7 days in healthcare (September 9th-15th, 2024)

/in /by

 

Summary

Biomedicine

  • Direct-to-consumer medical testing: an industry built on fear. This industry is growing rapidly and will reach $9 billion by 2033. Genetic tests, biochemical tests and monitoring systems are the most common offerings. A recent Australian study analyses several hundred tests offered directly to consumers and shows that the vast majority have little clinical use. Greater regulation of this industry is needed, as well as dialogue with the public regarding its benefits and risks. Although it is true that the citizen-consumer will have an increasing role in maintaining his or her own health, we must be careful to ensure that mere commercial interests do not act precisely against health.
  • A therapy attacks the tangles of a protein key to Alzheimer’s. The model has so far only been tested on mice, but offers promising results.
  • The new generation of radioactive drugs attacks cancer with molecular precision. Tumour-seeking radiopharmaceuticals mark a new direction for oncology and promise specific treatments with fewer side effects.

Global Health

  • Mariana Mazzucato promotes the economy of health for all with the WHO. The panel of conclusions of the WHO Council on Health Economics for All, chaired by the prestigious economist Mariana Mazzucato, is presented. It is based on the premise that the incredible economic development of the last century has brought many benefits, also in health, but at a high price of pollution, climate change, unhealthy diets and habits and a great weight of non-communicable diseases and resistance to antibiotics. The recommendations deal with four themes: Value, Financing, Innovation and Strengthening the capacities of the public health sector.
  • The lessons of covid-19 must be applied to control mpox in Africa. First, Africa does not have the resources to follow the disease; Second, vaccines must arrive quickly where they are needed; Third, Africa needs its own vaccine production and regulatory infrastructure.

International health policy

  • China to allow wholly foreign-owned hospitals to open for first time. China is opening up its system to the world. The Chinese government announced last Sunday that it will allow wholly foreign-owned hospitals to be set up in nine areas of the country, including the capital, in a bid to attract more foreign investment to boost its ailing economy.
  • Independent report on the NHS by Lord Darzi, a surgeon and former health minister. Key findings: Deterioration: The nation’s health has deteriorated over the past 15 years, with a marked increase in people living with multiple chronic conditions. Spending: A huge proportion of health spending is on hospitals and too little on the community and productivity is too low. Waiting lists: Waiting lists have grown, as have queues at emergency services. Cancer care: The UK has higher mortality rates than other countries. Lasting damage: The Health and Social Care Act 2012 did lasting damage to the NHS’s management and resource capacity. It took more than ten years to recover and the effects are still being felt. Productivity: too many resources have been allocated to hospitals, where productivity has fallen, compared to very few in the community. A non-technical report, very easy to read and prepared from common sense.
  • British Prime Minister Starmer launched his first long speech on health on September 12, after the publication of Lord Darzi’s report: “Major surgery is needed, not just bandages.” He announced a ten-year plan to reform the NHS. “Reform or die.” Instead of an exclusively top-down approach, the plan is intended to reflect the contributions of professionals and patients. It is unthinkable that such a speech would be made by a president of the Government in Spain, despite the fact that our SNS has as many or more problems than the NHS. Here we are dedicated to contingency policies, now the suicide plan and the ELA law, both interesting initiatives, but which do not address the problems of the system.
  • Draghi report on the future of competitiveness in Europe. The main ideas are: First, Europe needs to close the innovation gap with the USA and China; Second, Europe needs a plan for decarbonisation and competitiveness; and third, to increase security and reduce dependencies. This is a necessary report, since Europe has dedicated itself to outsourcing everything: innovation, production, energy and defence. In this way, it is impossible to preserve the European model, defined by Draghi himself, as characterised by prosperity, equity, freedom, peace and democracy.
  • The Draghi Report places the pharmaceutical industry as a strategic pillar in Europe. Among the things it mentions is that of the ten most sold biologicals in Europe only two are marketed by European companies.

National Health Policy (Spain)

  • The Ministry announces a plan to prevent suicide in Spain, where there is a disconcerting map of suicides and the suicide rate in Asturias doubles that of the Basque Country or Madrid.
  • The Asturian health system is experiencing an earthquake with 6,000 places affected. Almost one in three places will have a new owner, due to the transfer competitions and the stabilization competitions underway. The objective is to reduce temporary employment. Although the objective is perfectly defensible, the way of doing it threatens to make the cure worse than the disease. Transfer competitions inspired by unions, where seniority prevails and OPE’s designed without criteria and without intervention from either the medical units or the hospitals, threaten to destructure functioning teams and turn the whole system upside down.
  • FEDEA publishes a report on the Catalan agreement. The collection of all its taxes by Catalonia will mean a decrease in its contribution to the common fund and, therefore, represents a threat to services in other communities, mainly health. This will mean an increase in taxes paid by citizens of the territories that remain in the common regime, or a cut in state benefits that would also affect them negatively.
  • The Government proposes to increase MUFACE’s premiums by 28% to 1,300 euros, although this amount is still far from the public health expenditure without pharmacy of 1,608 euros. If the companies accepted this offer, the gap in relation to public health would be 308 euros, instead of the current 594. It seems that insurers would be willing to accept up to 20% less than public expenditure, which would be 1,335 euros, a figure very close to that offered by the government. Although there are voices from health employers’ associations complaining about this offer, the Government’s effort seems important and should not be underestimated, as seen from outside, it seems to be a great success in the negotiation of the insurers, carried out in very difficult circumstances. On the other hand, the association of independent doctors defends a mutual society without insurers, what they call direct Muface. As for the proposal of this association of a Muface without insurers, as a joke it is not bad. It seems to ignore something as simple as what health insurers do: the function of financing and purchasing services (selection of providers, evaluation and payment of the same) to attend to the health needs of the population covered. What they really do is manage a pool of risks. Are the associations of independent doctors going to perform these functions?
  • Generic medicines will have different prices to brand name medicines. Spain is the only country in Europe where generic and brand name medicines have the same price and that is a disincentive for the development of the generic industry. Generic penetration is stuck at 41% in units and 21% in economic value. Although there were differentiated prices for generics and brands in Spain, at one point the model was changed to equalize prices, distancing ourselves from what is usual in Europe. Originality, in dribs and drabs.

