Costs Spain

Outside of the United States, there are six primary producers in China, France, Mexico, Morocco, South Africa, and Spain. Mines in Newfoundland, Canada, were closed in 1990. Both Mexico and South Africa have lost market share to China which has high grade, low cost fluorspar. China is expected to dominate world markets because reserves are vast and production cost is low. Table 3 (2) shows a Hst of world producers by country of fluorspar in the early 1990s. 

The low cost of sulfur dyes, coupled with good fastness properties and the ease of appHcation, continues to ensure a high consumption. The number of manufacturers has fallen since the 1960s and production is mainly confined to the United States, U.K., Germany, and Spain. There is one principal producer in each of these countries. There are other, less well-known manufacturers in Russia, the People s RepubHc of China, South Korea, Japan, and Bra2il (Table 7). 

The fluohmic process is a third process for manufacturing hydrogen cyanide, which is being appHed in Spain and AustraUa. This process involves the reaction of ammonia with a hydrocarbon, usually propane or butane, in a fluidized bed of coke particles. The endothermic heat of reaction is suppHed electrically through electrodes immersed in the fluid bed. Yields from propane and ammonia are reportedly above 85% and the waste gas is essentially hydrogen, but the costs for electricity are high. Thus this process is appHcable only when there is an inexpensive source of power. 

The confluence of sharply rising Operations and Maintenance (O M) costs. NRC requested Individual Plant Examinations (IPEs) and increased personal computer capabilities gave rise to the R R Workstation. Its uses and maintains-current PSA models and databases for individual plants to perform O M planning and scheduling, and uses the PSA in IPE models to identify plant design, procedure and operational vulnerabilities. The Risk and Reliability Workstation Alliance was organized by EPRI to support the R R Workshop in order to achieve O M cost reduction, plant productivity and safety enhancement through risk-based, user-friendly, windowed software louls (Table 3.6 8). The Alliance, initiated in 1992, includes 25 U.S. utilities and four international partners from Spain, France, Korea, and Mexico. SAIC is the prime contractor for the R R Workstation, with participation of five other PSA vendors. 

Reference pricing was not introduced in Spain until December 2000. The fact that it is applied exclusively to bio-equivalent products leads, in the opinion of the authors, to the assumption that its effect on expenditure is limited, as a major market share is acquired by recently introduced drugs. The level at which the reference price is fixed is an important factor. For non-patented products, price competition should push the price towards the marginal cost, and therefore a reference price that is clearly higher than the cheapest generic could actually become a barrier to price competition in this case. 

The drug price intervention system in place in Spain since 1991 is based on the fixing of the price of each product by the health authorities, calculated according to its cost . This system allows for the possibility of excluding certain products or therapeutic groups from the price intervention system. It would be desirable to apply this exclusion principle to those products that are subject to a reasonable level of competition. Briefly, the main features of the Spanish system of price regulation are as follows ... 

Lopez, Bastida J. and E. Mossialos (2000), Pharmaceutical expenditure in Spain cost and control , International Journal of Health Services, 30 (3), 597-616. 

Since 1990, responsibility for containing the public pharmaceutical bill in Spain has fallen to a variety of instruments, none of which has proved particularly effective at cost containment, as can be seen from Table 6.1. These instruments have included stricter control over the National Health Service (NHS) (Sistema Nacional de Salud or SNS) budget for pharmaceuticals, modifications to the co-payment rates for certain drugs for chronic diseases, the exclusion of certain drugs from public financing (negative lists) and agreements with laboratories and pharmacies.1... 

In some cases maximum payable amounts are fixed. Those countries that have introduced reference pricing (RP) require the user to meet the additional cost over the RP (Germany, Spain). 

Specifically, Spain s experiences in the selective financing of pharmaceuticals up to 1997 (Order of 6 April 1993, developing Royal Decree 98/93 of 22 January 1993, which regulates the selection of medicines for purposes of financing by the National Health System, BOE No. 88, 13 April 1993, Madrid, Boletin Oficial del Estado) lead us to conclude that the effectiveness of these measures has been small as regards their cost containment objectives. The decrees on the selective financing of pharmaceuticals of 1993 and... 

Lopez-Casasnovas, G. (1999), Health care and cost containment in Spain , in E. Mossialos, J. Le Grand (eds), Health Care and Cost Containment in the European Union, London Ashgate, pp. 401—42. 

See also Hernandez s controversial article,36 with its strong criticism of the pharmaceutical cost containment policy adopted in Spain. 

Lobato19 studies the direct control of drag prices in Spain based on the difficulty of inspecting costs it is complicated to allocate fixed costs and estimate the size of the market for each product. Revisions of authorized prices to make up for inflation would have been insufficient. The main conclusion is the... 

Revilla, R. (1994), Pricing and financing of pharmaceuticals in Spain , in E. Mossialos, C. Ranos and B. Abel-Smith (eds), Cost Containment, Pricing and Financing of Pharmaceuticals in the European Community the Policy-makers View, London LSE Health, pp. 191-205. 

Cots, F., J. Monterde, X. Castells and S. Grau (1993), Calculo y analisis de los costes de farmacia por Grupos Relacionados de Diagnostico , communication presented at the 13th Conference on Health Economics, 2-4 June, Granada, Spain. 

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