scholarly journals 6.F. Round table: What is the evidence for and against price transparency in pharmaceutical pricing and procurement?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
Keyword(s):  
Full Range ◽  
Round Table ◽  
World Health ◽  
Pharmaceutical Pricing ◽  
Price Inflation ◽  
Price Transparency ◽  
Goods And Services ◽  
Pharmaceutical Procurement ◽  
Lower Ability ◽  
Pharmaceutical Prices

Abstract Although the potential for price transparency in pharmaceutical systems has been widely debated, there has been less discussion of the empirical basis to inform policymaking in this area. The lack of price transparency is viewed as one of the biggest barriers to joint pharmaceutical procurement, an initiative that has the potential to drive down pharmaceutical prices by pooling the purchasing power of smaller populations and thus improve the affordability of medicines. However, critics of the call for increased transparency in pharmaceutical pricing argue that such policies would lead to price inflation, particularly for countries with lower ability to pay or limited negotiating power. Given the widespread use of negotiated confidential discounts granted to different payers by manufacturers and the pervasiveness of international reference pricing as a policy mechanism for determining pharmaceutical prices, transparency policies would not only affect countries directly implementing them. As a result, policy-makers are often reluctant and unsure about how to proceed; this became readily apparent in the discussions around the Transparency Resolution at the World Health Assembly in May 2019. A concise overview of the evidence on the consequences of transparency policies is lacking. This panel draws on a wide-ranging literature review that sought to answer the following key research questions: Is there empirical evidence that examines the effect of price transparency on price development (within countries implementing the policy as well as other countries) In the area of pharmaceuticals? Regarding other types of healthcare goods and services? Regarding products from other industries? What insights can we learn from the available evidence and how transferrable is evidence from other healthcare dimensions or other industries to the issue of price transparency for pharmaceuticals? In this workshop we will bring together researchers to discuss the type of evidence available the extent to which it is empirically grounded. The workshop aims to address this issue and highlight evidence gaps for and against price transparency policies. Each panellist will talk for a maximum of 10 minutes presenting insights from their work; audience members will be actively invited to share their insights and reflections. Key messages The debate on price transparency in pharmaceutical systems needs to advance by looking at the full range of evidence available. Highlighting evidence gaps can endorse real world experiments to test theoretical arguments.

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

2021 ◽  
Author(s):  
Charles W. Patterson ◽  
Patrick A. Palines ◽  
Matthew J. Bartow ◽  
Daniel J. Womac ◽  
Jamie C. Zampell ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Full Range ◽  
Donor Site ◽  
World Health ◽  
Morbidly Obese ◽  
Diep Flap ◽  
Obese Patients ◽  
Class Iii ◽  
Recipient Site ◽  
Surgical Risk

Abstract Background From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30–34), II (BMI: 35–39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications. Results When examined together, the rate of any complication between the three groups only trended toward significance (p = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91–3.20, p = 0.03) and donor site (OR: 2.34, 95% CI: 1.09–5.05, p = 0.03) complications. Conclusion DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.

scholarly journals Round table: Toward a better living with schizophrenia

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Family Members ◽  
Round Table ◽  
Well Being ◽  
World Health ◽  
World Health Report ◽  
Full Time ◽  
Health Administrator ◽  
Positive Effects ◽  
Health Report ◽  
Catchment Areas

Abstract According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability, which accounts for 1.1% of the total DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). In the World Health Report [The WHO World Health Report: new understanding, new hope, 2001. Geneva]. In addition to the direct burden, there is considerable burden on the relatives who care for the sufferers. The workshop aimed to present and discuss different facets of what could be done for these persons and their families’ members in the light of what has been done in some European countries, which have conducted reforms. The round table will be introduced by presentations from two countries very much involved in psychiatric reforms which will present their attempts and results: first Italy with its emblematic radical deinstitutionalization model setting up a law to close down the psychiatric hospitals. The to-day situation will be presented underlying the huge diversity across Italian provinces and the dramatic lack of resources in some of them. Second the Portuguese reform will be described with a shift of psychiatric care toward general hospitals and its complete integration into health care catchment areas resulting in a increase of out patient acts among them home visits and a decrease of full time hospital admissions. Then a French three-year research program that focused on themes that aims to improve the every day well-being of people living with schizophrenia will be presented. This program aimed to provid new insights on their integration from different angles: information about the disease by doctors at diagnostic annoucement, on internet and actions to take on health administrator training against stigmatisation that could be extended to a larger public. Lastly the program allowed to interviewed face to face up to 67 people: 20 persons with schizophrenia, 20 person with bipolar disorders and 27 close ones to schizophrenic patients. A semi-structured interview collected information on the different aspects of care experiences plus “The Brief Illness Perception Questionnaire” allowed to measure and compare perceptions of the disease. This will allow to present the very positive effects of a program toward family members and patients themselves: “psychoeducation” that is a structured educationnal intervention which provides information and guidelines on how to react with their family member and influences positively the patient’s outcome as the well being of both patient and family members. Each presentation will extensively be discussed with the attendance and followed by some recommandations Key messages Although schizophrenia is a severe disorder much could be done to alleviate the burden on the patients and their family members. Reorganising the care systems trough adequate policies, setting up policies against stigmatisation and providing educational intervention should promote patients and families empowerment.

