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4131. Can Transparency Lower Prices and Improve Access to Pharmaceuticals? It Depends

Author:
Kalipso Chalkidou and Adrian Towse
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
spending on pharmaceuticals and other healthcare commodities is high and makes up a large proportion of healthcare spending in rich and poorer markets alike. A popular response to the problem of escalating drugs budgets has been transparency of drug pricing within and across borders. In a rare alignment of policy priorities, the Trump administration, the US Senate, and the World Health Organisation are calling for more transparency of the prices paid for prescription drugs as a means of tackling the ever-growing pharmaceuticals bill. Recently Italy’s health minister joined in, calling for a World Health Assembly resolution which would mandate WHO to “provide governments with a forum for sharing information on drug prices, revenues, research and development costs, public sector investments and research and development subsidies, marketing costs and other related information.” But is price transparency really the answer to healthcare systems’ fiscal sustainability challenges as they strive to expand access to new technologies or even merely sustain provision within strained public budgets? Well, it depends!
Topic:
Transparency, Medicine, Pharmaceuticals, and Price
Political Geography:
Global Focus

4132. WHO Technical Report on Cancer Pricing Misses the Mark—It Should Focus on the “Demand Side”

Author:
Kalipso Chalkidou, Adrian Towse, and Richard Sullivan
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Criticising cancer medicine pricing as too high is what football fans know as an "open goal"—a target that is hard to miss. Yet somehow the World Health Organization (WHO) Technical Report on Cancer Pricing manages to do just that with a paper to the WHO Executive Board calling for price and cost transparency. The assumption goes that transparency will reduce the prices and costs of cancer medicines, a mantra that has united the Trump administration, the US Congress, and the Italian health minister with many NGOs who have called for “greater cost and price transparency”—a sentiment echoed by KEI, which states that “international action is required to improve transparency in reporting the costs of R&D and production, including public sources of funding.”
Topic:
World Health Organization, Health Care Policy, Medicine, Cancer, and Price
Political Geography:
Global Focus

4133. Pooled Procurement of Drugs in Low and Middle Income Countries

Author:
Pierre Dubois, Yassine Lefouili, and Stephane Straub
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. Our empirical analysis is based on exhaustive data on drug sales quantities and expenditures over several years for forty important molecules. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated.
Topic:
Drugs, Medicine, Centralization, and Price
Political Geography:
Global Focus

4134. The Dos and Don’ts of USG Humanitarian Reorganization

Author:
Jeremy Konyndyk
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The FY 2020 budget request released by the White House last month contained a sweeping proposal to rationalize and streamline US government humanitarian assistance programs overseas. The proposal would merge the three humanitarian budget accounts (International Disaster Assistance, Migration and Refugee Assistance, and Food For Peace Title II); strip programming responsibilities from the State Department’s refugee bureau and consolidate them entirely in a new humanitarian bureau at USAID; and establish a vaguely described “dual hat” senior leader role to oversee humanitarian activities at both USAID and the State Department. The proposed changes would be the most significant overhaul of USG humanitarian structures in decades. The proposal in its current form is unlikely to get much traction in Congress, where it is seen on both sides of the aisle as dramatically weakening US leadership on refugees. In light of other moves by the administration—like slashing refugee resettlement numbers and treating asylum seekers roughly—that is a legitimate and vital concern. There is ample reason to approach the proposal with caution, particularly the idea of stripping away the refugee bureau’s resources.
Topic:
Foreign Aid, Budget, Refugees, and Humanitarian Crisis
Political Geography:
United States and North America

4135. Who Benefits from Pharmaceutical Price Controls? Evidence from India

Author:
Emma Boswell Dean
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
With the goal of driving down drug costs, governments across the globe have instituted various forms of pharmaceutical price control policies. Understanding the impacts of such policies is particularly important in low- and middle-income countries, where lack of insurance coverage means that prices can serve as a barrier to access for patients. In this paper, we examine the theoretical and empirical effects of one implementation of pharmaceutical price controls, in which the Indian government placed price ceilings on a set of essential medicines. We find that the legislation resulted in broadly declining prices amongst both directly impacted products and competing products. However, the legislation also led to decreased sales of price-controlled and closely related products, preventing trade that would have otherwise occurred. The sales of small, local generics manufacturers were most impacted by the legislation, seeing a 14.5 percent decrease in market share and a 5.3 percent decrease in sales. These products tend to be inexpensive, but we use novel data to show that they are also of lower average quality. We provide evidence that the legislation impacted consumer types differentially. The benefits of the legislation were largest for quality-sensitive consumers, while the downsides largely affected poor and rural consumers, two groups already suffering from low access to medicines.
Topic:
Medicine, Pharmaceuticals, Price, and Price Control
Political Geography:
Global Focus

4136. Making Basel III Work for Emerging Markets and Developing Economies

Author:
Thorsten Beck and Liliana Rojas-Suarez
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
A sound financial regulatory framework is critical for minimizing the risk imposed by financial system fra­gility. In the world’s emerging markets and developing economies (EMDEs), such regulation is also essential to support economic development and poverty reduc­tion. Meanwhile, it is increasingly recognized that global financial stability is a global public good: recent decades have seen the development of new inter­national financial regulatory standards, to serve as benchmarks for gauging regulation across countries, facilitate cooperation among financial supervisors from different countries, and create a level playing field for financial institutions wherever they operate. For the worldwide banking industry, the international regulatory standards promulgated by the Basel Com­mittee on Banking Supervision (BCBS) stand out for their wide-ranging scope and detail. Even though the latest Basel recommendations, adopted in late 2017 and known as Basel III, are, like their predecessors, calibrated primarily for advanced countries, many EMDEs are in the process of adopting and adapting them, and many others are considering it. They do so because they see it as in their long-term interest, but at the same time the new standards pose for them new risks and challenges. This report assesses the implica­tions of Basel III for EMDEs and provides recommen­dations for both international and local policymakers to make Basel III work for these economies.
Topic:
Development, Economics, Emerging Markets, and Markets
Political Geography:
Global Focus

