Posts

7 days in healthcare (January 22nd-28th, 2024)

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Summary

From the point of view of Biomedicine, highlight the article by Dr. Topol, famous American cardiologist and doctor, who says how generative AI can contribute to significantly reducing medical errors, which cause hundreds of thousands of deaths a year in the United States and around the world. An initial cancer screening seems to be making its way through a simple blood test, taking advantage of the sharing of certain molecular characteristics in all cancers. The University of Gothenburg in Sweden is developing a blood test for the early diagnosis of Alzheimer’s disease.

With regard to Global Health, an editorial in The Lancet refers to the economic problems in low- and middle-income countries in addressing health expenditures, given the great weight of debt interest, which is why it proposes as a solution its condonation. The first mass malaria vaccination begins in Africa. Universal healthcare in Tanzania. Universal coverage, long exclusive to Europe and high-income countries (with the exception of the United States), is now spreading to developing countries as well.

In terms of International Health Policy, the next American elections in 2024 already show what could be the priority issues during the campaign for Democrats and Republicans. For the former, reducing the high price of prescription drugs and women’s health (with pro-choice options); for Republicans, overcoming covid-19 and drug overdose. It does not seem that the repeal of Obamacare, which has reached a record of 21 million affiliates, is going to be a priority in the Republican campaign.

If we talk about National Health Policy (Spain), presentation by Minister Mónica García of her priorities in the Congressional health commission. Laws against alcohol consumption in young people and to protect direct public management in public healthcare. Announcement of the legalization of cannabis and increase in the portfolio of services in “dental” and “visual health”. The imminent approval of the Public Health Agency and the reform of the Framework Statute in 2024 are announced. In relation to this last point, it was announced that negotiations are being carried out with the unions and the communities. And what about the professionals? Don’t they have anything to say on this topic? Important announcement by the Ministry of the genetic portfolio of the National Health System, to be launched gradually throughout 2024. Health maps are being reformed and simplified in several communities: Aragón, Cantabria, Valencian Community and Asturias . It is striking that the reforms are promoted by PP governments in the first three communities, while the reform in Asturias, sponsored by a PSOE government, is opposed by the PP. Catalonia promotes the discussion of a National Health Pact. Among other issues, the elimination of the statutory personnel regime is proposed. Possibly this change cannot be made legally from an autonomous community, but the much-needed idea and the opening of the discussion are welcome.

As for Companies, at the international level, Novo Nordisk and Lilly find themselves with a new player in their battle regarding obesity: the Danish biotech company Zeland Pharma. When it comes to national news, the problems with Grifols continue. Interesting article in Expansión on professionalization and corporate governance in family businesses.

Biomedicine

Global Health

International health policy

  • USA
    • Article in JAMA: Focus on health problems in the 2024 American elections. It seems that health care is going to be very present in the American elections. Democrats’ issues are lowering prescription drug prices and women’s health (with pro-choice options); while the Republican issues are overcoming covid-19 and drug overdoses and border control policies in this regard. Despite Trump’s criticism of the Obamacare law, repealing the law is unlikely to be made a campaign priority (https://jamanetwork.com/journals/jama/fullarticle/2814471)
    • Obamacare enrollment boom, reaching 21 million in 2024 (https://www.nytimes.com/2024/01/25/us/politics/obamacare-open-enrollment.html)

National health policy

Companies

 

 

7 days in healthcare (December 11th-17th, 2023)

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Summary

From the point of view of Biomedicine, CRISPR therapy, which begins with sickle cell anemia, is great hope. In the end, the FDA approves two gene therapies for this disease, which affects 7.7 million people globally and is a chronic, debilitating disease that causes pain and reduces the quality and expectancy of life. New approved therapies include extraction, genetic modification and reinfusion into patients of their own hematopoietic stem cells. The problem is that these patients live mainly in sub-Saharan Africa and India, which are far from having the infrastructure to apply this therapy. The price of these therapies is about 2 million euros per patient, which again raises the problem of the problems of universalization of precision medicine. Ozempic, Alzheimer’s drugs and malaria vaccines among the scientific milestones of 2023 for Science magazine. For its part, Nature magazine chooses a non-human among its scientists of the year: ChatGPT.

