E-DRUG: Medicine price transparency in Brazilian hospitals
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Dear All
A recent Lancet viewpoint article talked about the contribution laws can
and have made to health in society (Attaran A, Pang T, Whitworth J,
Oxman A, McKee M. Healthy by law: the missed opportunity to use laws for
public health Lancet 379, Issue 9812, 21–27 January 2012, Pages 283–28).
[Article available at
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60069-X/fulltext\]
In the article the authors make reference to an initiative to increase
price transparency in public hospitals in Brazil by publishing the
prices the hospitals paid for the medicines on the MOH website (copied
below as fair use; citation numbers removed for clarity of reading).
"Brazil's experience with transparency of medical supply pricing is a
legal intervention consistent with the WHO Director-General's priorities
to harness information for health and strengthening health systems. In
the late 1990s, Brazil's Ministry of Health became concerned that
federally-funded health facilities were paying too much for drugs,
medical gases, and other supplies. The Minister of Health therefore
signed a portaria (ordinance) requiring large public hospitals to
publish the prices that they paid for medical supplies on the ministry
website. Nowadays, Brazil's information system is known as the Banco de
Preços em Saúde (price databank in health), and transparency has had
positive effects. Health system managers, informed of the prices that
their peers paid, drove prices downward; in a nationwide study, less
than 7% of medicine purchases occurred at a price exceeding the average
in the Banco at the time. Furthermore, in a largely decentralised health
system, centralisation of price information allows auditing and, in at
least one case, enforcement action against overpayment for drugs. In
view of the evidence of large mark-ups preventing access to essential
medicines in many countries the lessons are obvious."
This program provides evidence of how price transparency can assist in
public procurement through increasing the bargaining power of the
purchaser who might otherwise believe they are receiving a 'good' price
from the seller (this applies both to the hospitals as well as the
patients). This method can be applied across borders through regional
and international cooperation. E-Drug readers will be aware of the
recent Price Information Exchange (PIE) initiative undertaken by the WHO
WPRO office (PIEmed; http://www.piemeds.com) to establish a regional
procurement price database that facilitates information sharing on
public procurement among countries in the region. For countries where
this level of information sharing is not available, the MSH
International Drug Price Indicator Guide (http://erc.msh.org) provides a
useful resources of the prices of essential medicines on the
international market. Other resources specific to HIV, TB and Malara
medicines are also available e.g. the WHO's Global Price Reporting
Mechanism, the Price and Quality Reporting database of the Global Fund,
MSF Untangling the Web of HIV drug prices, etc. (the Health Action
International pricing page can be consulted for links to many of these
and more; http://www.haiweb.org/medicineprices)
[Please fix links to websites if they are broken in your web browser]
Regards
Douglas Ball
Pharmaceutical consultant
Public Health and Development
E-mail: douglasball[AT]yahoo.co.uk