4137. Aggregating Demand for Pharmaceuticals is Appealing, but Pooling Is Not a Panacea

Author:
Cassandra Nemzoff, Kalipso Chalkidou, and Mead Over
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
As low- and middle-income countries reduce their reliance on donor aid, they are increasingly obliged to assume some degree of financial responsibility for donor projects. This challenge will be particularly complex in the procurement of health commodities. In recent decades, recipient countries have benefitted from donor-aggregated demand and pooling mechanisms, negotiated prices, purchasing, and delivery of commodities. However, as countries shift away from donor support, their challenge will be finding a way to aggregate demand in order to achieve the benefits that the pooled purchasing arrangements of vertical health programs now provide. As a first step in tackling this challenge, much can be learned from a diverse group of pooled procurement initiatives that have developed over the past 40 years in high-, middle-, and low-income countries. This note reviews the rationale and functions of these initiatives, notes their potential benefits and barriers, and draws lessons regarding how best to incorporate pooled pharmaceutical purchasing models into the design and implementation of health financing reforms in countries in transition. We first provide a brief background on the procurement challenges faced by countries in transition. In section 2, we provide an overview of different types of pooling initiatives, highlighting the key features of each. Leveraging our research and key interviews, we outline the real and potential benefits of pooling in section 3, and the most pressing barriers that organizations or countries will face as they seek ways to aggregate demand in section 4. In section 5 we discuss some of the issues that countries and development partners should address when considering pooled procurement initiatives and make two recommendations: (1) countries and development partners should conduct further research on the merits of pooled procurement, and (2) they should develop a straw model of a pooled procurement governance structure that could be tested using a series of pilots.
Topic:
Budget, Public Health, Medicine, and Pharmaceuticals
Political Geography:
Global Focus

4138. To Stay or to Go? How European Right-wing Populist Parties are Adjusting to the Post-Brexit Era Public Opinion

Author:
David Fernández Marcos
Publication Date:
05-2019
Content Type:
Special Report
Institution:
Unidad de investigación sobre seguridad y cooperación (UNISCI)
Abstract:
Since the 1990s a great deal of literature has been written predicting the behaviour of right-wing populists explaining their policies and ideology. Until Brexit, there had been no such clear victory for right-wing populist policies. Drawing from the current state of the art, data from the national and European electoral party manifestos as well as Eurobarometer survey data from France, Germany, Italy and Sweden, this dissertation employs Strom’s rational choice-based party behaviour model to explore how the internal structure and each country’s political and institutional environments have mediated the right-wing populist parties’ reaction to the upswing of positive opinions about the European Union among European public opinion since Brexit. They have done so in two directions: by either continuing their promise to leave the EU or by dropping the promise and instead advocating institutional reform, in those cases where the parties seek to govern.
Topic:
Public Opinion, European Union, Brexit, Populism, and Far Right
Political Geography:
Europe

4139. La Entente franco-británica y España: El aliado que no fue

Author:
Pedro Panera
Publication Date:
10-2019
Content Type:
Journal Article
Journal:
Revista UNISCI/UNISCI Journal
Institution:
Unidad de investigación sobre seguridad y cooperación (UNISCI)
Abstract:
Lejos de las consideraciones tradicionales de que la España de inicios del siglo XX poco o nada tuvo que ver con en el panorama internacional, el presente artículo tratará de demostrar cómo Madrid orbitó en torno a Londres y París durante los prolegómenos de la Gran Guerra. Finalmente, la reticencia de Roma a hacer valer sus acuerdos adquiridos con los Imperios Centrales, declarándose neutral, alejó el foco del conflicto del Mediterráneo Occidental. La España de 1914 finalmente no participó en la contienda, pero es el propósito de este trabajo explicar en qué medida su Armada y su Ejército habían jugado un papel de primer orden en los planteamientos estratégicos del conflicto que cambiaría el mundo.
Topic:
Military Affairs, Geopolitics, History, and Alliance
Political Geography:
Britain, Europe, France, and Spain

4140. Causas del antimilitarismo y anti belicismo de la ciudadanía española: La incidencia del servicio militar (1808-2001)

Author:
Fernando Puell
Publication Date:
10-2019
Content Type:
Journal Article
Journal:
Revista UNISCI/UNISCI Journal
Institution:
Unidad de investigación sobre seguridad y cooperación (UNISCI)
Abstract:
El artículo plantea la tesis de que la oposición de grandes capas de población a prestar el servicio militar fue la principal causa del sentimiento antimilitarista y antibelicista que caracteriza a la sociedad española incluso en la actualidad. A tal efecto, se hará un recorrido de las manifestaciones de dicho rechazo a partir de la Guerra de la Independencia, momento en que aparecieron los primeros síntomas de este fenómeno. Después se contemplará la incidencia de la redención en metálico y la sustitución durante el periodo liberal, la de las guerras de Santo Domingo, Cuba y Filipinas en el último tercio del siglo XIX y de la de Marruecos en el primero del XX. El artículo finalizará con un análisis sobre la repercusión que la objeción de conciencia y la insumisión tuvieron en la suspensión del servicio militar en el año 2000. Para ello se utilizará un amplio espectro de fuentes testimoniales, legislativas y sociológicas, así como la abundante bibliografía disponible sobre el tema.
Topic:
History, Public Opinion, Armed Forces, and Military Affairs
Political Geography:
Europe and Spain