As far as Global Health is concerned, in the end, an international agreement is reached on the end of fossil fuels. COP28 was the first global conference on the subject after the Paris agreement in 2015 (COP21) in which a global limit to temperature growth was established at 1.5º. On December 13, 2023, the agreement on net zero emissions by 2050 will be reached. Fossil fuels generate a lot of wealth, but they are also the bulk of CO2 emissions. The problem is that there is no system that forces governments to meet that objective. A global treaty on plastics is proposed by the United Nations General Assembly (March, 2022). Plastic pollution is a global threat, since plastic is persistent and less than 10% is recycled, almost 6 billion tons now pollute the planet. This contains more than 10,500 chemicals, which includes carcinogens, neurotoxicants, etc.

Regarding International Health Policy, design by the European Union of a Plan to avoid shortages of more than 260 critical medicines, which includes storage and incentives for production

If we talk about National Health Policy (Spain), one in ten Spaniards on the waiting list, record numbers in health. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertation (the disdainfully called “peonadas”) or agreements with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities. The CIS Barometer is released (3rd wave, October 2023). 57.5% value positively the functioning of the National Health System, which means a great setback with respect to previous editions. In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN). Although this reinforcement is necessary, it must surely be complemented with what we could call “cohesion bodies”, among which could be HISPANICE, also proposed by FUNCAS.

In the field of Companies, on an international level, Cigna renounces creating a health insurance giant in the USA, by becoming part of Humana. AstraZeneca enters the world of vaccines. Regarding national news, Quirón advances in the construction of its hospital in Gijón (Asturias) and receives from the Ministry of Defense the management of the hospital on Isaac Peral Street (former Generalísimo Franco), closed for more than 30 years. Good results from Miranza and Ribera, the latter contemplating three new projects.

Biomedicine

Global Health

International health policy

National health policy

  • Waiting lists
    • One in ten Spaniards on the waiting list, record figures in healthcare. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertion (the so-called “peonadas”) or conciliation with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities (https://www.eldiario.es/sociedad/diez-espanoles-lista-espera-cifras-record-sanidad-quiere-atajar_1_10708957.html)
  • It is proposed to strengthen the Ministry of Health
    • In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN) (https://elpais.com/society/2023-12-11/potenciar-el-ministerio-de-sanidad.html)

Companies

 

7 days in healthcare (June, 19th-25th, 2023)

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Summary

From the point of view of Biomedicine, ethical problems continue to be discussed as a consequence of the creation of embryos without eggs or sperm. Until now, an embryo required an egg and a sperm, but this new approach would allow, in hypothesis, to solve problems of infertility or pregnancy loss, but it is a matter to regulate very carefully. Two studies in Nature seem to show that the Y chromosome makes men more vulnerable to tumors.

With regard to Global Health, The Lancet focuses on the great threat of diabetes, since it is estimated that in 2050 there will be 1.3 billion diabetics, a disease related to obesity, diet, tobacco, alcohol and sedentary lifestyle. Inequalities in access to morphine are denounced, with the United States and Europe almost completely monopolizing its use. An important issue, since this drug has a relevant role in the treatment of pain and in palliative care.

Regarding International Health Policy, according to the weekly WHO report, covid is declining in both the number of cases and deaths in all WHO regions of the world. Only in the African region is there a slight increase in the number of deaths, with a decrease in the number of new cases. In the United States, the commercialization of meat grown in the laboratory is approved. One of the authorized establishments belongs to the Spanish philanthropist José Andrés. Also in the United States, not minor problems continue as a result of the annulment of the Roe v Wade ruling that transfers the authorization of abortion to the states. In the United Kingdom, the problems with the emergency services continue and a strike of resident doctors is called. New health insurance law in South Africa, which appears to represent progress towards universal coverage in that country.

If we talk about National Health Policy (Spain), according to the WHO weekly bulletin, Spain is the country in Europe with the highest mortality from covid. The government and the communities agree to abolish the mandatory nature of masks in health centers and pharmacies. Ayuso, proclaimed President of the Community of Madrid, after the last elections. Absence of great news in the announcements of health measures for this legislature. As was already known, Spain is consolidating itself as a world power in clinical trials, an achievement no less.

