The FIFA Soccer World Cup in South Africa was a success and Spain was lucky to snatch a victory in the final minutes of a prolonged battle with The Netherlands. An estimated 700 million watched the game live and for five weeks all eyes were on South Africa. Barring some minor incidents the tournament was [...]
The FIFA Soccer World Cup in South Africa was a success and Spain was lucky to snatch a victory in the final minutes of a prolonged battle with The Netherlands. An estimated 700 million watched the game live and for five weeks all eyes were on South Africa. Barring some minor incidents the tournament was well run, efficient and a great pride to many South Africans. However, dig a bit deeper and you come to realize that not all is well in the land of soccer. FIFA is a business and its primary interest is to generate significant revenue (and some) to carry it between tournaments and to implement its inflexible business model. It has little regard for the broader economic implications of the tournament. The reason many countries pitch to host the tournament is based on the assumption that a FIFA World Cup will bring enormous benefits to a country – growth in tourism, opportunities for small businesses, investment in infrastructure, etc. Although some of these benefits may materialize, it overlooks the health budget impact the tournament has.
FIFA required the South African government to “… provide guarantees for the provision of medical services, legal prescripts surrounding foreign qualified medical and allied health professionals accompanying the teams and certain laws pertaining to health matters.” FIFA imposes a range of standards that cover stadia, emergency medical services, environmental health, port-of-entry health, communicable diseases, and hospital services. These requirements prompted “huge investments by South Africa in the development and improvement of infrastructure” (Deputy Health Minister South Africa), arguably a re-prioritization of the health budget to service FIFA’s needs. For instance, 700 new ambulances were bought, 5 new communication systems were established and aero-medical hospital services improved. Has South Africa generated the expected revenue to cover these expenses? There are indicators it has not and the tax payer has covered the bill. If so, how has this scenario impacted the delivery of health care services to South Africans – particularly the treatment of HIV/AIDS, TB, and malaria? Some health care facilities were completely renovated for FIFA. While it may be great walking through world-class facilities, patients actually require world-class service at world-class prices. Some may argue that all health improvements required by FIFA will benefit South Africans in the long-term. If so, the most difficult task lies ahead – maintaining and continuously improving what has been done.
Bibliography
China is relieving overcrowding in its prisons by exporting convicts to developing countries to support private company or government run projects. These projects are not known for absorbing local labour and Chinese prefer employing Chinese to complete such projects . Are Chinese convicts being used for infrastructure development in the health care sector or for [...]
China is relieving overcrowding in its prisons by exporting convicts to developing countries to support private company or government run projects. These projects are not known for absorbing local labour and Chinese prefer employing Chinese to complete such projects . Are Chinese convicts being used for infrastructure development in the health care sector or for the delivery of health care services at project sites? Its unknown and neither have a read of such news. However, this trend is concerning particularly as developing countries cannot afford more murderers and rapists roaming freely and contributing to unrest and crime escalation. Of greater concern is the risk this poses patients in developing countries.Read the story below for more information.
Source: China now exports its convicts
President Luiz Inacio Lula da Silva of Brazil is credited for the “nation’s unparalleled clout on the global stage and a stable, growing economy”. His center left credentials and policies are testimony to their workability in a leading developing country and evidence that while political orientation may be important, it is crucial to deliver on [...]
President Luiz Inacio Lula da Silva of Brazil is credited for the “nation’s unparalleled clout on the global stage and a stable, growing economy”. His center left credentials and policies are testimony to their workability in a leading developing country and evidence that while political orientation may be important, it is crucial to deliver on your promises. In 2002, world financial markets reacted negatively to his election but it certainly has not stopped many multinational firms exploring joint ventures with Brazilian firms and exploring methods of securing a piece of the Brazilian growth.
Brazilians go back to the voting stations on October 3 and in the interim the Worker’s Party and Social Democrats are deciding who their Presidential candidate should be. Jose Serra is the Social Democrat candidate and a previous Health Minister in the Cardoso cabinet. Given his liberal roots and pressure from within his party, Serra is likely to privatize state-run enterprises, pursue the liberal agenda started by Cardoso, be more accommodating of US and European policies, and invite private sector participation in exploiting oil reserves. Serra has a tough battle ahead of him and it is likely he will depend on minority parties such as the Socialist People’s Party to broaden his support base. If so, his liberal policies may be tempered which may preserve the status quo.
