Dividend policy issues in the European pharmaceutical industry: new empirical evidence

This paper examines dividend policy issues in the European pharmaceutical industry. This sector is of particular interest because of the high research and development expenditures and the associated risks characterizing the business models of many firms in this industry. In fact, from the perspective of corporate finance theory, this is a particular challenge for the managers of these corporations that may also have implications for the dividend policy implemented by the firms forming this sector. Moreover, the level of internal financing and litigation risks also seem to be high in the pharmaceutical industry. These facts could also affect the payout policy of the firms. Employing techniques of time series analysis, there is no evidence for dividend signaling and clear evidence for dividend smoothing in the European pharmaceutical industry. Given that dividend increases under certain assumptions can negatively affect the firms' ability to finance new investments in general and research and development projects in particular, these results of our empirical investigations could be described as highly plausible.

     

Soft regulations in pharmaceutical policy making

It is a challenge to improve public health within limited resources. Pharmaceutical policy making is a greater challenge due to conflicting interests between key stakeholder groups. This paper reviews current and future strategies to help improve the quality and efficiency of care, with special emphasis on demand-side controls for pharmaceutical prescribing. A large number of different educational, organizational, financial and regulatory strategies have been applied in pharmaceutical policy making. However, the effectiveness of most strategies has not been thoroughly evaluated and there is evidence that the behaviour of healthcare professionals is difficult to influence with traditional methods. During the last decades, new modes of governing and new governing constellations have also appeared in healthcare. However, relationships between those who regulate and those regulated are often unclear. New approaches have recently been introduced, including extensive dissemination strategies for guidelines and extensive quality assessment programmes where physicians’ performances are measured against agreed standards or against each other. The main components of these ’soft regulations’ are standardization, monitoring and agenda setting. However, the impact of these new modes on health provision and overall costs is often unknown, and the increased focus on monitoring may result in a higher conformity and uniformity that may not always benefit all key stakeholders. Alongside this, a substantial growth of auditing associations controlling a diminishing minority of people actually performing the tasks may be costly and counter-productive. As a result, new effective strategies are urgently needed to help maintain comprehensive healthcare without prohibitively raising taxes or insurance premiums. This is especially important where countries are faced with extreme financial problems. Healthcare researchers may benefit from researching other areas of society. However, any potential strategies initiated must be adequately researched, debated and evaluated to enhance implementation. We hope this opinion paper is the first step in the process to develop and implement new demand-side initiatives building on existing ’soft regulations’.     

Bangladesh pharmaceutical policy and politics

An analysis of the politics of Bangladesh pharmaceutical policy in the 1980s shows how significant health policy reforms in developing countries depend on political conditions both inside and outside the country. Bangladesh's drug policy of 1982 illustrates that governments can sometimes change public policy in ways unfavourable to multinational corporations, while the failed health policy reform of 1990 shows that reforms unfavourable to powerful domestic interest groups can be more difficult to achieve, even contributing to a government's downfall. The case provides evidence of basic changes in how the international agenda for health policy is set, especially the growing role of non-governmental organizations in international agencies and national policy debates. Understanding the political patterns of policy reform in Bangladesh has important implications for strategies to affect health policy in developing countries.     

Public attitude and knowledge on a new health policy for pharmaceutical care in Korea

OBJECTIVE: to assess college student's attitude and knowledge of the 'separation of dispensing and prescribing' policy in Korea. DESIGN: a self-administered questionnaire survey of 700 college students. MAIN OUTCOME MEASURES: the attitude was assessed by the degree of interest in the policy, agreement to the policy need, expectation for the policy effect, and perceptions of motivation for physician's strike. The knowledge level was measured using four questions describing the goal/motivation of the policy and eight describing its operational rules. RESULTS: the level of interest (2.60 on a four-point scale), and agreement to the need (2.66) and the potential effect of the policy (2.29-2.91) were not very high. Concern for economic loss was perceived as the strongest motivation for physician's strike. While relatively well understood for the goals/motivations of the policy (mean score: 69.58 out of 100), the operational details of the policy were not well-informed (32.52). Interest and agreement with the policy need were the most significant factors affecting the knowledge level (P<0.01). CONCLUSION: For other public policies in the future, policy makers in Korea need to ensure public consent for the necessity of the policy and to develop more effective strategies to inform the public of the practical details of the policy.     