In the field of Companies, internationally, Walmart (the largest supermarket chain in the USA) enters the primary care business, with 32 centers in 5 states. Walmart was already in healthcare, but it was with small clinics for minor care. Significant company purchases by Merck MSD and Lilly, which seems to confirm that M&A activity in pharmaceutical companies is reviving. In the Spanish national arena, ASEBIO announces an increase in investment in R&D by biotech companies in 2022.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

 

7 days in healthcare (January 9th-15th, 2023)

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Summary

From the point of view of Biomedicine, everything seems to indicate that important advances in the diagnosis and treatment of certain diseases are coming in the not too distant future, with cancer vaccines, the new FLASH radiotherapy, the diagnostic revolution of virtual biopsies and the incorporation of certain devices (such as smart watches) in the prevention and monitoring of certain pathologies.

With regard to Global Health, it should be noted that climate change seriously threatens our health, according to The Lancet. Another important article in this magazine refers to the fact that the covid has revealed the inequalities between social groups and countries in dealing with the pandemic, as well as the absence of a global health architecture.

As for International Health Policy, with regard to covid, an editorial in The Lancet says that far from being overcome, 2023 brings new concerns, such as the impact of the situation in China or the new form XBB.1.5 in the United States. In China, the post-covid zero situation continues, officially acknowledging almost 60,000 deaths in the last month, despite the fact that the WHO insists on the request for more transparency in that country. In the United States, the abortion pill, according to the FDA, can already be purchased in pharmacies and by mail order, even in states where abortion is totally prohibited, which indicates the difficulty of shortcuts and of wanting to close doors to the field. In the United Kingdom the serious crisis of the NHS continues. The health minister of the shadow Labor cabinet publishes in the Financial Times an article with a long-term approach to reforms, something that, regardless of its content, we miss in Spain by all parties. An important editorial in The Economist where it says that part of the solution to the NHS’s problems involves solving the problems of Primary Care, proposing several changes, but without losing perspective that a large part of the problems are in hospitals, with the situation of waiting lists and emergencies. He also opposes the Labor Party’s proposal, made last week, to end the independent mini-company character of Primary Care in the UK, in order to make primary care physicians salaried. The Economist carries out a study that says that in the United Kingdom there are 260 deaths a week (more than 12,000 a year) as a result of delays in the emergency room. The British are turning more and more to private healthcare, as increase problems in the public sector. The EU devises plans to avoid medicine shortages and dependence on China.

If we talk about National Health Policy (Spain), the drop in the incidence of covid continues, despite the situation in China and the American variant called Kraken. The Primary Care strike in the Community of Madrid is reactivated and a strike is on the brink in 8 autonomous communities, while the emergencies are collapsed. Despite the plans, recent studies show that almost half of public health workers are temporary. In relation to the Strategic Plan of the pharmaceutical industry, both BIOSIM and AESEG, as well as the representatives of orphan drugs, position themselves with requests, in a clear attempt not to leave this plan only in the hands of large innovative companies, as suggested by the photo of La Moncloa, with Sánchez meeting with the main leaders of pharmaceutical multinationals.

In the field of Companies, internationally, relevant news for Pfizer, BioNTech and AstraZeneca. In our country, it is worth noting the steps taken by Viamed (new hospital in Tarragona), Ribera (great growth in turnover in 2022), Miranza (which continues its growth), Korian (which is preparing to integrate Group 5) and the CUN (which has just renovated part of its hospitalization area). For its part, KKR has completed the acquisition of IVI, an important in vitro fertilization company of Spanish origin.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

7 days in healthcare (September 12th-18th, 2022)

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Summary

From the point of view of biomedicine, immunotherapy (in colon cancer) and CAR-T therapies (in lupus) continue to expand their therapeutic possibilities. Advances against infections for resistant bacteria. Will there ever come a time when cancer can be diagnosed by a simple blood test? This possibility does not seem very remote, according to papers presented at the meeting of the European Society of Medical Oncology.

Regarding Global Health, an important work directed by Jeffrey Sachs and published by The Lancet on the delays and errors of both governments and the WHO in dealing with the covid pandemic, which could have produced 17.7 million of  deaths, many of them preventable.

