E-drug: Feeding the beast? (cont'd)
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In a personal message Halima Kagee, School of Pharmacy, University
of the Western Cape has encouraged me to write more re:
Moving from rewarding drug companies according to increasing sales
of more expensive drugs to rewarding companies according to their
contributions to improving health care outcomes.
My special interest is misleading drug promotion. I believe that
reforming the incentives would be better than regulation (but both are
needed).
Because pharmaceutical companies are rewarded in proportion to sales
regardless of impact on health it is unreasonable to expect them to be
able to produce information which is not misleading. It is NOT
something the companies have control over. It is a system problem.
Unfortunately it is difficult to measure companies contribution towards
health care outcomes so that we can pay them accordingly.
However the "capped maximum annual contracts" used by PHARMAC
in New Zealand show what can be done. These work by phasing out
the subsidy once an agreed sales volume has been reached.
Under that system I have heard of drug reps persuading doctors who
where overusing a drug to reduce their use of a drug which had
exceeded the agreed sales volume. The reps motivation is to
maximise profits for the company but in that case lower use is good
for patients also.
There are 3 main problems:
1. The NZ model is based on being able to subsidize drugs. This
depends not so much on wealth but on the gap between the rich and
the poor and thus the political support for equity of access to drugs.
2. You need to be able to estimate the "sales volume" your
country / region / organisation needs.
3. You need to be able to get the company to accept a contract with
maximum payment only if the target is reached but not exceeded.
Because many companies are accustomed to driving demand up
without limits rather than responding to customers needs, this requires
them to make a major cultural shift.
4. You could still have overuse in some areas and underuse in other
areas. Measuring that and adjusting the rewards accordingly would be
complex but not impossible and could lead to major improvements in
health care outcomes.
This approach does open up the possibility of using non monetary
rewards such as international good publicity.
Regards,
Peter
Dr Peter Mansfield
GP
Director, MaLAM (Medical Lobby for Appropriate Marketing)
peter.mansfield@flinders.edu.au
www.camtech.net.au/malam
PO Box 172 Daw Pk SA 5041 Australia
ph/fax +61 8 83742245
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