Pricing and reimbursement of generic pharmaceuticals in Turkey: Evaluation of hypertension drugs from 2007 to 2013

Purpose

This study was designed to examine the effects of drug pricing and reimbursement politics on drug expenditures from January 2007 to September 2013, with a focus on internal reference pricing in Turkey.

Parallel trade of pharmaceuticals: The Danish market for statins

This paper investigates and quantifies the impact of parallel trade in markets for pharmaceuticals. The paper develops a structural model of demand and supply using data on price, sales, and the characteristics of statins in Denmark and simulates outcomes under a complete ban of parallel imports, keeping other regulatory schemes unchanged. There are two sets of key results. The first set focuses on price effects. On average, prices increase more in markets where the molecule has lost patent protection; wholesale prices for both generic and original products increase after competition from parallel importers is removed, but the final price paid by consumers (after deducting reimbursement) increases more for original products than for generics because most changes in wholesale prices are absorbed by the prevailing reimbursement rules. The second set of results reports the effects on market participants. My model takes into consideration consumers' preferences, allowing them to substitute between products. Prohibiting parallel imports induces consumers to substitute towards original products for which they have stronger preferences. In sum, banning parallel imports leads to (a) an increase in variable profits for original producers and a decrease for generic firms, (b) an increase in governmental health‐care expenditures, and (c) a decrease in the welfare of Danish patients and firms.     

An Evaluation of Health Service Impacts Consequent to Switching from Brand to Generic Venlafaxine in New Zealand under Conditions of Price Neutrality

ObjectiveTo study the health impact on adult New Zealand patients who switch from originator brand to generic venlafaxine.MethodsThe national pharmacy database was used to select patients using venlafaxine for at least 6 months. Switchers and nonswitchers were identified, and switch behavior was compared for a 12-month follow-up period. Change in health service use following switching was also compared between switchers and nonswitchers including use of the emergency department, hospital, and specialist outpatient services over the same period.ResultsApproximately 12% of all originator brand users switched to generic venlafaxine, at least half of whom continued to use the generic throughout the follow-up period to August 1, 2012. Almost 60% of new users of the generic venlafaxine, however, switched to using the originator brand. Aside from a slight reduction in the use of outpatient services among switchers, there were no significant differences in health services use between switchers and nonswitchers for either existing or new venlafaxine users.ConclusionsAlthough both products remain fully subsidized and available, there is little incentive for prescribers, pharmacists, or patients to switch to the less expensive generic brand. If savings to the national New Zealand budget are to be realized, additional policy measures should be implemented to minimize incentives for multiple and reverse switching, and prescribers, as key opinion leaders, could take the lead in promoting generics to their patients.     

Partnership in practice: what parents of a disabled child want from a generic health professional in Australia

Despite the love that exists between children with disabilities and their parents and the positive contribution that children with a disability make to families and communities, caring for a child with a disability can be difficult and demanding for parents, carers and the family. Their interaction with the many and varied health professionals they encounter can serve to either ameliorate or exacerbate these difficulties. In this paper we report on a qualitative needs analysis undertaken as part of a project to develop disability awareness resources for generic health professionals (GHP). Data were collected through focus groups (n = 5) and individual interviews (n = 7) with 34 parents/carers and was analysed using a process of thematic analysis. ‘Partnership’ was identified as the overarching theme that answers the question ‘What do parents/carers want from a GHP?’ Three further themes were identified that together tell the partnership ‘story’. These are: ‘The GHP–parent partnership’, ‘Qualities of a GHP’, and ‘The role of advocacy in the GHP‐parent partnership’. Implications are presented that highlight the importance of advocacy in GHP–parent partnerships and suggest improvements in GHP education and preparation.     

The sustainability of public health expenditures: evidence from the Canadian federation

The fiscal sustainability of government health expenditures is defined as the gap between growth rates of spending and measures of the resource base. The results show that over the period 1965–2008, real per capita Canadian provincial government health spending has grown at rates that exceed growth in basic measures of the resource base such as per capita gross domestic product (GDP), per capita federal transfers and per capita provincial government revenues. Forecasts of future spending to 2035 using determinant regression and growth rate extrapolation techniques show that Canadian provincial government health spending is projected to continue rising in the future and its share of provincial GDP will rise. While the amount spent on health is ultimately a public policy choice, provincial government health spending also cannot continue growing faster than the resource base indefinitely.     

Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers

OBJECTIVES: We assessed the impact of graphic Canadian cigarette warning labels. METHODS: We used a longitudinal telephone survey of 616 adult smokers. RESULTS: Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. CONCLUSIONS: Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes.     