Regarding international health policy, the WHO says that the end of the covid pandemic may be in sight, although at the same time a new variant (BJ.1) of covid is evident in Europe. Important debate in Europe (Scotland and France) on euthanasia and assisted death. The French Ethics Committee opens the door to this possibility. The financing of the American FDA was questioned, due to its great economic dependence on the pharmaceutical industry. Biden launches a speech commemorating Kennedy’s in 1962 when he decided to go to the Moon, but this time oriented towards the fight against cancer.

If we talk about national health policy (Spain), the PDeCAT presents an amendment to the entire equity law, which it accuses of interfering in regional powers and of confusing agreement with privatization. Surprising statements from the Ministry of Health in a parliamentary response, saying that its functions in relation to the waiting lists are only to inform and monitor, as if it did not have the possibility of signing agreements with the communities to address this problem or of launching other actions. Concern, there are even demonstrations in the street, of the relatives of the elderly admitted to residences. The Community of Madrid announces that it will reduce the waiting lists by half. Although we would like it not to be the case this time, this announcement is preceded by other similar ones from different governments, which always came to nothing in terms of effectiveness. The search for solutions by the Ministry of Finance to the MUFACE model, highly impacted by inflation, seems to recognize its underfinancing.

In the field of companies, from the international point of view, important success for Sanofi, with its new vaccine against bronchiolitis. In Spain, important corporate movements in Korian, HM Hospitales, Miranza and Ribera.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (April 4-10, 2022)

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SUMMARY

From the point of view of biomedicine, it is worth highlighting the fact, highlighted by the journal Nature, that the WHO took more than two years to recognize the airborne transmission of covid. A new generation of vaccines that prevent cancer can make tumors disappear before they appear, according to an article in Science. The natural experiment from South Korea and Hong Kong shows that the “omicron” variant can be fatal in unvaccinated people.

As far as Global Health is concerned, the situation in Ukraine gives us difficult lessons in global health, explains the editor of The Lancet. It should be noted that the black American population already exceeds the white population in mortality from opioids. Until now, deaths from this cause occurred mainly in “non-colleged educated” whites.

Regarding international health policy, the European health agencies (EMA and ECDC) say that it is too early for the second “booster” of the covid vaccine. Ten years of “Choosing Wisely” the revolution in medical practice that tries to minimize worthless or low value health interventions.

If we talk about national health policy (Spain), the appearance of the 2022 Health Barometer (First wave) is important. It should be noted that waiting lists are the main concern of the population; the delay in a high percentage of cases to see a primary care physician; and that the positive perception of the public system decreases, while that of the private system increases. Report on health professionals, which says that within five years there will be a shortage of 9,000 doctors.

In the field of companies, from the international point of view, Moderna’s agreement with the non-profit entity IAVI to apply mRNA technology to various diseases should be highlighted. SpainCares confirms that Spain is not in an advantageous position with regard to health tourism.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

  • COVID

o The United States donates more than 100 million doses of covid vaccine for children (https://www.ft.com/content/3e5f9359-67a5-4f24-971e-51761119899b)

o Shanghai residents beg for food and medicine as authorities lock down the city (https://www.ft.com/content/3e439a10-860b-4ae6-9070-ad8546da8850)

o Olaf Scholz, German Chancellor, fails in Parliament with his plan to make the vaccine mandatory (https://www.ft.com/content/7d0610bf-3cf9-4edd-a392-e9d97dc9fade)

o COVID deaths rise in the UK, with infections at record highs (https://www.theguardian.com/world/2022/apr/05/covid-related-deaths-rise-england-infections-record-high )

o The European health agencies (EMA and ECDC) say that it is too early for the second covid vaccine “booster” (https://www.nytimes.com/2022/04/06/world/europe/covid-second- booster-europe.html)

  • Other themes

o Ten years of “Choosing Wisely”, which revolutionized medical practice based on recommendations of “do not do”, to reduce low-value health care (https://www.nejm.org/doi/full/10.1056/ NEJMp2200422)

o Life expectancy in the US continues to decline in 2021, despite covid vaccines (https://www.washingtonpost.com/health/2022/04/07/life-expectancy-covid/)

o Oklahoma passes one of the toughest anti-abortion laws in the US, following a Republican strategy (https://www.ft.com/content/cee6a170-fa23-47cb-b554-d457d68f225b)

o Important report by the Nuffield Trust on the recovery of health systems after covid, analyzing the situation in several countries (https://www.nuffieldtrust.org.uk/research/health-system-recovery-from-covid-19- international-lessons-for-the-nhs)

o Great impact in the United Kingdom of the Ockenden Report, on maternity care, with the detection of serious problems, published by the British Government (https://www.gov.uk/government/publications/final-report-of- the-ockenden-review/ockenden-review-summary-of-findings-conclusions-and-essential-actions)