Given these dynamics, what impact will Serra’s election have on pharmaceutical policy? He is credited for “defying the pharmaceutical lobby” and supported the introduction of cheap generic drugs and free ARVs. He also supported the growth of the generic manufacturing industry and establishing the Brazilian Food and Drug Administration, ANVISA. His willingness to tackle pharmaceutical companies is likely to spill over into the tobacco industry. Furthermore, he leveraged flexibilities in the international and domestic trade regulatory regime to break Merck’s patent on Efavirenz and successfully implemented mechanisms to reduce its price. This has not deterred multinational pharmaceutical companies from seeking opportunities in Brazil. In fact, Sanofi-Aventis, Aspen Pharmacare, and Celesio are some examples of firms jumping onto the 16% growth per annum (by 2013) of the pharmaceutical market.
Serra’s party ideology is at odds with his track record as a Health Minister. How does he plan reconciling liberal economic policies with state-led interventions in the pharmaceutical market? Will his center right party nullify much of the Brazilian success in pharmaceutical policy over the past decade? Will minority parties in his coalition have the final say of which way pharmaceutical policy swings? We’ll see in the months ahead whether Serra is elected as Brazil’s President and if so how he plans leading his country in the pharmaceutical policy domain.
Bibliography
- The toughest Brazilian presidential campaign in decades takes off
- Brazil upbeat as 2 unknowns vie for Silva’s job
- Brazil: Serra’s Health Card
Industry-funded CME is a hot topic particular when it’s been found that such funding materially alters the prescribing and dispensing habits of physicians and pharmacists, respectively. There is no doubt that there is a connection between practitioner behavior and industry funding, but is banning industry-funded CME necessarily the way to go? It seems somewhat of [...]
Industry-funded CME is a hot topic particular when it’s been found that such funding materially alters the prescribing and dispensing habits of physicians and pharmacists, respectively. There is no doubt that there is a connection between practitioner behavior and industry funding, but is banning industry-funded CME necessarily the way to go? It seems somewhat of an exaggerated reaction to a process that can be managed with some creativity.
The University of Michigan Medical School joins a handful of leading institutions to ban such activities – Sloan Kettering Memorial Cancer Center, East Carolina University’s Brody School of Medicine, and Kaiser Permanente’s mid-Atlantic region. CME, and medical information in general, serves an important economic function. It overcomes (to a degree) market failure in the healthcare sector caused by information asymmetry particularly between the pharmaceutical companies and patients (and practitioners as agents of patients). Given that industry funding is a significant contributor to total CME activities, banning such activities would distort the market. Practitioners (both pharmacists and physicians) would probably spend more time seeking medical information to update their knowledge, would spend more of their resources procuring updated information, and as a consequence would have less time and resources to treat their patients. Alternatively, practitioners may simply not bother updating their knowledge and ultimately compromise quality of care and their patient’s well-being in the process.
So, what are the alternatives? A new model for CME is required – one that permits industry funding and negates its usual effect on practitioner behavior. Following the publication of the Macy Foundation Report (Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning), Stanford University School of Medicine announced its intent to implement a “fundamentally different model of CME”. Stanford does not allow commercial support for a specific subject, speaker, or educational activity and their industry interaction policy speaks to these issues. Stanford’s approach is not an outright ban of industry-funded CME. Instead it aims to balance its internal CME needs through a “metric-based quality improvement and patient safety curriculum” and the industry’s desire to influence practitioner behavior. It’s a tough balance and it’s unclear whether Stanford’s approach will work. It may improve relations with industry or it may motivate industry to work around Stanford and focus its funding on other institutions.
Bioethicists would prefer that Stanford ban industry-funding altogether. Some believe that “private doctors and academic physicians who are paid to speak for drug companies should be barred from presenting educational material at accredited conferences”. Would it make any difference if the presenters were not paid by pharmaceutical companies? It’s still the same information. Or, would it be better if non-healthcare practitioners presented the information for instance, an accountant or lawyer? This way we would have an independent and objective person deliver information they know nothing about. Instead of focusing on who presents the information bioethicists should be concerned with the quality of information presented (methods, outcomes, etc) and on the effects of the information. It makes no difference who presents, but the quality of information certainly matters and so does its effect on patients.
Bibliography
1. Debate Over Industry Role in Educating Doctors
2. Developing More Effective Means of Achieving Improved Performance Among Practicing Physicians through use of metric-based quality improvement focused curricula, pedagogiocal innovation, and simulated and immersive learning.
3. Policy and Guidelines for Interactions between the Stanford University School of Medicine, the Stanford Hospital and Clinics, and Lucile Packard Children’s Hospital with the Pharmaceutical, Biotech, Medical Device, and Hospital and Research Equipment and Supplies Industries (“Industry”)
4. University of Michigan Bans Industry Funded CME
5. ACCME Annual Report Data 2009
6. Continuing Education in the Health Professions: Improving Healthcare through Lifelong Learning
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