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スペイン保健相は、医療費削減のために弱症状の効果の薄い456品の薬を健康保険の対象から除外し、4億4000万0000ユーロの節約
Los expertos alertan de que fármacos más caros sustituirán a los excluidos
La desfinanciación de medicamentos puede provocar que se recurra a otros aún cubiertos
La medida saca algunos fármacos obsoletos pero también otros muchos eficaces
Los especialistas creen que el ahorro que prevé Sanidad no está garantizado
Experts warn that more expensive drugs replace the excluded
The de-funding of drugs can cause it to resort to other still covered
The measure removes some obsolete drugs but also many other effective
Experts believe that the expected savings are not guaranteed health
Health will bring 456 drugs in public funding
DOCUMENT: Drugs that have no public funding
Mary R. Sahuquillo Madrid 27 JUN 2012 - 18:00 CET
The de-funding of drugs can cause it to resort to other still covered
The measure removes some obsolete drugs but also many other effective
Experts believe that the expected savings are not guaranteed health
Health will bring 456 drugs in public funding
DOCUMENT: Drugs that have no public funding
Mary R. Sahuquillo Madrid 27 JUN 2012 - 18:00 CET
The exclusion of the drug list of 456 drugs funded Health will propose today to the autonomous communities has its risks. The measure, which aims to save 440 million euros, and for which public funding would come from antacids to antitussives or antivirals, can cause consumption to move to other products that do continue to be funded but are more expensive.
Not the first time it occurs. The above 'medicamentazos' carried out in 1993 by the government of Felipe Gonzalez and in 1998 by Jose Maria Aznar did not get the expected savings. This past year, the Popular Party Executive aimed to save 16,000 million euros, as he drew from funding more than 800 drugs, but drug spending bill, however, increased.
Marciano Sánchez-Bayle, a spokesman for the Federation of Associations for the Defense of Public Health, believes that these drugs are replaced by others who are actually on the list of funded. "There is a clear risk of displacement of the prescription. For example, an alternative to codeine, which would finance would prescribe drugs and acetaminophen with codeine more expensive but not out of the list. This is not only much more expensive causes the patient to take something that does not really need, "he says.
An article published in the European Journal of Health Economics analyzes a similar measure launched in Turkey. In this country the lack of funding for certain drugs caused the increased spending on others that were an alternative therapy and were still in the public catalog.
Health effect assumes that switching to other drugs
Health assumes that this can happen. In fact, the document sent to the communities mentioned. Although it states that this effect can not be controlled from the regulatory mechanisms, but from good prescribing practice. He proposes the existence of "active monitoring" of the recipes indicate the pros.
"It does not address the situation of expensive drugs and without any added therapeutic value," says Llamazares
The proposal mixes many effective drugs with other obsolete
Gaspar Llamazares, spokesman for Health of the United Left, does not agree with the measure. "From the health point of view it is questionable whether it is necessary to eliminate this class of drugs for minor symptoms. There are minor symptoms that should have some type of therapy funded, "he says. Llamazares also think you're missing the opportunity to trim the list of funded drugs where really needed. "As the designer drugs, those that incorporate a different route of administration, excipient ... but pose no improvement over existing drugs, and yet another are much more expensive," said IU spokesman. "They play that cost drugs from one to three euros and does not address the situation of others that are expensive and have no added therapeutic. This is where savings can be achieved, "he adds.
The pharmaceutical industry has shown for out of the system commonly used drugs
Something that matches José Martínez Olmos, Health spokesman of the PSOE, which criticizes as "unfair and ineffective" without any mixture also very effective way with other drugs that are no longer prescribed. "It will affect patients who need these drugs and that will be seriously harmed. It is also likely that the calculated savings impact does not occur. This is not the way to economize, "argues the former general secretary of Health, which also speaks to this effect" slip "of these drugs to others who are on the list of funded.
Jose Manuel Freire, a professor at National School of Health, is alarmed that the proposal of Health is not accompanied by a study on the effects of the measure. "This can have negative effects on patients and has not made any impact analysis. These drastic measures should be consulted not only with the regions also with medical societies, for example, "he says. Freire also believes that the procedure for review of the product catalog funded should be more continuous, especially in certain high-priced drugs with little therapeutic value.