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o Decrease in the incidence of covid: up to 420.17 cases per 100,000 inhabitants over 60 years of age, according to the new measurement method (https://www.redaccionmedica.com/directo/coronavirus-ultimas-noticias/20220410)

o The mask will no longer be mandatory indoors on April 20 (https://www.elmundo.es/ciencia-y-salud/salud/2022/04/06/624d770121efa0ed708b45bb.html)

o COVID only worries 30% of Spaniards, according to the COSMO Spain study, coordinated by the Carlos III Health Institute (https://www.actasanitaria.com/salud-mental/covid-19-solo-pretrabajo-30 -spanish-two-years-pandemic_2002232_102.html)

  • Other themes

o The 2022 Health Barometer (First wave) appears (https://datos.cis.es/pdf/Es3357mar_A.pdf). Some data of interest: the waiting lists, the worst valued by the Spanish (https://www.lavanguardia.com/vida/20220407/8184215/listas-espera-peor-valorado-espanoles-barometro-sanitario-2022.html ); 55% of patients take more than 7 days to get an appointment with their family doctor (https://www.lavanguardia.com/vida/20220408/8185940/55-pacientes-tarda-mas-7-dias-conseguir- family-doctor-appointment.html); lowers the positive perception of the public system and increases that of the private (https://www.diariofarma.com/2022/04/07/cis-baja-la-percepcion-positiva-del-sistema-publico-y-aumenta-la-de-la-privada)

o Within five years there will be a shortage of almost 9,000 doctors (https://www.lavanguardia.com/vida/20220404/8174200/cinco-anos-faltaran-9000-medicos.html), according to the report “Supply-need for medical specialists 2021- 2035”, prepared by Patricia Barber and Beatriz González López-Valcárcel (https://cgcom.es/sites/default/files//u395/2022informeofertanecesidadespecialistasmedicos2021_2035.pdf)

o “Case of masks” a loot of 2,000 million for the purchase of material during the state of alarm (https://elpais.com/espana/2022-04-10/caso-mascarillas-un-botin-de-2000-millones -in-the-law-of-the-jungle.html)

o WAIT Report: Spain falls in time for access to new medicines (https://www.diariofarma.com/2022/04/06/espana-ha-autorizado-el-53-de-los-farmacos-aprobados -in-europe-between-2017-y-2020), to see the WAIT report: https://www.efpia.eu/media/602652/efpia-patient-wait-indicator-final-250521.pdf

o Published the “Report on the initial budgets of the Public Administrations” (AIREF, April 7, 2022) (https://www.airef.es/wp-content/uploads/2021/04/PRESUPUESTOS-INICIALES/Informe-Ptos -initials-2021-.pdf)

o Spain leads the world consumption of benzodiazepines (https://www.elperiodico.com/es/sociedad/20220402/espana-lidera-consumo-mundial-benzodiazepinas-13438583)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

  • International News

o Moderna reaches an agreement with IAVI (non-profit association) to apply mRNA to various diseases (https://www.plantadoce.com/empresa/moderna-llega-a-un-acuerdo-con-iavi-para-aplicar -mRNA-for-various-diseases.html)

o Pfizer buys the British biotech company ReViral for 481 million euros (https://www.expansion.com/empresas/industria/2022/04/08/624fd580468aebc31f8b46bb.html)