Vaccination policy against hepatitis A in Italy

In Italy, improved sanitation and living conditions have led to a decline in the rate of hepatitis A infection among children generating an increasing proportion of adults susceptible to this virus. Shellfish consumption is a major source of infection while person to person transmission is important in the spread of infection and in the maintenance of outbreaks. Thus prevention of secondary HAV infection is a crucial point. A randomised controlled trial of hepatitis A vaccine in household contacts of people with sporadic HAV infection in Italy has shown a protective efficacy of 82% (CI 20-96%). The two secondary infections in the vaccine group were symptomless, suggesting that the disease expression may be weaker in vaccinated subjects.     

Public policy and pharmaceutical innovation.

Historically, new drug introductions have played a central role in medical progress and the availability of cost-effective therapies. Nevertheless, public policy toward pharmaceuticals has been characterized in recent times by increasingly stringent regulatory controls, shorter effective patent terms, and increased encouragement of generic product usage. This has had an adverse effect on the incentives and capabilities of firms to undertake new drug research and development activity. The industry has experienced sharply rising research and development costs, declining annual new drug introductions, and fewer independent sources of drug development. This paper considers the effects of government regulatory policies on the pharmaceutical innovation process from several related perspectives. It also examines the merits of current public policy proposals designed to stimulate drug innovation including patent restoration and various regulatory reform measures.     

成本效果象限方法及其在药品政策中的应用研究

文章在梳理成本效果象限方法与增量成本效果率指标关系的基础上,回顾了增量成本效果率阈值在国际药品政策领域的应用状况及争议,目的在于揭示增量成本效果率阈值作为决策准则在药品遴选与补偿政策中的作用与局限,并提出该分析工具在我国医疗卫生改革中应用的相关政策建议。     

Health sector reform and pharmaceutical policy in Peru

This article analyzes the Shared Pharmaceutical Management Program (PACFARM) and its relationship to pharmaceutical policy in Peru within the scope of health sector reform. Implementation of various programs for essential medicines has involved an on-going effort towards improving the supply of essential drugs to the community. However, the corresponding legal framework includes random and disconnected regulations which hinder the feasibility of a consistent national drug policy. PACFARM is a decentralized system for the provision of essential medicines on a care-level basis, self-supported by revolving funds. While expanded coverage and decreased economic barriers to access to essential medicines provided the basis for a pharmaceutical policy and traits of supply management efficiency kept pace with administrative modernization as part of the reform, other aspects hindered the program's implementation and limited its effects, including deregulation and the very processes of change in the sector. The study's methodology included qualitative and quantitative techniques, prioritizing an analysis of the program's implementation.     

Recent developments in occupational health policy in Italy

On two occasions in the past, Italy has been in a leading position regarding occupational health: in 1700, thanks to work carried out by Dr. B. Ramazzini, and at the beginning of this century, with the founding of the first "Clinica del Lavoro" in Milan. Experience with and considerations of the interaction between the workplace, society as a whole, and the various institutions in the field of occupational health have played an important role in the general political discussion since the 1960s. In this article, we describe the effects of the workers' model of inquiry into health hazards on work organization, the National Health Service, workers' health conditions, and the scientific milieu. We also provide an analysis of present conditions and difficulties, particularly with regard to environmental problems and perspectives.     

The USSR's new alcohol policy

Alcoholism, long a major health and social problem in the USSR, came under renewed and determined attack in 1985. Already significant gains have been made, but there are also signs that the problem may to some extent have been driven underground.     

