-being under public supervision, it is relatively easy that, starting with a problem of access to a medicine, we end up demanding a State pact for health, so that political parties do not be what they are, so that professionals, managers and politicians are governed by altruism, and other various desiderata.
From a health economics analysis point of view, the incentive for desirable innovation, evaluation and regulatory regulation of what can and cannot be done are always the key pieces. We have before us today, as partial derivatives of the problem in terms of regulation, the proposals for European legislation on the sector; in innovation, a plethora of technological changes that hit even the walls that until now have delimited the sector, and in evaluation, the confirmation of instrumental changes in how to evaluate and weight by severity, funds kept in silos, or the threat of crude interventions in discounts and penalties.
In effect, the new regulation expected from a Europe with little commitment to the health services of Europeans to cover their shame dictates in favor of medicines that are affordable in price, equitably accessible, transparent, in line with the purchasing capacities of the countries... and At the same time, it maintains policies in which price differences (due to purchasing capacity) generate parallel trade and shortages – which is seen as good for a single market – and a lack of transparency comes face to face with international reference prices. Or the maintenance of a patent regime that offers modifications to dominant positions for those who advocate in favor of competition. So many inconsistencies are difficult to digest. And, above all, because Europe dictates, regulates and then leaves the cost of compliance to the states themselves.
This drift generates in a country like ours the prediction of how tempting it will be for the State to centrifuge its imbalance to the autonomous communities: one defines the portfolio and others fit the invoices that are generated. And all this after the recognition from the economy and the industry of the relevance of the sector and the pharmaceutical industry in general, well received in these environments, and without reciprocated financial kindness towards the public managers of the medicine on a day-to-day basis.
This leaves the health sector and the public management of medicines on the back foot, with budgetary growth allocations for all expenditure that often completely absorb the increase in the pharmaceutical part. Europe centrifuges the states; these, in Spain, to the Autonomous Communities; their Treasury advisors, to those of Health, and these, for a “take these straws away from me there”, centrifuge the managers of pharmaceutical spending, who must harness the powers and capabilities of a modern, international industry, counting on an instrument to do so. fragile and often not supported by public opinion, which they claim to protect.
In this situation, the antidote can be none other than clarifying as much as possible the social issue implicit in the value of the medicine, and incorporating, involving them in the decision, those who have control and maximum responsibility for the sustainability of the system. To do this, the more at the top, the better: presidency, economy and downwards.
That the drug manager ignores the global problem and takes responsibility for sustainability is absurd. As it is that some health economists lend themselves to being architects of economic restrictions in the health world, ignoring the reality of the opportunity costs of spending in other sectors of social policy.