  • National News

o David Medina (Spaincares): “In the tourism-health binomial, we are not in the top ranking” (https://www.plantadoce.com/adn/david-medina-spaincares-en-el-binomio-turismo-salud -we-are-not-at-the-top-of-the-ranking.html)

o Savana closes a round of 23 million euros, hand in hand with Conexo Ventures (https://www.plantadoce.com/empresa/savana-cierra-una-ronda-de-23-millones-de-euros-de- the-hand-of-connected-ventures.html)

o Sanitas shoots up sales of health insurance by 47%, with 377,000 new policies (https://cincodias.elpais.com/cincodias/2022/04/07/companias/1649322015_528839.html)

o PharmaMar and CNIO allocate 1.2 million euros to testing breast cancer drugs (https://www.plantadoce.com/empresa/pharma-mar-y-el-cnio-destinan-12-millones-de- euros-to-test-drugs-against-breast-cancer.html)

o Miranza underpins its expansion, reaching 80.6 million euros (https://www.plantadoce.com/empresa/miranza-apuntala-su-expansion-tras-incrementar-sus-ventas-un-35-hasta-806 -millions-of-euros.html)

o Farmasierra celebrates its 25th anniversary, reinforcing R&D (https://www.diariomedico.com/farmacia/industria/empresas/farmasierra-celebra-su-25-aniversario-advancing-towards-a-model-industria-40. html)

o Pfizer will export gene therapies from Spain to America (https://www.eleconomista.es/salud/noticias/11706685/04/22/Pfizer-exportara-a-America-terapias-genicas-desde-Espana.html)

 

Conversations with healthcare industry leaders (Ramón Berra, General Director of Miranza)

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Roland Berger, a strategic consultancy, intends to organize regular breakfasts with leaders of the health sector in the broad sense. The first of them, December 13, 2021, was with Ramón Berra, General Director of the Miranza ophthalmology company.

 

 

Origin of the company

The Miranza company was born in 2019 and consists of a set of clinics dedicated to ophthalmology, its origin being the merger of the IMO of Barcelona and some Innovaocular clinics (San Sebastián, Madrid, Seville and Cádiz).

It is based on the fact that ophthalmology is a non-hospital specialty, which can be developed without problems in a non-hospital environment and it was possible to consolidate a series of clinics to form a prestigious professional company dedicated to ophthalmology in its entirety and different subspecialties. In this sense, they differ from other ophthalmological chains, dedicated almost exclusively to refractive surgery.

Miranza, today

The company has 20 centers throughout Spain and on Friday, December 17, 2021, it begins its international career with the first center in Andorra.

It is a company that has grown mainly through acquisition, presence in large cities, with medium and high complexity surgery, always led by teams of ophthalmologists with recognized prestige, at least locally.

Acquisition method

Miranza’s approach to a prestigious ophthalmological group is to buy the company (100%), never the property, with which ophthalmologists can continue to receive income as owners of rented properties; with a service provision contract (which specifies a service period and a “non-compete” period) and they are offered the possibility of reinvesting in the parent company and thus becoming minority partners of Miranza.

Miranza has approached the great ophthalmologists of this country, in such a way that it can be said that around 70% of ophthalmology leaders collaborate with Miranza.

An original formula for Medical Management

Miranza has launched an original formula for the group’s Medical Directorate. The key role of medical leadership and the difficulty of forming a recognized medical leadership need not be stressed when there are many medical leaders in the same specialty. The formula is that of the Clínical Leader Forum, a collegiate medical directorate, made up of 9 ophthalmologists.

The pandemic has not impeded the growth of Miranza

Miranza was founded in 2019. Arguably, the onset of the pandemic in early 2020 could have derailed the plan. But nothing further, despite the pandemic, Miranza has grown in the level of billing, number of patients, activity and knowledge.

He doesn’t want to be a “Frankenstein”

Miranza has developed protocols and clinical guidelines, since his intention is not to become a Frankenstein of ophthalmology, but to constitute something of value, beyond the value of the different members.

To do this, it has launched a network, with the idea of ​​sharing knowledge and clinical guidelines for action. This approach has groups of the different subspecialties of ophthalmology (retina, glaucoma, anterior segment, cataracts, etc.)

It also has an Intranet, to share experiences throughout the group.

Miranza Academy

A very interesting experience is the launch of this initiative. In the middle of the pandemic, there were 4 daily training webinars.

They also do two weekly clinical sessions.

Investigation and development

Miranza is aware that the only way to maintain and strengthen its leadership position is through extensive R&D activity. That is why it has a corporate R&D team to which in 2020 it has dedicated 7 million euros.

They have 90 multi-center projects, 2 European projects, public sector funded research, and industry agreements for multi-center trials.

All centers have their R&D coordinator.

The creation of the brand

The Miranza brand was created after a very participatory work with a branding agency (suggests look and hope).

