# Sante: Aksè a tretman medikal - fwontyè kap vini an?

Selon yon nouvo rapò, Romania has come last in a ranking of European nations against their per capita consumption of medical drugs – but for all the wrong reasons. Far from Romanians being healthy enough to eschew prescription drugs, the country’s rock-bottom position instead reflects its citizens’ lack of access to pharmaceuticals, according to the Trade Union of Industrial Medical Drugs Producers in Romania (PRIMERHealth), which represents 16 of the country’s most prominent pharma producers.

It’s a sobering example of a situation increasingly facing citizens across the EU: that living a healthy life is not necessarily a question of whether the right medical treatments exist; it’s whether patients can get access to them.

Affordability is key

While Romania’s pharma market is growing year-on-year (€2.6 billion in 2017 at producer prices), domestic medicine producers have seen their market share almost halve over the last decade, with the budget allocated to drug subsidies standing at less than €75 per capita – a reimbursement allocation that hasn’t changed since 2011 and is currently the lowest in the EU. Medicine prices have also been frozen since 2015.

This means that the shortfall between government-funded medicines and clinical demand has to be made up by patients and by producers via the 25% ‘clawback tax’, which, in turn, has had a negative impact on the availability of cheap drugs. In just three years, around 2,000 low-cost drugs have disappeared, leaving patients with little option but to fund more expensive alternatives from their own pockets.

The news is no better for over-the-counter (OTC) remedies and supplements. Europe-wide, this sector represents between 35-45% of the pharma market, whereas in Romania, the figure stands at around 25%, further underscoring citizens’ lack of access to alternative treatment and care solutions.

Rare disease patients sidelined

If the plight of Romanian patients makes grim reading, the situation in many European countries is even worse when it comes to access to medicines for rare diseases. With more governments playing the healthcare numbers game, there’s often a reluctance to reimburse treatments where only a relatively small percentage of the population is affected.

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In Croatia, the government recently announced its intention to put all Spinal Muscular Atrophy (SMA) patients on a new clinical trial for a drug produced by pharma giant Roche. It sounds like a good news story, except an effective and European Medicines Agency-approved drug – Spinraza – already exists, and the government still has yet to make a decision on whether its citizens will get access.

Spinraza was approved by the EMA twelve months ago, but the fact that many EU member states still have not approved the drug for reimbursement has meant that few are benefiting from the breakthrough. This, despite the evidence of high levels of efficacy when children are treated at an early stage, preferably before they start to show symptoms.

The Croatian government’s official line is that Roche’s drug is taken orally, making it potentially more widely applicable, while Spinraza requires ongoing medical intervention. Critics, however, claim that the decision is based on the cost of supporting patients on Spinraza, rather than on any considered clinical basis.

Waiting times are lengthening everywhere

In addition to spotty access to breakthrough rare disease treatments, wait time is another issue that prevents patients from getting the quality care they need.

Perhaps surprisingly, Iland ranks the worst in Europe in terms of expected waiting times for treatment, according to the Euro Health Consumer Index 2017 compiled by Swedish think tank Health Consumer Powerhouse (HCP). Of 35 countries reviewed using a variety of measures, Ireland earned just 21^st place overall, with the country also scoring poorly on equality, online appointments, and consultant access.

Another six EU countries – the UK, Sweden, Poland, Italy, Slovakia and Greece – were singled out as providing poor emergency department waiting times. Which is bad news for improving health outcomes overall. Researchers did note that healthcare across the continent was ‘steadily improving’, but warned of the dangers of the inefficient, unequal funding and delivery of care services.

The report cautions that many countries are still pursuing inefficient funding and delivery models and could make quick improvements by simply following the lead of more successful healthcare infrastructures, such as those pioneered by list leaders the Netherlands, Switzerland and Norway.

Storing up problems for the future

While countries like Romania and Croatia are struggling to find a way to match healthcare provision to patient demand, widespread underfunding is likely to continue to have serious consequences across Europe in years to come.

There is evidence to show that Europe’s health-care model as a whole is under pressure, not only from the introduction of post-crash austerity measures that have seen investment levels dip significantly since 2009, but also from an increasingly ageing population that is set to stretch resources to snapping point over the next 30 years.

Which makes it all the more important that patients have improved access to affordable medicines – at every age.

 

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