Pharmaceutical Prices

2018 ◽  
Author(s):  
Stuart O. Schweitzer ◽  
Z. John Lu
Keyword(s):  
United States ◽  
Product Quality ◽  
Pharmaceutical Expenditure ◽  
Healthcare Spending ◽  
The United States ◽  
Detailed Examination ◽  
Pharmaceutical Pricing ◽  
The Difference ◽  
The Impact ◽  
Pharmaceutical Prices

This chapter provides a detailed examination of pharmaceutical pricing strategies in the United States. It points out that pharmaceutical expenditure as a share of total healthcare spending has historically been quite low in comparison to that of hospitalization and physician services. It identifies several common measures of pharmaceutical prices, and highlights the difference in conclusions reached based on different measures. It offers a critical review of several models used to explain pharmaceutical price behavior, which are grouped into three major categories: market structure models, R&D cost-based models, and product quality or value based models. The chapter concludes that prices of brand-name drugs in the United States are largely driven by product quality attributes, not cost of R&D. Lastly, the chapter examines the impact of generic entry on price.

scholarly journals Conceptual Principles of State Regulation of Industry on the Basis of New Industrial Policy

2021 ◽  
pp. 197-205
Author(s):  
Eduard SHCHEPANSKIY
Keyword(s):  
Life Cycle ◽  
Industrial Policy ◽  
Structural Adjustment ◽  
Full Range ◽  
State Regulation ◽  
Innovation Activity ◽  
The European Union ◽  
Goods And Services ◽  
Basic Characteristics ◽  
Knowledge Intensive

It is proved that for effective state regulation of industry it is necessary to pursue a clear, high-quality and purposeful state industrial policy. To do this, we should use the full range of available mechanisms and tools. In the course of the research it was established that industrial policy means a set of measures of state regulation of economic processes at the sectoral and corporate levels, aimed at stimulating innovation activity, structural adjustment of the economy and economic growth. The necessity of pursuing the new industrial policy, which can be defined as a policy of maintaining competitiveness, is substantiated. It is determined that the process of state regulation of industry is a set of actions of the state as an institution used to influence the activities of economic entities (enterprises, corporations, entrepreneurs, etc.), as well as certain aspects of this activity related to acquisition of factors of production, organization of production, distribution and sale of goods and services in all phases of the life cycle of the business entity and the life cycle of its products. State regulation based on industrial policy has both positive and critical statements, the essence of which depends on the subject under discussion, namely, policy as a set of state measures and policy as a means to achieve political goals. It is proposed to allocate a list of new conditions for the implementation of effective state regulation of industry on the basis of state industrial policy, which form the conceptual basis of the new industrial policy. The main (basic) characteristics of state regulation of industry on the basis of traditional and new industrial policy are given, where the scenarios of traditional (vertical) policy and new (horizontal) policy are based. Based on the analysis of the practice of state regulation of industry in the European Union, priority areas of regulation have been identified, namely: increasing competitiveness through the development of new markets; strengthening of innovative activity, development of knowledge-intensive businesses; accelerating the process of restructuring companies and industries; improving the institutional and legislative environment; protection of intellectual and property rights; improving the quality and skills of the workforce.

scholarly journals Цифрові платформи як рушійна сила цифрової трансформації економіки

2020 ◽  
pp. 127-132
Author(s):  
Кургузенкова Л.А. ◽  
Федоренко А.І.
Keyword(s):  
Business Models ◽  
Full Range ◽  
Digital Transformation ◽  
Digital Platforms ◽  
Digital Platform ◽  
Market Control ◽  
Goods And Services ◽  
National Market ◽  
The One ◽  
Definition Of

