Providing affordable medicines in transitional countries

The term “transitional”, as currently applied to national economies and countries, refers to those former communist systems which are still engaged in the long process of transformation; a centrally planned economy is progressively being replaced by market orientation, and communist ideology and totalitarian rule have gradually given way to democratic political structures. That process has come into motion in many parts of the world, but nowhere more conspicuously than in the Countries of Central and Eastern Europe (CCEE) and the Newly Independent States (NIS) which emerged from the former Soviet Union. Because of this ongoing process of change, the question of drug pricing and cost containment in these countries unavoidably has to be approached in a broad perspective, involving various other aspects of health and drug policy; well-intended measures on one front could all too readily disrupt a fragile situation on another. In fact most aspects of the health care system in these countries, largely shaped in the past according the Semashko model, have been undergoing major reform. Whereas previously the system was totally state-run and controlled, and pharmaceuticals were produced in state factories, distributed by state wholesalers and supplied and reimbursed through state pharmacies, the health care market has in most of these countries now rapidly and even suddenly opened up; systems have generally been restructured around health insurance schemes [3], and drug production and supply have largely been privatized, with subsequent changes in reimbursement schemes [1]. Many countries in the CCEE have already made great progress in their transition towards a democratic society and a market economy. Most of these countries have embarked on health care reform, separating financing and health services from the State, and in parallel separating health financing from health services delivery (the purchaserprovider split). At the same time, macroeconomic pressures have generally forced governments into implementing a large degree of deregulation, including measures in the health care and pharmaceuticals market. In carrying out that process of deregulation, the authorities have unfortunately often failed to take into account the special risks of market failure which exist in the field of medicines and which render strong government involvement essential; as long experience in the West has shown, regulation in matters ranging from advertising and drug safety studies to pricing is essential if society is to be protected. Particular caution is called for in view of the marginal health situation: the state of health of populations varies widely across this part of Europe, and in many of the transitional countries it has declined. Particular concerns relate to the spread of tuberculosis and HIV-AIDS. There are also considerable differences within countries in terms of health status as well as access to health services [2].