The family doctor Cristina House also believes that the measure is limited to exclude low-priced drugs but does not affect other where the real savings lie. "They will continue to fund expensive drugs and effectiveness is more than doubtful, as many antihypertensive or antidiabetic ..." he says.
For her, some preparations of the list for Health, as those within the category of treatment of cognitive impairment associated with age, with active ingredients such as piracetam, or folium ginkgo extract - antidiarrheals as alkaloids Ergot or vasodilators such as vincamine, are obsolete or rarely used. However, alert, exclusive of other very useful and effective. "They take all the ointments of topical treatments for inflammatory (nonsteroidal topical treatments), which will make the oral anti-inflammatory consumption, with more side effects increases." He says. "And take away funding syrups or products for upper airway colds useful and effective, which will also cause the resort to more expensive treatments," he says.
This expert also alert other risk with this group of drugs widely consumed cold: that the city go on their own to the pharmacy to not enjoy funding and treat yourself. "It's more advisable that the treatments for colds go through the judgment of a physician, and not people indiscriminately go to the pharmacy," he adds.
¿Drugs obsolete?
However, on Monday, before meeting the list of drugs and scope of the measure, the Health Minister said the review would be funded product by analyzing its efficiency. "There are still outdated drugs in the gazetteer and are publicly funded," he said. Drugs "with little therapeutic value" that would be "replaced by better ones or lower price." That day I get to even say that some of them might well be replaced by "any other product, often natural." An allusion to home remedies that alarmed experts.
But the argument Mato, who talks about old drugs is not clear to some experts. The list proposed health is very broad and diverse. "Surely it was time to exclude flavonoids, alkaloids for migraine, passionflower extract and some stuff," Ricard Meneu analyzes of the Institute for Health Services Research. "But this exclusion of public funding is not similar to the previous focus on products with low therapeutic value. But not the same as removing the ginko biloba, which does nothing but cheap and used a lot in Alzheimer's and similar laxatives and antidiarrheals, to be effective. Or similarly cerebral vasodilators, but leaving the memantine. Another thing is you want them out of the financing, "abounds.
The pharmaceutical industry has not yet ruled on the list today reported El Pais. Await an official statement. However, the management of laboratories, Farmaindustria, always was in favor of excluding funding drugs for mild symptoms, such as acetaminophen or aspirin, which do not appear in the proposal of Mato Grosso. A few days ago its president, Jordi Ramentol said he hoped that this lack of funding would take place "as soon as possible."
Llamazares says that support of the measure of the pharmaceutical industry than in others disagreed medicamentazos-is precisely for this purpose slip. "It will lead citizens to more modern and expensive drugs, which does not mean they are more effective, with what will still get benefit," he says. Olmos also notes that the position of the industry is "striking." PSOE spokesman said that following the delisting of funded medicines that are out of price rise.
Not the first time it occurs. The above 'medicamentazos' carried out in 1993 by the government of Felipe Gonzalez and in 1998 by Jose Maria Aznar did not get the expected savings. This past year, the Popular Party Executive aimed to save 16,000 million euros, as he drew from funding more than 800 drugs, but drug spending bill, however, increased.
Marciano Sánchez-Bayle, a spokesman for the Federation of Associations for the Defense of Public Health, believes that these drugs are replaced by others who are actually on the list of funded. "There is a clear risk of displacement of the prescription. For example, an alternative to codeine, which would finance would prescribe drugs and acetaminophen with codeine more expensive but not out of the list. This is not only much more expensive causes the patient to take something that does not really need, "he says.
An article published in the European Journal of Health Economics analyzes a similar measure launched in Turkey. In this country the lack of funding for certain drugs caused the increased spending on others that were an alternative therapy and were still in the public catalog.
Health effect assumes that switching to other drugs
Health assumes that this can happen. In fact, the document sent to the communities mentioned. Although it states that this effect can not be controlled from the regulatory mechanisms, but from good prescribing practice. He proposes the existence of "active monitoring" of the recipes indicate the pros.