The article deals with the theoretical aspects of structures such as digital platforms, the revelation of the contemporary importance of digital platforms for economic and social development. Digital platforms have been found to be a relatively new phenomenon that has evolved over the last ten years. Approaches of scientists and practitioners to define the definition of «digital platform», their composition, common and distinguishing features between existing types of digital platforms are analyzed. The study found that most scholars are unanimous in identifying the digital platform as a key digital transformation tool that provides information sharing and transactions between a large number of online users. Generalizing scientists’ claims, the author defines an online platform by which we understand bilateral or multilateral markets with an infrastructure that operates online and facilitates transactions between different parties in the process of buying and selling goods and services. It is established that the largest companies in the world by the index of market capitalization now use platform business models. The stages of digital transformation of the market using digital platforms are presented, each of the six stages is characterized. The advantages of enterprises as a result of application of platform business models are highlighted. The strategies of monetization of digital platforms are considered, the mechanism of realization of each of them is described. Thus, it can be argued that digital platforms are a breakthrough innovation that can radically change the structure of the national market. On the one hand, digital platforms help to avoid the intermediary chain, offering the ultimate consumer the full range of options. On the other hand, in the case of «digital monopoly», the owners of successful platforms receive effective market control levers (including information asymmetries) and can impose their pricing policies on service consumers. In these circumstances, the «traditional» business in strategic terms is threatened by the risk of loss of distribution channels and full dependence on platform owners.

The Complexity of Pharmaceutical Prices: An Economic Analysis

2019 ◽  
Vol 24 (4) ◽  
Author(s):  
Erwin Blackstone ◽  
Joseph Fuhr Jr.
Keyword(s):  
Patent Protection ◽  
Insurance Companies ◽  
Market Work ◽  
Pharmaceutical Pricing ◽  
Pharmaceutical Firms ◽  
Generic Market ◽  
Substantial Risk ◽  
Pharmaceutical Prices ◽  
List Prices

This article examines the complexity of pharmaceutical pricing. Specifically, list prices are often considerably higher than net prices. PBMs have considerable market power to obtain substantial discounts (rebates) from pharmaceutical companies which encourages higher list prices. In general the generic market work well. At issue is how much of the discounts are passed on to other stakeholders. High prices during market exclusivity or patent protection encourages R&D. Pharmaceuticals spend a large percentage of revenues on R&D, earn large profits which are somewhat overstated and take substantial risk. Many firms never make a profit. Drugs provide great value and increase the quality of life of patients. Since subscribers often change insurance companies, insurers have a shorter time horizon than pharmaceutical firms, which could lead to coverage issues. Policies to mitigate high drug prices include changes to PBM rebate practices, stricter patent approvals and reduction of barriers for generics and biosimilars.

scholarly journals Agricultural sustainability: concepts, principles and evidence

2007 ◽  
Vol 363 (1491) ◽  
pp. 447-465 ◽  
Author(s):  
Jules Pretty
Keyword(s):  
Natural Capital ◽  
Full Range ◽  
Agricultural Sustainability ◽  
Agricultural Systems ◽  
Ecological Processes ◽  
Environmental Goods ◽  
Goods And Services ◽  
Energy Flows ◽  
Food Productivity ◽  
Livestock Productivity

Concerns about sustainability in agricultural systems centre on the need to develop technologies and practices that do not have adverse effects on environmental goods and services, are accessible to and effective for farmers, and lead to improvements in food productivity. Despite great progress in agricultural productivity in the past half-century, with crop and livestock productivity strongly driven by increased use of fertilizers, irrigation water, agricultural machinery, pesticides and land, it would be over-optimistic to assume that these relationships will remain linear in the future. New approaches are needed that will integrate biological and ecological processes into food production, minimize the use of those non-renewable inputs that cause harm to the environment or to the health of farmers and consumers, make productive use of the knowledge and skills of farmers, so substituting human capital for costly external inputs, and make productive use of people's collective capacities to work together to solve common agricultural and natural resource problems, such as for pest, watershed, irrigation, forest and credit management. These principles help to build important capital assets for agricultural systems: natural; social; human; physical; and financial capital. Improving natural capital is a central aim, and dividends can come from making the best use of the genotypes of crops and animals and the ecological conditions under which they are grown or raised. Agricultural sustainability suggests a focus on both genotype improvements through the full range of modern biological approaches and improved understanding of the benefits of ecological and agronomic management, manipulation and redesign. The ecological management of agroecosystems that addresses energy flows, nutrient cycling, population-regulating mechanisms and system resilience can lead to the redesign of agriculture at a landscape scale. Sustainable agriculture outcomes can be positive for food productivity, reduced pesticide use and carbon balances. Significant challenges, however, remain to develop national and international policies to support the wider emergence of more sustainable forms of agricultural production across both industrialized and developing countries.