新时期宏观卫生政策的取向

从新时期卫生工作的角度，对未来宏观卫生政策的政策取向进行一些有益的探讨：新时期应首先确立“人民健康福利优先”的思路．政府的公共卫生政策应投资于人民健康，宏观经济政策应有利于提高人民健康水平；建立与完善卫生服务体系，加强与提高公共卫生的社会职能；指导思想应坚持以人为本，协调、全面和可持续发展的科学发展观；坚持改革开放，适应社会主义市场经济发展要求；坚持以预防为主，以农村为重点，为人民群众提供良好的医疗卫生服务；开放医疗市场，吸收国内外资金、技术和卫生管理经验，发展卫生事业、对宏观卫生政策的基本思路和重点领域也进行了有益的探索。     

The cultural shift in Italy's pharmaceutical policy in 1994: a case history

The advent of the National Health Service in 1978 in Italy also resulted in the compilation of a formulary of pharmaceutical products to be distributed free of charge. During the subsequent years the formulary increased in size with the introduction of new drugs and consequently pharmaceutical expenses increased steadily, reaching a peak in 1992. The years preceding this peak of expenses were characterized by pervasive corruption that involved several government civil servants and even the Minister of Health, as well as several members of the national committees responsible for the approval and pricing of medicinal products. The present article summarizes the events from 1992 in Italy when the revelation of corruption in the healthcare system and the pressure of public opinion obliged the authorities to make drastic changes in the pharmaceutical policy, and also introduces and discusses the reactions and the impact of such changes on pharmaceutical expenses and drug utilization over the following years.     

The impact of pharmaceutical policy measures: An endogenous structural-break approach

Pharmaceutical spending in many countries has seen a steep increase in recent years. Governments have adopted several measures to reduce pharmaceutical expenditure growth, ranging from increased co-payments to price decreases determined administratively. Promotion of generic consumption has also ranked high in political priorities. We adopt a novel time series approach to the detection of which policy measures have a noticeable impact. The number and timing of the structural breaks are endogenously determined. As an illustration, we assess the overall impact of the several policy measures on total pharmaceutical spending, using monthly data from January 1995 to August 2008 for the Portuguese market. Our findings suggest that, in general, policy measures aimed at controlling pharmaceutical expenditure have been unsuccessful. Two breaks that were identified coincide with administratively determined price decreases. Measures aimed at increasing competition in the market had no visible effect on the dynamics of Government spending in pharmaceutical products. In particular, the introduction of reference pricing had only a transitory effect of less than one year, with historical growth resuming quickly. The consequence of this policy ineffectiveness is a transfer of financial burden from the Government to the patients, with no apparent effect on the dynamics of total pharmaceutical spending.     

药品价格比较方法在药品政策中的应用研究

文章从药品价格比较的意义、研究方法、进展以及在国外药品政策中的应用等方面进行研究,旨在总结药品价格比较信息在药品政策中运用的原则,并提出在我国原创药定价、药品招标采购定价以及药品价格监测、评价和报告机制中运用药品价格比较方法的政策建议,进一步提高我国药品价格规制政策的运行效果。     

Health policy versus industrial policy in the pharmaceutical sector: the case of Canada

This paper analyses the trade-off between health policy and industrial policy objectives in the field of pharmaceuticals in the Canadian policy setting. In Canada pharmaceutical regulation is organized in two tiers. The federal government is responsible for the conduct of industrial policy for the pharmaceutical sector, including the patenting of new molecular entities, the registration and approval of pharmaceutical products, and the pricing of new products. At the province level, policy-makers are responsible for the reimbursement of the cost of medicines; the methodologies implemented for this purpose may be geared towards meeting the objective of cost containment within tight health budgets rather than addressing industrial policy objectives and, thereby, supporting the pharmaceutical industry. The reimbursement methodologies implemented may also be related with the strength of pharmaceutical presence in each province. The paper provides evidence from two such provinces, British Columbia and Ontario, and contrasts pharmaceutical policy-making at the provincial level with that at the federal level.     

Drug policy in China: pharmaceutical distribution in rural areas

In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.