"It does not address the situation of expensive drugs and without any added therapeutic value," says Llamazares
The proposal mixes many effective drugs with other obsolete
Gaspar Llamazares, spokesman for Health of the United Left, does not agree with the measure. "From the health point of view it is questionable whether it is necessary to eliminate this class of drugs for minor symptoms. There are minor symptoms that should have some type of therapy funded, "he says. Llamazares also think you're missing the opportunity to trim the list of funded drugs where really needed. "As the designer drugs, those that incorporate a different route of administration, excipient ... but pose no improvement over existing drugs, and yet another are much more expensive," said IU spokesman. "They play that cost drugs from one to three euros and does not address the situation of others that are expensive and have no added therapeutic. This is where savings can be achieved, "he adds.
The pharmaceutical industry has shown for out of the system commonly used drugs
Something that matches José Martínez Olmos, Health spokesman of the PSOE, which criticizes as "unfair and ineffective" without any mixture also very effective way with other drugs that are no longer prescribed. "It will affect patients who need these drugs and that will be seriously harmed. It is also likely that the calculated savings impact does not occur. This is not the way to economize, "argues the former general secretary of Health, which also speaks to this effect" slip "of these drugs to others who are on the list of funded.
Jose Manuel Freire, a professor at National School of Health, is alarmed that the proposal of Health is not accompanied by a study on the effects of the measure. "This can have negative effects on patients and has not made any impact analysis. These drastic measures should be consulted not only with the regions also with medical societies, for example, "he says. Freire also believes that the procedure for review of the product catalog funded should be more continuous, especially in certain high-priced drugs with little therapeutic value.
The family doctor Cristina House also believes that the measure is limited to exclude low-priced drugs but does not affect other where the real savings lie. "They will continue to fund expensive drugs and effectiveness is more than doubtful, as many antihypertensive or antidiabetic ..." he says.
For her, some preparations of the list for Health, as those within the category of treatment of cognitive impairment associated with age, with active ingredients such as piracetam, or folium ginkgo extract - antidiarrheals as alkaloids Ergot or vasodilators such as vincamine, are obsolete or rarely used. However, alert, exclusive of other very useful and effective. "They take all the ointments of topical treatments for inflammatory (nonsteroidal topical treatments), which will make the oral anti-inflammatory consumption, with more side effects increases." He says. "And take away funding syrups or products for upper airway colds useful and effective, which will also cause the resort to more expensive treatments," he says.
This expert also alert other risk with this group of drugs widely consumed cold: that the city go on their own to the pharmacy to not enjoy funding and treat yourself. "It's more advisable that the treatments for colds go through the judgment of a physician, and not people indiscriminately go to the pharmacy," he adds.
¿Drugs obsolete?
However, on Monday, before meeting the list of drugs and scope of the measure, the Health Minister said the review would be funded product by analyzing its efficiency. "There are still outdated drugs in the gazetteer and are publicly funded," he said. Drugs "with little therapeutic value" that would be "replaced by better ones or lower price." That day I get to even say that some of them might well be replaced by "any other product, often natural." An allusion to home remedies that alarmed experts.
But the argument Mato, who talks about old drugs is not clear to some experts. The list proposed health is very broad and diverse. "Surely it was time to exclude flavonoids, alkaloids for migraine, passionflower extract and some stuff," Ricard Meneu analyzes of the Institute for Health Services Research. "But this exclusion of public funding is not similar to the previous focus on products with low therapeutic value. But not the same as removing the ginko biloba, which does nothing but cheap and used a lot in Alzheimer's and similar laxatives and antidiarrheals, to be effective. Or similarly cerebral vasodilators, but leaving the memantine. Another thing is you want them out of the financing, "abounds.
The pharmaceutical industry has not yet ruled on the list today reported El Pais. Await an official statement. However, the management of laboratories, Farmaindustria, always was in favor of excluding funding drugs for mild symptoms, such as acetaminophen or aspirin, which do not appear in the proposal of Mato Grosso. A few days ago its president, Jordi Ramentol said he hoped that this lack of funding would take place "as soon as possible."
Llamazares says that support of the measure of the pharmaceutical industry than in others disagreed medicamentazos-is precisely for this purpose slip. "It will lead citizens to more modern and expensive drugs, which does not mean they are more effective, with what will still get benefit," he says. Olmos also notes that the position of the industry is "striking." PSOE spokesman said that following the delisting of funded medicines that are out of price rise.
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