医院放射与放疗系统的综合布线及网络方案

本文以肿瘤医院为例,简述了放射信息系统、放疗信息系统的综合布线与网络方案设计。     

Sociology of pharmaceuticals development and regulation: a realist empirical research programme

A realist conceptualisation of interests is proposed in opposition to the fashionable view that interests, objectivity and reality are merely social constructs, and that sociological analyses should be confined to discourse, actor-networks and micro-contextual practices. The objective interests of pharmaceutical companies in profit-maximisation, and of patients/public health in the optimisation of drugs' benefit-risk ratios, can be empirically validated. The relationship between those interests and pharmaceutical regulation is best characterised by 'neo-liberal corporate bias' at the macro- and meso-levels. How such bias manifests itself at the micro-social level of science-based pharmaceutical testing and regulatory decision making is examined using a realist sociology of scientific knowledge, which appreciates that assessment of the validity of techno-scientific knowledge claims is essential for their sociological explanation. Commercial interests are shown to have biased science away from the interests of public health, in favour of industry. International comparisons of drug regulation demonstrate that drug injuries are not necessarily an inevitable by-product of pharmaceutical progress because some countries have fewer drug safety problems than others. Similarly, the lowering of techno-scientific standards for drug safety testing is not an inevitable cost of faster development of therapeutically valuable medicines, but a consequence of the internationalisation of neo-liberal corporate bias.     

医院管理者一般管理能力素质评价体系的实证研究

一般管理能力素质是管理者影响管理行为有效性的内在心理特点。它包括管理意识、管理策略和管理技能3个层面。从一般管理能力素质内涵及特性入手,构建医院管理者一般管理能力素质评价体系。运用层次分析法进行实证分析,评价结论与实际结果相符,认为该评价体系具有科学性。     

浅谈医院改建和新建中的综合布线

通过分析目前医院基建中普遍存在的问题，阐明综合布线的概念、优越性以及影响医院基建中的综合布线主要原因。医院基建中的综合布线的设计思想和注意点，以及施工管理中的注意点。     

The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia

AIMS: The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication. METHOD: This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b). RESULTS: The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21). CONCLUSION: Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.     

The importance of being expert: the quest for cancer information on the Internet

To people with the necessary technology the internet can provide vast amounts of health information. However, there are concerns about the quality of the information and how it may affect relationships between patients and doctors. Little empirical research has examined how the internet is used by those diagnosed with a serious illness. This study uses in-depth interviews collected for DIPEx projects with men and women with cancer. The analysis is informed by Radley and Billig's (Sociol. Health Illness 2 (1996) 220) observation that accounts of illness require patients to simultaneously display themselves as 'worthy individuals, as more or less fit participants in the social world' and on Arthur Frank's work on quest narratives. Drawing on in-depth interviews with a woman with inflammatory breast cancer and a man with prostate cancer I will demonstrate how the internet has been used not only to gather information and gain support from others but also to make sense of the experience of cancer. The ability to access health information on the internet may provide patients with an opportunity to display a particularly modern marker of competence and social fitness. However, one of the consequences of easier access to health information may be the emergence of a felt imperative to be (or present oneself as) an expert and critical patient, able to question advice and locate effective treatments for oneself.     

Physical activity and ethnicity: evidence from the Canadian Community Health Survey

BACKGROUND: A large proportion of the Canadian population lives a sedentary lifestyle. Few data are available describing the physical activity behaviours among specific ethnic groups in Canada, so the purpose of this study is to examine the relationship between ethnicity and the level of self-reported physical activity. METHODS: Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 yrs; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time moderate (> or = 1.5 kcal x kg(-1) day(-1) (kkd)); moderate to high (> or = 3 kkd) and high physical activity (> or = 6 kkd) were calculated, and multiple logistic regression models were used to quantify the odds of being physically active across ethnic groups, after adjustment for several covariates (White referent group). RESULTS: The rank order of prevalence of being moderately physically active by ethnicity was: White (49%), Other (48%), NA Aboriginal (47%), Latin American (40%), East/Southeast Asian (39%), Black (38%), West Asian/Arab (36%), South Asian (34%). Aboriginal men and women had the highest prevalences of being physically active at > or = 3 kkd (M = 32%, F = 22%) while East/Southeast Asian (19%) and East Asian/Arab men (19%), and South Asian women (12%) had the lowest prevalences. After accounting for covariates, Aboriginal men were at elevated odds of being physically active compared to Whites (> or = 3 kkd, OR=1.6, p < 0.05; > or = 6 kkd, OR = 2.7, p < 0.05). Only 7% and 3% of Canadian men and women, respectively, were active at > or = 6 kkd. CONCLUSION: These results suggest that the prevalence of physically active Canadian adults varies by ethnicity. Strategies to promote physical activity and prevent physical inactivity should consider these findings.