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E Mossialos, M Mrazek, T Walley, Eds. UK: Cornwall, 2004, £24.99, ISBN 0335214657
Few markets are as controlled by government as pharmaceuticals. Medicines permeate health care, are a major source of health care, and are made by one of the world’s most successful high technology industrial groups—the pharmaceutical industry. In Europe there exists both socialised healthcare systems and one of the few high tech industries in which Europe can compete with the USA and Japan. The European Union as a whole, and particularly the countries which have a thriving pharmaceutical industry, want to maintain a strong and competitive industry which provides substantial tax income and very significant export earnings in some countries. On the other hand, the countries want to achieve a healthy population in which they at least maintain equity, quality, and improve efficiency while containing costs. How. then, can this circle be squared? The answer is, not easily—and not in any simple or uniform way.
There is a sort of dynamic equilibrium between cost containment, quality, equity and efficiency—rather like a balloon half filled with water, squeeze one area and another bulges out. Squeeze costs and a problem with equity may bulge out. Health professionals, managers, policy makers, the public, the media, and sometimes the law are regularly made aware of aspects of these tensions. However, as we often see one issue at a time, it can be hard to set the policy in any sort of context. This book, part of a series from the influential European Observatory on Health Systems and Policies, is the most comprehensive book I have seen on medication policies in the EU. While keeping to the focus described in the title, it avoids a narrow perspective, including sections on prescribing, patients and medicines, “lifestyle” drugs, and alternative medicines.
The book consists of 21, usually multi-authored, chapters. A common problem with this sort of edited work is that it is hard to get the contributors’ chapters to flow and contribute to the whole. The editors solve this problem by starting with an excellent 37 page overview that flows as a whole while contextualising the chapters. It is worth buying the book for this overview alone. The early chapters cover issues such as the politics of pharmaceuticals, EU policy, price and reimbursement control, and measuring the consequence of policy outcomes. The middle section covers good prescribing, patients and medicines, financial incentives, community and hospital pharmacy, cost sharing, and off-patent and over-the-counter markets. The future is looked to in pharmacogenetics/genomics and debate about payment for lifestyle drugs. Policy in the Central, Eastern and the old USSR countries is also reviewed. The final chapter suggests a framework for fair containment of costs.
The overall message is that this is a very complex area, and one should transfer lessons from one country to another with caution. The blurb states that the book is for students of health policy, and for managers, and policy makers; however, I think it is of use to students and professionals in professions related to medicines and, not least, to many in the pharmaceutical industry. There is no perfect solution to balancing quality, equity, efficiency and costs, but the contents of this book will contribute to wiser policy being made.