Miranza’s policy with previous brands is to put Miranza as a name, respecting the original names as surnames. Only in the case of IMO and Vissum, due to their great presence, it is done the other way around, those brands are respected as a name and Miranza is given as a surname.

An effort in telemedicine

Apart from online dating, Miranza has made an effort in the development of telemedicine, particularly for second opinions.

It has even been seen that the consultation / surgery conversion ratio is higher in second opinions than in normal consultations.

A concern for quality

The IMO is accredited by the Joint Commission and for its part, Miranza has developed a set of healthcare quality indicators, which are analyzed on a monthly basis.

Patient experience

Miranza is going to launch a patient portal, in order to follow and improve the patient experience in the company

A bit of numbers

73% of Miranza’s billing is to private patients, only 20% is made to insurance companies. It also has a small collaboration with the Administration for issues of the waiting list, but it is an area in which it does not want to grow, given the danger of phagocytization by way of the waiting list of normal activity.

In terms of turnover, it has 80 million euros of sales and 11 million of EBIDTA.

A great effort in operations

Payroll, accounting and treasury are centralized.

A purchasing center has been set up and a catalog of approved materials has been developed, including intraocular lenses. There is an agreement with ophthalmologists by which 70% of the lenses that are placed have to be from the corporate catalog; for the remaining 30% they have freedom of choice.

There is a central contact center, which allows a homogeneous treatment of calls.

An effort has also been made in systems, adding a layer to the pre-existing systems, which allows to have a minimum electronic medical record and a management control panel.

The future

Miranza wants to continue growing, developing in areas of Spain where it is not, also in Portugal, without forgetting future projects in Latin America and North Africa.

Miranza receives many calls from ophthalmological consultations who want to explore joining the company, from which we can deduce that Miranza arouses attraction among these professionals.

7 days in healthcare (15-21 November, 2021)

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ABSTRACT

From the international point of view, the plan of the American Democrats to negotiate the price of medicines and its possible impact on innovation continues to be discussed; Europe is once again the engine of the pandemic, with demonstrations in some European cities against confinements and COVID passport measures; and finally, the United States reach a peak in mortality from opioid as the covid pandemic continues.

At the national level, four elements of interest: 1. Spain exceeds 100 cases per 100,000 inhabitants, although the situation is worrying, nothing to do with that of other European countries; 2. The state-of-the-art health PERTE is presented, doubts regarding its reformist impact; 3. Publication of the draft law that aims to consolidate the universality and equity of our National Health System; 4. The waiting lists are published as of June 30, 2021.

In terms of company news, perhaps most relevant is that both Merck and Pfizer’s COVID therapies will be available in generics for low- and middle-income countries.

INTERNATIONAL

  • Request for action in Afghanistan, given the food emergency, by the director of the World Food Program. Disaster is the consequence of conflict, economic collapse and drought (The Lancet, Nov 20 21)
  • Intense debate in the USA about the consequences for pharmaceutical innovation of the regulatory framework on the price of drugs that the Biden Administration wants to approve (NEJM, Nov 18, 21)
  • Democrats in the USA have a plan to reduce the price of drugs, without harming innovation (The Economist, Nov 20 21)
  • A year after the decision of the British NHS to move towards zero carbon emissions by the health system, another 13 countries, including Spain, have joined this approach, which entails important changes, especially in supply chains (The Lancet, Nov 17 21)
  • Europe is once again the engine of the pandemic, with the extremely worrying situation in Austria, Germany, the Netherlands, Belgium, the United Kingdom, Ireland, Hungary, Romania and Russia, among others (Le Monde, 17 Nov 21)
  • Austria returns to lockdown (The Guardian, Nov 18 21)
  • Thousands of people protest in Vienna against confinement and mandatory vaccination (El País, 20 Nov 21)
  • Germany tightens restrictions on the unvaccinated and will force health workers and nursing home workers to be vaccinated (El País, 18 Nov 21)
  • Bavaria cancels Christmas markets, given the growth of the pandemic (The Guardian, 19 Nov 21)
  • The third dose can be extended to all adults, says British Health Minister Sajid Javid (The Guardian,
  • The majority of the European population, in favor of COVID passports (The Guardian, 19 Nov 21)
  • The use of masks reduces the incidence by 53%, according to an international study published in the British Medical Journal (The Guardian, 18 Nov 21)
  • In the USA, mortality from opioid overdose reaches record growth, while the pandemic continues (NYT, Nov 17, 21)
  • Fauci says the pandemic may be under control in 2022, with more third doses (The Guardian, Nov 17, 21)
  • Europe will prioritize the local manufacture of drugs to gain autonomy. This coming week the new EU pharmaceutical strategy will be approved (El Economista 21 Nov 21)