Tropical forests: much more than stocks of wood

1988 ◽  
Vol 4 (2) ◽  
pp. 209-221 ◽  
Author(s):  
Norman Myers
Keyword(s):  
Genetic Resources ◽  
Tropical Forests ◽  
Forest Ecosystems ◽  
Raw Materials ◽  
Full Range ◽  
Wood Products ◽  
Environmental Benefits ◽  
The Other ◽  
Goods And Services ◽  
Modern Agriculture

ABSTRACTTropical forests offer many more products than the category for which they are best known, viz. wood products. They can supply a host of raw materials, such as resins, oils, fibres and fruits, which collectively represent a commercial value far higher than is generally recognized. In addition they provide an exceptional abundance and variety of genetic resources, which make substantial contributions to modern agriculture, medicine, industry and energy. On top of these materials, tropical forests supply significant environmental benefits, such as protection of the soil and safeguards for watershed systems. While it is sometimes difficult to quantify the economic values of these diverse goods and services, they are often to be reckoned as equal to, if not higher than, the marketplace values represented by the commercial hardwood timber. Yet when the forests are exploited for their hardwood timber, the process is usually so disruptive to forest ecosystems that the other outputs are severely reduced. By contrast, one may exploit the forests for their other outputs with virtually no disruption to forest ecosystems. The paper describes the main categories of non-wood products available from tropical forests, analyses their relative worth, and offers summarized proposals for an expanded approach to forest development in order to take integrative account of the full range of forest benefits.

HIV, AIDS, and Drug Abuse in the International Sector

1997 ◽  
Vol 27 (1) ◽  
pp. 1-8
Author(s):  
James A. Inciardi ◽  
Lana D. Harrison
Keyword(s):  
Hiv Infection ◽  
Full Range ◽  
The United States ◽  
Sub Saharan Africa ◽  
Cumulative Distribution ◽  
African Women ◽  
World Health ◽  
Childbearing Age ◽  
The World ◽  
Hiv Aids

AIDS has become the leading cause of death among people under age 45 in many major cities throughout the United States and Western Europe, and the projected mortality rate for those infected with HIV is virtually 100%. As of July 5, 1996, the World Health Organization (WHO) Global Programme on AIDS reported a cumulative 1,393,649 AIDS cases from 193 countries (WHO 1996). This represented a 19% increase in actual cases reported a year earlier. However, the WHO estimates that allowing for incomplete reporting and under-diagnosis, there were probably some 7.7 million cumulative AIDS cases by mid-1996. In terms of HIV, the WHO estimates that there has been a cumulative distribution of almost 30 million HIV-infected individuals as of mid-1996 (WHO 1996). The joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that some 20.1 million adults were living with HIV infection or AIDS at the close of 1995. By the year 2000, UNAIDS estimates project that 30 to 40 million people will have been infected with HIV worldwide (UNAIDS 1996). With more than 19 million HIV-infected adults, Sub-Saharan Africa remains the most affected region of the world (WHO 1996). The predominant mode of transmission since the beginning of the epidemic has been through heterosexual contact. The reuse of unsterilized hypodermic needles in transfusions and inoculations is also relatively common in many African nations. In a number of countries in that part of the world, furthermore, HIV infection has been spread through population movements due to situations of conflict or poverty (Decosas et al. 1995). The lower status of women in a number of African nations has also contributed to the rapid spread of the epidemic (UNAIDS 1996). HIV infections in African women outnumber men by a ratio of 6 to 5. More than 6 million women of childbearing age have been affected, and UNAIDS believes that as many as I million children may already have been infected either prior to or during birth, or during breast feeding (UNAIDS 1996). Another contributing factor has been the full range of sexually transmitted diseases, which increase the risk of HIV infection if left untreated (UNAIDS 1996).

scholarly journals A new malaria vector in Africa: Predicting the expansion range of Anopheles stephensi and identifying the urban populations at risk

2020 ◽  
Vol 117 (40) ◽  
pp. 24900-24908 ◽  
Author(s):  
M. E. Sinka ◽  
S. Pironon ◽  
N. C. Massey ◽  
J. Longbottom ◽  
J. Hemingway ◽  
...  
Keyword(s):  
Anopheles Stephensi ◽  
Close Association ◽  
Mosquito Species ◽  
Full Range ◽  
Spatial Models ◽  
Urban Environments ◽  
World Health ◽  
Horn Of Africa ◽  
Populations At Risk ◽  
Health Organization

In 2012, an unusual outbreak of urban malaria was reported from Djibouti City in the Horn of Africa and increasingly severe outbreaks have been reported annually ever since. Subsequent investigations discovered the presence of an Asian mosquito species; Anopheles stephensi, a species known to thrive in urban environments. Since that first report, An. stephensi has been identified in Ethiopia and Sudan, and this worrying development has prompted the World Health Organization (WHO) to publish a vector alert calling for active mosquito surveillance in the region. Using an up-to-date database of published locational records for An. stephensi across its full range (Asia, Arabian Peninsula, Horn of Africa) and a set of spatial models that identify the environmental conditions that characterize a species’ preferred habitat, we provide evidence-based maps predicting the possible locations across Africa where An. stephensi could establish if allowed to spread unchecked. Unsurprisingly, due to this species’ close association with man-made habitats, our maps predict a high probability of presence within many urban cities across Africa where our estimates suggest that over 126 million people reside. Our results strongly support the WHO’s call for surveillance and targeted vector control and provide a basis for the prioritization of surveillance.

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