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PHARMACOLUMN

Treatment policy debated

THE ECONOMIC downturn has not left Slovakia’s health sector unaffected. The economic crisis has meant more jobless people, less in premiums paid to health insurance companies and less money available for health care in general. This creates pressure to find measures to make the system work more effectively and efficiently as well as to reduce spending. But specialists warn that saving funds in inappropriate ways may lead to increased costs in the future.

THE ECONOMIC downturn has not left Slovakia’s health sector unaffected. The economic crisis has meant more jobless people, less in premiums paid to health insurance companies and less money available for health care in general. This creates pressure to find measures to make the system work more effectively and efficiently as well as to reduce spending. But specialists warn that saving funds in inappropriate ways may lead to increased costs in the future.

“The medicines policy is part of the health policy of the state and depends on the country’s economy,” Pavol Trnovec, vice chairman of the Slovak Association of Research-Based Pharmaceutical Companies (SAFS) told The Slovak Spectator. “The aim of the quality medicines policy should be not only reduction of costs but also sensible investment in the health of individuals as well as the whole population. It is also necessary to keep in mind that expenditures for medicines are not the only cost of health care.”

Use of medicinal drugs is one of the best statistically-followed segments of health care since the quantity of consumed drugs can be calculated down to the level of packages and number of pills and calculated in euros spent. This, according to Trnovec, lures some people to advocate curbing of funds spent on drugs when there is a need to reduce overall spending.

“This is simply easier, faster and in a short-term also more effective than dealing with more complex issues, for example, the network of hospitals, surgeries performed and the quality or effectiveness of health care provided in the hospitals,” said Trnovec. “A wise man once said that solutions of today are problems of tomorrow. In that context we need to consider that the simplicity of applying a restrictive medicines policy can provide solutions that may, paradoxically, increase future costs for treatment of patients untreated or insufficiently treated now. It would be wise to have control mechanisms in place to prevent this risk.”

To reduce expenditures on medicines the Slovak Health Ministry has introduced several cost-cutting measures.

In spite of the significant degree of regulation of the medicines market in Slovakia, patients here have access to the most modern medications, according to Trnovec. The Health Ministry, health insurance companies, doctors and other stakeholders share that opinion.

“Slovak patients have above-average access to most critical medicines,” Martin Višňanský, a member of Všeobecná Zdravotná Poisťovňa (VšZP) health insurer’s board of directors and the director of its section on strategy and politics of health, told The Slovak Spectator. “We have improved the access for oncology therapy, biological treatment, thrombolysis and many others. During the last 18 months VšZP has implemented the access model with pharmacoeconomical assessment of new innovative drugs in order to evaluate the price for QALY (meaning the cost of quality-adjusted life years or willingness to pay for innovation) which is the same as in Great Britain.”

Tomáš Szalay from the Health Policy Institute think tank agrees that patients in Slovakia have very quick access to new modern medicines which are often covered from the country’s health insurance scheme better than in more wealthy EU countries.

Trnovec believes that it is necessary to maintain this trend, arguing that an untreated or insufficiently treated patient means a likelihood of more health complications later and probably more expensive treatment in the future.

“An adequately and well-treated patient is a person who feels better, one who will contribute to his or her family, community and society,” said Trnovec. “The improvement of a patient’s health condition prolongs his or her life, mental and social wellbeing, as well as that of his or her family and relatives. All this positively influences increases in production and the economic growth of the country.”

According to Szalay, untreated patients mean more serious diseases and complications and higher costs in the future, a lower quality of life and premature deaths.

“There are many patients who are not sufficiently treated in Slovakia,” Iveta Vaverková from the Slovak Society of General Practice told The Slovak Spectator. “Many patients suffer from diseases not yet diagnosed by doctors or if a physician has diagnosed them with a disease the patients are not treated at all or are treated insufficiently.”

Ján Bielik, the chairman of the Slovak Society of Pharmacoeconomics, believes that untreated patients mean an increased occurrence of various diseases, reduced labour productivity when patients are in productive age groups, a lower quality of life, early deaths and a shortened average period of survival after diagnosis.

Examples of such ‘time bombs’ are diabetes and obesity, while Bielik also sees cardiovascular diseases as the biggest threat to the health of many Slovaks from the viewpoint of untreated patients and future costs for health care.

“Cardiovascular diseases are responsible for at least one-half of all deaths in Slovakia,” Bielik told The Slovak Spectator, pointing out that they can be successfully treated. He cited the National Programme for Prevention of Cardiovascular Diseases of the Slovak Society of Cardiology which found that minimal, but adequate, treatment of patients in the age group between 45 and 64 years who have a 20-percent risk of cardiovascular disease during the next 10 years, would prevent about 6,000 new cardiovascular illnesses and save about 1,400 lives in the first three years of the programme. Bielik believes that from the viewpoint of the economics of health care, this is a highly effective intervention.

The Dôvera health insurer sees the question of untreated patients as linked particularly to the low involvement of the Slovak population in taking care of their own health, not any inaccessibility to medicines.

“The low usage of preventive checks guaranteed by the law and covered by health insurance companies from the public health scheme is an example,” Andrea Horka, the spokesperson of Dôvera, told The Slovak Spectator.

According to Višňanský, patients in Slovakia have “access to their general practitioners, access to all critical health-care services, and in case of emergency and/or critical illness they have everything covered by public health insurance,” so he disagrees with any suggestion that Slovak patients are not properly treated because of the health-care system in Slovakia. Nevertheless he said that sooner or later the time will come for the patients as well as for the system to improve as there is space for this among all stakeholders.

In the case of undiagnosed or untreated patients, Trnovec said it is first necessary to set clear target parameters and strategies for their achievement, to increase health awareness in the population, to support preventive programmes, to introduce the latest diagnostic methods and then in response to treat as many patients as possible by the most suitable, cost-effective, and modern methods and medications.


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