Companies

  • International
    • Sanofi is betting on a “revolutionary factory” to respond to future pandemics. Located in Neuville-sur-Saône, in the Rhône, the new production site is almost entirely mobile and modular and will allow up to four vaccines to be manufactured at a time.
    • Pharmaceutical groups want to control greenhouse gases produced by asthma inhalers. Both GSK and AstraZeneca are finalizing trials of inhalers that cause a much smaller carbon footprint.
  • National
    • The German Ulrich Medical is establishing its third international subsidiary in Spain. This century-old family business has already opened branches in the United States and France.

Biomedicine

Global Health

  • Moving forward in the economics of health for all. The panel of conclusions of the WHO Council on Health Economics for All, chaired by the prestigious economist Mariana Mazzucato, is presented. It is based on the premise that the incredible economic development of the last century has brought many benefits, also in health, but at a high price of pollution, climate change, unhealthy diets and habits and a great weight of non-communicable diseases and antibiotic resistance. The recommendations deal with four themes: Value, Financing, Innovation and Strengthening the capacities of the public health sector (https://www.thelancet.com/action/showPdf?pii=S0140-6736%2824%2901873-7)
  • Article from the journal Nature. The lessons of covid-19 must be applied to control mpox in Africa. First, Africa does not have the resources to follow the disease; second, vaccines must arrive quickly where they are needed; Third, Africa needs its own vaccine production and regulatory infrastructure (https://www.nature.com/articles/d41586-024-02912-6)
  • Cholera deaths are rising despite being easily preventable. According to the WHO, mortality rose by 71% last year, compared to only a 13% increase in cases (https://www.nytimes.com/2024/09/11/health/cholera-deaths-cases.html)

International Health Policy

  • UK and the National Health Service
    • Independent report on the NHS by Lord Darzi, a surgeon and former health minister. Key findings include: Deterioration: The nation’s health has deteriorated over the past 15 years, with a marked increase in people living with multiple chronic conditions. Spending: A very significant proportion of healthcare spending is in hospitals and too little in the community and productivity is too low. Waiting lists: Waiting lists have grown, as have queues at emergency departments. Cancer care: The UK has higher mortality rates than other countries. Lasting damage: The Health and Social Care Act 2012 did lasting damage to the NHS’s management and resourcing capacity. It took more than ten years to recover and the effects are still being felt. Productivity: Too many resources have been allocated to hospitals, where productivity fell, versus too few in the community. (https://www.nytimes.com/2024/09/11/health/cholera-deaths-cases.html). Nuffield Trust comment: why is the Darzi report so important (https://www.nuffieldtrust.org.uk/news-item/why-is-the-darzi-report-so-important)
    • On 12 September, following the publication of Lord Darzi’s report, British Prime Minister Starmer launches his first long speech on healthcare: “Major surgery is needed, not just plasters.” He announces a ten-year plan for NHS reform. “Reform or die.” Rather than a purely top-down approach, the plan is intended to reflect input from professionals and patients (https://www.gov.uk/government/news/pm-major-surgery-not-sticking-plaster-solutions-needed-to-rebuild-nhs). King’s Fund reaction to Prime Minister’s speech (https://www.kingsfund.org.uk/insight-and-analysis/press-releases/prime-minister-first-health-care-speech-since-taking-office)

National health policy

  • FEDEA and the Catalan agreement
    • FEDEA publishes a report of reflections on the Catalan agreement. The collection of all its taxes by Catalonia will mean a decrease in its contribution to the common fund and, therefore, represents a threat to services in other communities, mainly health. This will mean an increase in taxes paid by citizens of the territories that remain in the common regime, or a cut in state benefits that would also affect them negatively. (https://fedea.net/algunas-reflexiones-al-hilo-del-debate-sobre-el-concierto-catalan/)
  • MUFACE
    • The Government proposes to increase premiums by 28% to 1,300 euros, although this amount is still far from the public health expenditure without pharmacy of 1,608 euros. If the companies accepted this offer, the gap in relation to public health would be 308 euros, instead of the current 594. It seems that insurers would be willing to accept up to 20% less than public expenditure, which would be 1,335 euros, a figure very close to that offered by the government. On the other hand, the association of independent doctors defends a mutual insurance company without insurers, what they call direct Muface (https://theobjective.com/economia/2024-09-09/gobierno-propone-subir-primas-muface/)

Companies