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Director Center for Pharmaceutical Health Services Research School of Pharmacy Temple University Philadelphia, Pennsylvania
| By George C Halvorson and George J Isham MD. Published by
Jossey-Bass, San Francisco, CA, 2003. ISBN 0-7879-6888-9. Clothbound, xxx +
271 pp. (24 x 16 cm), $30.
wwww.josseybass.com
|
Published Online, November 17, 2003. www.theannals.com, DOI 10.1345/aph.1D273
The following is an especially good example of their treatment of pharmaceutical pricing:
In nations with a fixed national health budget, the drug companies must negotiate a price directly with the government. "We'd like two dollars a pill," the manufacturer's salesperson might tell the minister of health."What good does the drug do?" the minister might ask.
"Well, it reduces arthritis inflammation."
"Fine," the minister might say. "How much better is it than the old inflammation reduction drug we have now that costs us ten cents a pill?"
"Well," the manufacturer might reply, "our tests show the new drug reduces pain 5 percent better than your current drug."
At that point, classical market forces come into play. Value becomes relevant. Is a 5 percent improvement in pain relief worth a 2000 percent increase in price?
"Sorry," the minister might say. "Two dollars a pill isn't a good deal. We'll just keep using the old drug."
"Well," the pharmaceutical representative might reply. "Let's not be hasty. Two dollars is just our American retail price. We can do better. How about fifty cents a pill? Would you buy them for your patients for fifty cents?"
"No," the health minister says. "You're still increasing our costs 500 percent for only a 5 percent improvement in care. That, my friend, is not a good deal for our taxpayers."
This also transpires with hospitals, clinics, surgery, and physicians, to name a few. When we have seen that most experiments or demonstrations have failed because of strong vested interests, we are introduced to what the authors view as a possible, reasonable future direction for the US system, an adoption of the German system, with a single payer. The authors call for a national health strategy with 7 initiatives: initiative 1 should improve quality of care and patient safety; initiative 2 should address consumer choices, behaviors, and incentives, creating an improved market model for both buying and selling health care; initiative 3 should improve population health; initiative 4 should prevent monopolistic and other anticompetitive behaviors; initiative 5 should create a workable framework for dealing with the uninsured; initiative 6, to make sure miracles keep happening, should result in providing adequate support to the healthcare delivery system by funding training, medical education, medical research, a resupply of the healthcare workforce, and a reengineering of actual healthcare delivery, particularly in hospital settings; and initiative 7 creates an underpinning for the entire cost and value agenda: the creation of an automated medical record that will give the physician and patient in the examination room all of the information needed to provide the best care efficiently and consistently.
One might not agree with everything written in the book, but it is a productive exercise to consider their proposals seriously. The book is suggested as required reading for all healthcare system managers and administrators. It should be discussed at inservice seminars and journal clubs. The healthcare system will be reformed and improved and, if we don't have consensus for suggested changes to the pharmacy sector, others will make such decisions for us.
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