Report on pharmaceutical policy 2015, published by diariofarma.

Some notable cuts in public health spending

The economic crisis has hit the public health sector whose spending has gone down from 70,579 million euros in 2009 to 61,710 million in 2013, bringing down GDP from 6.5% to 5.9%. This significant decrease in public health spending, more than 12% in just four years, is exceptional in the European context, where health expenditures continued to rise in this period, despite the slow growth over previous periods. Health spending has only declined in 2009-2013 in absolute terms in rescued countries (Greece, Portugal, Ireland) as well as in Spain.

The Government has been very effective in implementing measures to reduce expenditure in the health sector. To achieve this “accomplishment”, the Government used two types of measures: actions on staff, basically reducing wages and the number of employees; and actions on the pharmaceutical industry, reducing the price of medicines. In absolute terms, the impact of the measures taken with respect to staff is slightly higher, but in relative terms of percentage reduction in spending, the most affected was the pharmaceutical industry.

Another feature of this significant reduction in public health spending is that it was carried out in the absence of reform measures to give certain sustainability to the changes (improvements in management, changes in the care model, fighting avoidable costs, emphasis on public / private partnerships, etc.). Perhaps the only exception was the introduction of pharmaceutical co-payment for pensioners, the closest thing to a reform during this period.

All these measures have to be viewed from the perspective of the Stability Programme, which provides that the weight of public health spending stands at 5.3% of GDP in the 2018 horizon.

Limited impact of the measures

Perhaps most surprising, following the sharp decline in public health spending is that health has been almost absent from recent election campaigns which suggests that it was not a priority of the contesting parties, nor was it among the most evident social priorities.

The explanation is not simple, but after the 2010-2013 downturn, spending stabilized in 2014 and grew slightly in 2015. The deterioration in quality is certainly there, but its best-known indicator, waiting lists, does not allow a very disturbing message of the evolution of the sector. In the November CIS survey, health still did not feature as a major problem for citizens.

The question is obvious: if reaction has been low, does this mean that declines in health spending are justified? Perhaps we were spending too much and what is “normal” is the current situation?

A change in health league

The truth is that Spain has never spent much on healthcare compared to other European countries. While it is true that with this reduced spending, Spain’s health league has changed. It has gone from 1,577 euros / citizen / year in 2009, 12% less than the average of the Eurozone-19, to 1,348 euros, 30% below. The same phenomenon occurs in the weight of public health spending. One can say that we have gone from not being too far behind the advanced countries of Europe in public health spending, to meeting the heights of Lithuania and Croatia.

Need to establish a recovery in public health spending

Despite the limited social impact of the measures, several reasons advocate the need for a recovery in public health spending: aging and increase in chronic diseases; renovation needs equipment (totally obsolete as a result of the crisis); increased demand and higher requirements thereof; emergence of new technologies, not only pharmacological but also in the area of medical devices; and finally, the international comparison, primarily with the European Union- 15

Naturally, this growth of public spending must be reconciled with reform measures: only the increase of public resources, together with the promotion of measures to encourage the responsible use of resources and discriminating towards those most in need, can ensure a quality health system, open to the incorporation of innovation, despite the major drivers of upward spending.

In this context, the main priority of public health is the recovery of lost spending in the period 2009-2013, to return to levels closer to the advanced countries of Europe. Surely this cannot be done in one year, given the deficit commitments of our country, but over a parliamentary term.

What agreements represent Farmaindustria

We have seen how the health sector has been hit by the crisis and, within it, the pharmaceutical subsector is the one that has suffered in relative terms. It is logical that the recovery in spending, a priority for the entire health sector is expressed more clearly in the pharmaceutical industry.

It is in this sense that we must view the agreement concluded between Farmaindustria and the Ministries of Finance and Health, on 4 November 2015. Regarding the concern for sustainability, the agreement links the growth of public spending on innovative drugs to the growth of the economy: companies are committed first to compensate the State if this spending grows faster than GDP. The agreement is valid for one year, but renewable for three additional years. It also envisages measures on efficiency and collaboration in terms of patient access to innovation.

Therefore, this agreement is part of the measures necessary for a progressive recovery in health spending, but always from a perspective of sustainability, linking this recovery to economic growth.

Some negative reactions

The agreement, instead of being welcomed and imitated by other industry players, attracted criticism from the Professional Medical Association, which considered it part of a logic zero-sum, so that any rise in pharmaceutical spending would be detrimental to other items, namely the professionals. Rather than joining the efforts to recover health spending that ultimately can only be understood in the long run through a change in some of the forecasts of the Stability Program.

It is hardly understandable that from the highest corporate medical instances constant belligerence against the pharmaceutical industry is maintained, up to the point of challenging the patent system. All this instead of joining the efforts to recover public health spending.

The agreement concluded with Farmaindustria, an example for the sector 

This agreement should be an example for all players in the health sector, to focus their priorities on what really matters: the recovery in health spending. Something that will only be accepted by the economic authorities if at the same time reform measures arise from within the depths of the system, which ensure long-term sustainability. If this does not happen again and spending skyrockets, we very much fear that we will be back to taking the same measures: actions on professionals and the pharmaceutical industry.