Turning Healthcare Around

SEP-OCT 2017|BY ALEXANDRA LOLI

Healthcare, a fundamental human right and a vital element of national services, has taken a blow in Greece during the crisis. Business Partners’ Thought Leaders in Healthcare examine the changing world of healthcare in Greece and offer their proposals for turning it around for the economy and the society.

A Pharmaceutical Policy for the Coming Decade

PASCAL APOSTOLIDIS, PRESIDENT OF THE HELLENIC ASSOCIATION OF PHARMACEUTICAL COMPANIES (SFEE) AND GENERAL MANAGER OF ABBVIE GREECE

The majority of health & welfare systems globally are currently being tested. World aging combined with an increase in chronic diseases and the necessity of the states to be fiscally disciplined but also promote radical pharmaceutical and medical innovation create a problem with no easy solution. However, any solution has to aim to improve people’s lives.

Greece has been in recession since 2008, making the above problem more acute. The public pharmaceutical expenditure of the country was reduced by 62% between 2009 and today. The quality of treatment has remained generally stable because of the ever-growing pharma industry participation in the total expenditure via rebates and clawbacks. This approach has proven unsustainable; a distortion of the market, a reality acknowledged by all health stakeholders.

Our current pharmaceutical policy has reached its limits and cannot lead to a sustainable future. The current public expenditure cap is insufficient for a country like Greece, and the industry is called to cover any excesses. I really wonder if there is any other European country where the industry is forced to cover approximately 30% of the total pharmaceutical expenditure.

All health stakeholders should come together to work on designing a pharmaceutical policy for the next decade. Greece’s population is aging faster than the European average. It is therefore our fundamental obligation to take immediate action. In addition to an increase in public pharmaceutical expenditure, we should also carefully review the way we allocate our current resources. We should immediately implement essential reforms, such as the use of therapeutic protocols and patient registries (where necessary), as well as a negotiation process for new, innovative and high cost medicines, and an increased use of generic medicines. The introduction of an independent health technology assessment (HTA) organization is of crucial importance. Any delay in the aforementioned reforms bears huge cost for the country.

The obsession with insisting on high rebates and unlimited clawback creates feelings of mistrust. This mistrust leads to disinvestment, while the goal should be to attract more funds from pharma companies. In Greece, a country that needs to attract investments, it is good to start with the companies that are already on the ground and are thus familiar with the local business environment, the culture, and the comparative advantages.

We need to simplify the legal framework for clinical trials and introduce tax incentives so that Greece can reach its full potential, which is to triple the current investments.

I have briefly mentioned some fundamental reforms that would lead us to a sustainable and long-term pharmaceutical policy. There is one more thing that is equally important: political will. We should stop micromanaging in the health sector, and we should focus our attention on the entire picture. We need will, vision, and cooperation from all stakeholders. At the end of the day, health is a social good and not a sum of individual interests.

Healthcare Spending Toward Efficiency

MATTI ARVELA, EXECUTIVE DIRECTOR AND GENERAL MANAGER, AMGEN HELLAS & CYPRUS

Despite the financial crisis, Greece can be proud for having something that is not a given even in countries that are not facing such fiscal restructurings: universal healthcare coverage. However, in 2016, the coverage bill—which exceeds by far the €1.945 billion pharma budget due to inefficiencies in the system—was partially covered by the increased copayments by the already financially troubled Greek patients and put unbearable burden on the pharma industry.

Our healthcare system is indisputably living at the margins of fiscal sustainability, and we should look into the current spending decisions vis-à-vis the structural changes under way.

Primarily in our pricing system. Currently, on-patent products are 53% less expensive vs. the EU average, while generic prices are 54% more expensive vs. the EU averages. The solution here is to fully implement the current pricing legislation for off-patent and generic products. If we fix this broken sustainability cycle, we will be able to create savings for the healthcare system, reduce copayments for Greek patients, and create headroom for innovative solutions.

Furthermore, there is room for our healthcare system to restructure to a more holistic ownership of budgets on different levels, incentivizing smart budget allocation to achieve overall efficiencies and the best use of available resources for the benefit of patients. At this stage, the National Organization for Healthcare Services Provision (EOPYY), the MoH, and individual hospitals, all portray a mosaic of different budget owners that work in silos without being able to deliver the best outcomes for patients and the healthcare system.

The health technology assessment (HTA) system currently under development could lead to the creation of an organization that will consider available resources as a whole and aim to evaluate all medical and medicinal interventions holistically, not making decisions solely informed by prices. By being able to evaluate the impact of an intervention in terms of its price, HCP time engagement in therapy, nurses’ time in therapy, hospital beds occupied, ambulatory occupancy, medical examinations needed, circular door effect (ineffective interventions that lead to hospital discharges and re-admissions), etc., we will ensure that our spending decisions create value for the entire healthcare system and not only for individual budget owners.

