Health Spain

B Ribas Spanish National Centre for Environmental Health, Spain K Richter Graz University of Technology,... 

WANG H, PROVAN G J and HELLIWELL K (2001) Catechin, the principle bioactive compounds in green tea, and their interactions with food components , in Proc of Eur Conf on Bioactive Compounds in Plant Foods - Health effects and Perspectives for the Food Industry, 26-28 April, 2001, Tenerife, Spain, 221-2. 

Watanabe, T. et al., Separation and determination of yellow and red Safflower pigments in food by capillary electrophoresis, Biosci. Biotech. Biochem., 61, 1179, 1997. Fekrat, H., The application of crocin and saffron ethanol-extractable components in formulation of health care and beauty care products. Proceedings of International Symposium on Saffron Biology and Biotechnology, Fernandez, J.A. and Abdullaev, R, Eds., Albacete, Spain, 2004, p. 650. 

Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, San Llorenf 21, 43201 Reus, Spain e-mail joaquim.rovira urv.cat... 

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 ... 

In order to determine whether or not the growth in pharmaceutical expenditure entails an increase in the price of the resources used in health production, the important factor to determine is the significance or otherwise of the innovation and its marginal contribution to health production. The large number of new products in some markets, such as Spain, Italy and Germany that provide a very small degree of innovation may constitute an indication of increasing prices rather than an increase in value (contribution to the improvement of health status and welfare). 

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

Our empirical evaluation of competition between pharmaceuticals was based on information on prescription drug consumption by non-hospital patients in the National Health Service (NHS) in England in 19% and the Sistema Nacional de Salud or SNS (National Health System) in Spain in 1997. The authors wish to thank Statistics Division IE of the UK Department of Health and the Directorate-General of Pharmacy and Health Products of the Spanish Ministry of Health and Consumer Affairs for supplying us with these data. As can be seen from Table 4.1, public consumption of pharmaceuticals... 

Table 4.4 shows the market share of the most frequently prescribed chemical substance in England and Spain and the H index for prescription concentration in public health care. 

Laboratories are known to apply for the authorization of new active ingredients in order to ensure that the prices of new products are higher than those of products already on the market. Once marketed, products are subject to such strict price regulation that the authorities barely allow adjustment even for general inflation. We have calculated that only 30.05 per cent of the new chemical entities authorized for the first time in Spain between 1990 and 1997 were actually classified as therapeutic improvements at the time of their introduction onto the market. For this evaluation we used the definitions and data on therapeutic improvement released each year by the Ministry of Health and Consumer Affairs in their publication Informacion Terapeutica del Sistema Nacional de Salud. 

In contrast to this, the main objective of price regulation in Spain is to contain the pharmaceutical bill of the SNS.14 The Directorate-General of Pharmacy fixes the ex-factory price of each and every one of the presentations of the pharmaceuticals included in public health care. This authorized price is the maximum ruling price in both the public health sector and direct sales to the public in pharmacies. Laboratories can only make price increases above the maximum price fixed for each presentation when the government authorizes a general price revision. The markups of distributing wholesalers and pharmacists are also fixed by the authorities as a percentage over the exfactory price. 

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... 

Table 6.1 Evolution of public health expenditure in Spain (1989-2001) (%)...

Spain undoubtedly constitutes an atypical case in the context of the European Union (EU) as regards the growth of public health expenditure within health expenditure as a whole. A cursory look at the figures reveals that the percentage of public spending within overall health expenditure remains... 

To sum up, the question that should concern decision-makers now is not so much whether Spain s current level of expenditure can be put on a par with that attained by its neighbouring countries, but rather to what extent current growth rates of public health spending are compatible with the income scenarios fixed by the Spanish public sector in the process of European convergence and its frameworks of stability. 

As we have stated elsewhere (Lopez-Casasnovas1), there is ample reason to believe that the rise in health spending in Spain can be traced to the diagnostic and therapeutic content of average health provision, for which the forecasts to date predict an increase in use as a consequence of the ageing of the population. 

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... 

We consider that working towards a stable framework for the sector in Spain is one of the main challenges for the evolution of public financing of health expenditure. The necessary consensus to achieve this could be built on the discussion already formalized in parliament around a broad agreement for the pharmaceutical sector, although we are very much afraid that in the end electoral issues will outweigh what is advisable and rational. 

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. 

We could say that in Spain today there is an invisible college uniting Spanish researchers interested in the economics of pharmaceuticals and the pharmaceutical industry. This can be seen by analysing the cross-references. It is also symptomatic that practically every year a special session dedicated to this topic is held at the Conference on Health Economics. 

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