Expenditure: on healthcare

The USA is the largest market for medical devices with a total value of 60 billion in 2000. The EU market is second largest at 41 billion, followed by Japan at 24.5 billion. In 2000, the EU accounted for 25.6% of the world medical devices market compared to an estimated 31.0% share in 1993. The reduction in overall market share is due partly to rapid expansion in medical technology sales in other markets, partly to market consolidation resulting in better distribution channels, and also because of reducing prices of medical devices. However, the decrease in world maiket share is also due to a significantly lower expenditure on healthcare (5.7% of GDP in EU compared to 13.9% in the USA and 7.1% in Japan). 

Like other industrialized countries, Japan s rising expenditure on healthcare has implications for its position as a major R D base. The... 

Table 7.2 shows the regulatory authorities in selected countries. A summary of the health system, both public and private in selected countries, is given in Appendix 9. It shows the %GDP each country spends on healthcare, per capita health expenditure, number of hospital beds, and doctors/1000 population. 

In healthcare there is a corresponding great divide and per capita investment in countries in the North compared with those in the South is a well-known example. For example, annual per capita expenditures on overall healthcare in the USA was 6,094 in 2007, whereas it is 2,560 in the UK, 1,135 in Korea and 21 in Ethiopia.21 At the same time, very few countries in the South have an industrial infrastructure that can support the discovery and development of medicinal agents—be they synthetic or derived from plant, microbial or marine biomaterials. Consequently, these countries are substantially reliant on imported drugs for primary healthcare—if governments or local residents are able to afford them. 

Improving access, fostering appropriate use, and reducing unnecessary expenditures continues to be a challenge for the poor, the uninsured, minority groups, rural and inner city residents, and other priority populations. The agency supports studies of access, healthcare utilization, and expenditures to identify whether particular approaches to healthcare delivery and payment alter behaviors in ways that promote access and/or economize on healthcare resource use. 

In the mid-1990s, expenditure on pharmaceuticals— largely expenditure on PBS listed medicines—accounted for 15% of total healthcare expenditure in Australia, which was 8.5% of gross domestic product. Of the total outlays on the PBS, manufacturers receive 67%, pharmacists 26%, and wholesalers 7%. ... 

The effectiveness of various measures to contain expenditure on medicines in the UK can only be assessed in the context of the situation in other European Union countries. Table 21.1 gives data for the total expenditure on health care as a percentage of gross domestic product (GDP), expenditure on medicines as a percentage of total healthcare spend, the national pharmaceutical industry s research and development expenditure in euro-millions, the general price index and the medicines price index nationally compared to a European price of 100, and the national pharmaceutical consumption per capita expressed as defined daily doses (DDD). These comparisons are based on OECD Health Data 2000. 

Country Medicine prices according Pharmaceutical expenditure Spending on healthcare ... 

Total expenditure on pharmaceuticals and other medical non-durables %GDP % Total healthcare expenditure Per capita, USS exchange rate... 

From this, two facts emerge. First, it is not the best use of its time for a health service to focus on cutting expenditure on the drugs budget, since this is a tiny proportion of the cost. Second, it is inappropriate for the pharma-company to seek to increase market share in such a tiny market. Pharma-companies would do better to find ways of participating in the wider aspects of healthcare delivery— because that is where the money is DM, with its multifaceted and comprehensive approach, provides that vehicle. 

Kyriopoulos et al. (1995) compared different estimates of HIV/AIDS healthcare expenditure in Greece based on study years 1987-1993. Average annual cost per... 

We are now in a cycle characterized by incremental innovation, not therapeutic breakthroughs, and it is reasonable for industry critics to question the industry on the value of its innovations. A wave of patent expiries, high failure rates of developmental products, pressure to reduce or contain healthcare inflation (prices and expenditures), and access to essential medicines in developing countries have resulted in a global environment of increasing hostility. At this point it is difficult to predict the direction in which the environment will move over the next three to five years. 

Since 1994 the government has developed a comprehensive primary healthcare policy with a focus on preventive rather than curative healthcare. The healthcare system is being restructured holistically to ensure eiffordable equality and accessibility to all South Africans. Healthcare expenditure was predominantly concentrated on providing curative, high technology medicine in urban areas. 

Economic and humanistic outcome evaluations are now made as part of healthcare governance. The information gained from valid outcome measures can be used on a national level to allocate expenditures for treating various sectors of the population (e.g. the elderly, neonates, etc.) or to determine which programs will receive financial resources (e.g. vaccine programs vs. acute influenza treatments). Outcome information can be used to help make decisions regarding the inclusion or exclusion of drugs on formularies. Complete information about the economic, humanistic... 

Work groups identified several trends for the future. Major factors expected to affect pharmacy included a growing elderly population, more health promotion and wellness activities, increased efforts to prove the cost effectiveness of drugs, a decline in healthcare expenditures as a proportion of the Gross National Product, and an increase in nontraditional therapies. There would be more sophisticated drug delivery systems, and more prescription drugs would become available on a nonprescription basis. Finally, it was believed that pharmacists... 

Expenditure per head per year in different countries varies dramatically as shown in Eigure 45.3. The figure also illustrates the proportion of healthcare costs paid privately, indicating that the Americans, the Canadians and the Mexicans pay a high proportion of their own costs while the Irish, Slovaks and Luxembourgeois (and the British although they are not shown on the figure) are treated from the public purse. 

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