The objective of this report is to provide an assessment of the reform process of the health care sector in the Countries of Central and Eastern Europe (CCEE). It shall assess the overall direction of the reforms and focus in particular on health financing and pharmaceutical policy making as two important elements of structural reform. The first part of this report provides a brief overview of the state of health of CCEE populations and the process of health care reform. The second part of the report discusses health financing and pharmaceutical policy reform.
The aim of this paper is to review alternative methods of regulating the price of pharmaceuticals bought by the NHS from the perspective of the experience of the economic regulation of other industries in the UK, notably the privatised utilities. The NHS procures medicines in a variety of ways, subject to different methods of price control, but the main control is on profits via the PPRS.
This OHE- Briefing summarises the presentations and discussion at the session on 'Modelling in Economic Evaluation' at the Conference of the International Society for Technology Assessment in Health Care (ISTAHC) in San Francisco 26th June 1996.
The recent increase in the number of published economic evaluations has been considerable [Wellcome, 1992; Udvarhelyi et al, 1992]. It is of some concern, however that reviews of economic evaluations have highlighted a high degree of methodological shortcomings in many studies [Adams at al, 1992; Gerard, 1992]. Furthermore, the situation does not appear to have improved over time [Udvarhelyi et al, 1992]. In particular, the importance of dealing systematically and comprehensively with uncertainty appears to have been overlooked by many analysts.
Recent decades have seen a significant improvement in the health status of citizens in Western Europe and the USA. This is evident from death rate statistics which fell in the USA from 10.6 to 5.4/1000 between 1940 and 1990, from improvements in life expectancy, and from the near elimination of the acute conditions which were the major public health concern early this century. This progress has arisen from a combination of public health measures, improved health education, preventative medicine, screening programmes and advances in treatment.
In the last decade society has become more health conscious than ever before. A major factor in this change of attitude is the widespread availability of information about healthy lifestyles from both the media and health professionals. People have a greater awareness of the dangers of smoking, of a high fat diet and of taking little or no exercise. They might be expected to be more willing to make changes in their own lifestyle, to participate in health screening and to self-medicate for minor ailments.
That there is a positive association between unemployment and a variety of measures of ill health is clear. What is less clear is how this association arises. Two questions summarise much of the debate which has concerned researchers for many years. Firstly, does unemployment cause a deterioration in health or, conversely, are the sick more likely to become unemployed? If the latter, then the association is merely a statistical artefact. As unemployment starts to rise, employers lay of the relatively sick first, rather than the fit.
Treatment of children with growth hormone is well recognised under the NHS and its cost (between £5,000-£10,000 per annum per child) has generally been accepted. Since the biotechnologically produced hormone (rhGH) first appeared on the market in 1985 it has been increasingly prescribed by general practitioners at the request of hospital consultants whose pharmacies felt unable to pay the high cost.
The objective of medical care is to improve people's health. This includes avoiding illness whenever possible, alleviating suffering and disability when illness does occur, and prolonging life, particularly through the prevention of premature deaths.
The Government's National Health Service reforms are designed to increase cost effectiveness, widen consumer choice and improve the quality of care. In making the case for these reforms, the White Paper Working for Patients (CM 555) pointed to the wide variations in performance throughout the health service.