Current challenges

Several major challenges for the coming years in Central and Eastern European and the Newly Inde-pendent States can be identified:

– The available funds for drug reimbursement will not be sufficient to meet the rising demand from patients and professionals; effective cost containment measures will be necessary, while at the same time access to needed medicines will have to be guaranteed and quality of treatment improved.

The policies to meet these conflicting needs will have to be developed and implemented through a participatory process that can ensure public and professional confidence.

– Drug regulation is rapidly brought into line with EU regulations, as negotiations for the enlargement of the Union proceed; however it will at the same time be necessary to prove better systems for the enforcement of regulations and policies than those currently existing, and it is vital to ensure that this harmonization will not lead to decreased access of needed drugs.

– In each country the domestic pharmaceutical industry will face the need for an ongoing improvement in quality and efficiency if it is to compete effectively in a rapidly changing market. Patent legislation will change product portfolios. Export markets, particularly those offered by the Newly Independent States, will remain of major importance to successful developments for CCEE companies. These industries will therefore need to be commercially astute and enterprising, and in that they will no doubt be supported by the governments; that however must not prejudice the implementation of critical policies on drug pricing and use.

– In the Newly Independent States the pharmaceutical sector is now entering a new stage of develop-ment. Modest economic growth and decentralization in principle offer opportunities for new devel-opment; health care reform may gradually deliver results. However, despite the positive economic development in several of these countries, it is clear that all will remain in a transitional stage for

several years at least, and that the environment for change and innovation will not always be positive and stable. Recent economic turmoil only underlines the need for ongoing reform and adaptation of the sector if one is to achieve sustainable systems and structures.

– In all CCEE and NIS countries, continuing improvements in sector management should strengthen recently established structures and create sustainability. National drug policies will continue to play a stimulating strategic role. The quality of the drugs on the market and of domestic production in general needs further development. However important price is, one will have to be wary of the temptation to let economy prevail over quality.

– Rational selection and prescribing of drugs is critical because of the often low standard of inherited prescribing practices and the current lack of money. A comprehensive approach, with initiatives at regional and hospital level, is needed to achieve tangible results. Fundamental changes in the educational system should make health professionals more patient focussed and health outcome oriented, with special emphasis on drug selection and prescribing.

7. Conclusion

The situation of the countries of Central and Eastern Europe and the Newly Independent States is immensely variable, as is their rate of progress, both economically and in the development of health systems. Viewed globally they occupy a situation intermediate between that of the industrialized west and the developing world. Some, particularly the countries approaching the point of accession to the European Union, have the potential to attain western standards within a decade. For others it will take much longer and they may for a generation or more continue to struggle with large populations which will not be capable of affording drugs at the price levels customary in the west. For these countries it would seem essential to contemplate the application of strongly differentiated pricing for drugs available internationally, as discussed in Chapter 15 with respect to the developing world.

References

[1] Pace of change steps up in Central and Eastern Europe,Scrip Magazine(January) (1998).

[2] M. McKee and B. Jacobsen, Public health in Europe,Lancet356(9230) (2000), 665–670.

[3] H.U. Deppe and S. Oreskovic, Back to Europe: back to Bismarck?Int. J. Health Services26(4) (1996), 777–802.

[4] G.I. Petrova, Monitoring of national drug policies – regional comparison between Bulgaria, Romania, former Yugoslav republic of Macedonia and Bosnia Herzegovina,Centr. Eur. J. Public Health9(4) (2001), 205-213.

[5] F.W. Stobbelaar and N. Menabde, Development of the pharmaceutical sector in the Newly Independent States,Eurohealth, 4(6) (special issue winter 1998/9) (1998/1999), 80–84.

[6] N. Nazmi Sari and J. Langenbrunner, Consumer out-of-pocket spending for pharmaceuticals in Kazakhstan: implications for sectoral reform,Health Policy and Planning16(4) (2001), 428–434.

[7] WHO/EURO, Proceedings of a seminar on drug financing, reimbursement and pricing policies in CCEE, Budapest, 1997.

[8] WHO/EURO, Report of a meeting on policies on pricing and reimbursement of medicines in Europe, November 2000.

[9] CADREAC, Proceedings of the first meeting of the drug regulatory authorities in CCEE, National Drug Institute, Sofia, Bulgaria, 1997.

[10] CADREAC, Collaborative agreement of drug regulatory authorities of EU associated countries, http://www.cadreac.org, accessed on June 10, 2002.

[11] Pan European Regulatory Forum, http://perf.eudra.org/, accessed on June 10, 2002.

[12] D.R. King and P. Kanavos, Encouraging the use of generic medicines: implications for transitional economies, Croat.

Med. J.43(4) (2002), 462–469.

[13] P. Kanavos, WHO/EURO and LSE, The pharmaceutical market in the Balkans (1997) (unpublished document).

[14] R.A. Kiivet et al., Changes in the use of anti-bacterial drugs in the countries of Central and Eastern Europe,Eur. J. Clin.

Pharm.48(1995), 299–304.

[15] R. Škrbi´c, D. Babi´c-Djuri´c, S. Stojisvlevi´c-Šatara et al., The role of drug donations on hospital use of antibiotics during the war and post-war period,Int. J. Risk and Safety in Med.14(2001), 31–40.

Further reading

E. Goldstein et al., The World Bank, technical paper no. 341; Trends in health services, status and finance: the transition in Central and Eastern Europe, 1996.

P. Berkmans et al., Inappropriate drug donation practices in Bosnia and Herzegovina, 1992 to 1996,The New England Journal of Medicine337(25), 1842–1845.

Report of a WHO/WTO Workshop on Differential Pricing and Financing of Essential Drugs, Høsbjør, Norway, World Health Organization and World Trade Organization, April 2001.

IOS Press

Chapter 15