National health systems

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... 

The Agreement of the Parliamentary Subcommittee to advance in the consolidation of the National Health System, of 30 September 1997, set out to... 

However, these results are not applicable to compulsory pubhc insurance, nor to National Health Systems. The most notable differences between drag co-payment in an insurance market and in a National Health System or compulsory public insurance environment lie in their voluntariness or otherwise (users ability to choose their coverage) and the ultimate financing of the services (risk-adjusted premiums as opposed to taxes or social insurance contributions adjusted according to economic capacity). Hence, in compulsory public insurance systems, co-payment regulation is used not only as a health policy instrument but also as one of redistribution of income. 

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... 

Juez and Tamayo51 also apply time-series analysis to the evaluation of the consequences of introducing selective financing in 1993. Using the aggregate monthly data on pharmaceutical expenditure of the National Health System between 1991 and 1995, in constant deseasonalized pesetas, the authors compare the observed evolution with the theoretical evolution according to a linear fit. They conclude that the measure had a notable effect in the short term, but was absorbed in the long term. 

Selection of target pharmaceuticals (see Table 1) was based on the following criteria (1) the sales and practices in Spain (according to National Health system), (2) compound pharmacokinetics (the percentage of excretion as nonmetabolized substance), (3) their occurrence in the aquatic media (data taken from other similar studies), and (4) on data provided by environmental risk assessment approaches, which link the calculation of predicted environmental concentrations (PEC) with toxicity data in order to evaluate which compounds are more liable to pose an environmental risk for aquatic organisms [20-22], In the current European... 

The provisions of the new Regulation (EC) 726/2004 do not affect the powers of Member States authorities as regards setting the prices of medicinal products or their inclusion in the scope of the national health system or social security schemes on the basis of health, economic and social conditions. In particular, Member States shall be free to choose from the particulars shown in the marketing authorisation those therapeutic indications and pack sizes which will be covered by their social security bodies. 

Health sector development is a vital government obligation. In a national health system, proper use of well known and newer essential medicines for priority health problems depends on certain minimal level of medical and pharmaceutical services. This includes inexpensive diagnostic test to confirm diagnosis, and well-informed trained clinicians, pharmacists, nurses and other health staff to help patients, especially those with chronic illnesses, to adhere to their treatments. An overall capacity strengthening of the health and supply systems is a pre-requisite to respond adequately to the increased medical and pharmaceutical needs of populations. 

The demand for drug abuse treatment is an important indicator for assessing the world drug situation because it reveals the drugs which place the largest burden on national health systems. Member States reported a total of 4.5 million people under treatment for drug abuse to UNODC. Of the 25 million people (0.6% of the world s population age 15-65) estimated to be heavily... 

The Chinese, Japanese, Indian, and Native (North and South) American cultures all have traditional systems of herbal medicine. In China and Japan, the use of herbal remedies is officially promoted by a government ministry and included in national health systems. In India, herbalism is part of the ancient but still widely used system of Ayurvedic medicine. Native Americans use herbs in a spiritual sense, placing emphasis on their purifying and cleansing properties both physically and mentally. 

One might think that leaders and policymakers would be aware of each other s national health systems and, by emulating the best features, that they would tend to move toward harmonization and greater similarity. 

Roemer, M.I. National Health Systems of the World Oxford University Press Oxford, UK, 1993 Vol. 2, 61. 

Over the last two decades there has been a resurgence of interest in the study and use of medicinal plants. The WHO (World Health Organization) has confirmed the importance of traditional medicine to a majority of the. world s population and encourages all countries to preserve and to use the safe and positive elements of traditional medicine in their national health systems. The WHO Traditional Medicine Programme (1) was inspired by the observation that 80% of the world s population treats diseases exclusively with traditional medicines, and most traditional therapies involve the use of plant extracts or their active constituents. Vegetable species from South America and China are of particular interest in view of their wide use in traditional medicine they offer local populations immediately accessible safe and effective therapeutic products. However only a small fraction of South American and Chinese medicinal plants have been studied. Therefore it is of general interest to document the experience of traditional healers, to select interesting medicinal species and to identify the constituents responsible for their therapeutic or toxic effects. 

It is permitted to offer to legal entities directly connected with the provision of healthcare, medical and training goods and services that improve patients healthcare and benefit the national health system. These must be made in accordance with the legislation and with complete transparency, publicity and includes ... 

Pharmaceutical companies can ask physicians to provide counselling or expert services or other similar services, with the reservation of the regulations in force, for physicians of the national health system and university physicians ... 

Whenever samples are provided, a copy of the current SPC must always be given, together with updated price information, conditions of reimbursement in the national health system, if applicable, and, when feasible, an estimate of the cost of treatment. 

Help countries formulate and implement a national drug policy (NDP) and integrate the work into their national health system in ensuring commitment of all stakeholders. 

The publicly owned and operated national health systems of many countries are examples of in-kind supply-side subsidies. In-kind subsidies are often provided for a more limited range of goods and services, including drugs, donations or loans of premises for health facilities, training, and payment of staff salaries. 

Observers have argued that the implementation of the National Health System gave rise to a double and contradictory effect. For example, according to Pelissero and Carreri (1997 314) ... 

Bioimpedance is a non-invasive, safe and relatively inexpensive technique to assess body composition of both healthy and illness patients. The body impedance analyzer developed in this work was conducted according to the requirements of healthcare applications, such as portability and low cost. These characteristics are considered very important for large-scale use, benefiting the National Health System (NHS) and homecare users. It can be concluded that the developed system can be used for body composition assessment over a wide aging range. 

Although there are few studies on the use of NIV as a marker for the presence of CRF, there have been some informative studies on the use of LTOT that reflect the complexity of using LTOT to estimate the prevalence of disease. LTOT is most commonly prescribed for chronic obstructive pulmonary disease (COPD), with international guidelines guiding its use. (3,4) However, criteria used to prescribe LTOT still vary by regional and national health systems (5,7). For example, LTOT may be prescribed in patients in whom the Pao2 is more than or less than the value commonly derived from clinical trials (8). In one study, patients prescribed LTOT exceeded those actually receiving LTOT by as much as 30% (9). 

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