NATIONAL

  • Spain exceeds 100 cases per 100,000 inhabitants for the first time in two months (El País, 18 Nov 21). Comment: although the situation is worrying, it has nothing to do, however serious, with that of other parts of Europe. It seems that the high immunization, the fifth wave and the high percentage of vaccination are at the origin of this situation. However, we do not know if this differential is going to be maintained or we are heading towards a situation similar to that of most of the rest of Europe.
  • The autonomous communities denounce that they once again lack legal tools in the face of another wave of the pandemic (El Mundo, Nov 21, 21)
  • The state-of-the-art health PERTE is presented, which entails 1,489 million investment until 2023 (diariofarma, 15 Nov 21). Comment: there is no transformation in the sense of reforming the health system (which they consider good) and it is an investment aimed at the biotechnology industry. Mentions of primary care are imprecise. In summary: facing the transformation of the health system and to what extent European funds can help, including digitization, is an issue that remains to be seen
  • Published the Draft Law that modifies various regulations to consolidate equity, universality and cohesion of the National Health System, which seeks to prevent co-payments and promote direct management (Diario Médico, Nov 16 21)
  • Waiting lists published as of June 30, 2021: 121 days on average to undergo surgery and 75 days to visit a specialist. 661,162 people, waiting for an intervention. The lists are close to those in 2019 (La Vanguardia, Nov 26 21)
  • ASPE offers its collaboration to end the waiting lists (Medical Redaction, Nov 18 21)
  • Summer-22 is set as the limit to reform the Framework Statute in the summer of 2022, for which it is announced that there will be minor changes to adapt to the Basic Statute of Public Employees and the labour conditions of residents (Diario Médico, Nov 18, 21)
  • The Public Health Center will go to the Council of Ministers soon (Consalud, 19 Nov 21)

COMPANIES, EMPLOYERS AND MAIN ACTORS IN HEALTH

  • Pfizer’s anticovid pill will be sold as a generic drug in 95 low- and middle-income countries, mainly in Africa and Asia, although the agreement excludes some countries hit hard by the pandemic. Previously, Merck had announced something similar (NYT, Nov 16 21)
  • European regulators, with serious doubts about Biogen’s Alzheimer’s drug (FT, Nov 17 21)
  • DKV remains in the MUFACE system (company declarations)
  • The EMA launches the emergency authorization process for the NOVAVAX vaccine, which would be the first vaccine with recombinant proteins developed in the European Union (Expansión, 18 Nov 21)
  • Quirónsalud launches two new phase I clinical trial units in Madrid and Barcelona, ​​following an agreement with Next Oncology (Diario Médico, 19 Nov 21)
  • Prim improves its profit by 90% in the first nine months of the year, to 12 million (PlantaDoce, Nov 15, 21)
  • Moderna appoints new general manager for Spain and Portugal, Juan Carlos Gil (PlantaDoce, Nov 16 21)
  • Miranza expands its presence in the Basque Country and opens a new center in Bilbao (PlantaDoce, 15 Nov 21)
  • The German biotechnology company CureVac will begin second-generation vaccine trials (ConSalud, 19 Nov 21)
  • Rovi expects to reach growth forecasts for 2023 this year (CincoDías, Nov 16, 21)
  • Pfizer, BioNTech and Moderna expect to bill 62,000 million euros in 2021 with their vaccines (CincoDías, 15 Nov 21)
  • The Spanish HIPRA vaccine will prove its effectiveness as a booster injection for Pfizer vaccinated (Expansión, 16 Nov 21)
  • USA will pay 4,650 million euros to Pfizer for 10 million anti-covid treatments (CincoDías, Nov 18, 21)
  • Almirall collapses on the stock market, after losing 40 million euros (Expansión, 15 Nov 21)