Moreover, we need to take advantage of all R&D and manufacturing successes, such as the commercialization of biosimilars. These similar-to-biologics medicinal products, which require dedicated regulatory and access processes, are entering the EU and Greek pharma markets and are expected to create savings up to €33.4 billion euros in eight EU countries by 2020. Biosimilars will represent a novel opportunity for the Greek healthcare system to offer patients access to innovative therapeutic solutions.

To conclude, I would like to stress that there is room for Greece to maneuver toward a financially sustainable healthcare system for the benefit of patients and their families.

The Future of Pharma Care in Greece

AGATA JAKONCIC, MANAGING DIRECTOR MSD, GREECE, CYPRUS, MALTA

Pharmaceutical care in Greece is at the crossroads. The austerity mechanisms of clawback and rebate are not sufficient to ensure budget efficiency and effectiveness and system financial sustainability. These mechanisms are appropriate for short periods of time and under conditions of severe pharma spending reductions. Now that Greece has to combine a stable state contribution to pharmaceutical care within an increasing demand environment, the focus should be on structural changes that enable the system to do more with less or the same expenditure.

However, the current operating model allows total market to increase disproportionally while capping state contribution, leading to increased pharma industry (through claw backs and rebates) and patient contributions. This has led to EOPYY losing track of its budget. In 2017, despite increasing rebates by 130 million euros at least, clawback remains at last year levels. The same failing strategy is also applied in the hospital sector, leading pharma industry to exceed 1 billion euros in contributions in 2017 alone. This poses risks for patients. If companies become unable to follow this devastating clawback trend, patients will face significant access problems to effective medicines.

The failure of the clawback and rebates system also led to new restrictions in market access for new and innovative products. The new reimbursement rules and the interpretation of the new product by the law as well as the imposition of the additional 25% entry fee for new products in the list make launch of new products very difficult and endanger patient access and population health levels. No country can improve its population health by relying on past products and hindering innovation.

However, despite its contribution, pharma innovation seems to be perceived nowadays as a threat rather than as an investment and a fundamental patients’ right in our country.

This approach undermines government initiatives towards increasing public sector efficiency, like the negotiations approach. If a new product starts with 40% rebate and additional clawback charges which can lead to charges of 60% of the product price before accounting for personnel and product costs, the only sensible negotiation strategy for a company is to negotiate for fewer austerities.

Recent improvements, such as the electronic prescription system and introduction of therapeutic protocols, have not exploited their full potentials. Although the infrastructure is in place, Greece lacks considerably in real-world evidence generation that would allow for improving system’s efficiency and patients’ prognosis.

Within MSD, we strive for a predictable, evidence-based, value-driven and financially sustainable healthcare system. The implementation of a well-designed and stable pricing and reimbursement policy alongside a clear focus on prevention and an efficient prescribing system would enhance the element of predictability.

Furthermore, the introduction of a self-contained HTA organization with streamlined processes is a prerequisite for ensuring that Greek patients exercise their right of accessing the most effective treatment at the right cost and in timely fashion.

Also, the triangulation of the electronic prescription system, the expansion of prescribing therapeutic protocols and the forthcoming electronic patient records would create the basis for setting Greece as a Centre of Excellence in real-world evidence generation. Such an achievement would not only allow for optimizing patient outcomes but also create alternative sources of revenue for the Greek healthcare system.

This is the vision we aspire and we keep focused on every day we serve patients and people needs in Greece.

Innovation and Technology in Healthcare: Enablers for “Doing More with Less”/span>

PANAGIOTIS MPARAS, CHAIRMAN AND MANAGING DIRECTOR, PHILIPS HELLAS S.A.

In these times of financial austerity, the focus on price reductions and cost cutting has reduced the capacity to introduce and sustain innovative healthcare solutions in Greece.

Although this may be deemed understandable at first, since there are challenging financial targets to be met, the need to shift toward solutions that bring added value in healthcare as a whole is far more important in the longer term.

In many cases, the power of innovation and technology to support new paradigms that can bring better clinical outcomes to the population at a lower cost is overlooked.

For instance, there is compelling evidence that one of the greatest drivers for the reduction of healthcare costs is early prevention. Prolonged and non-efficient hospitalization is one of the main elements that impose a severe financial burden to both public and private systems. Philips is the biggest proponent of the “hospital to home” concept through enabling technologies in telemedicine and remote monitoring. The key idea behind our solutions is to generate better clinical outcomes at lower costs.

Moreover, “first time right” diagnosis and treatment through the use of modern, state-of-the-art imaging equipment and novel therapeutic practices is a key driver for increasing efficiency and productivity, bringing down costs from unnecessary repeat diagnostic scans or suboptimal clinical outcomes.

Personal Health solutions are also a good example: Innovative technology, supporting a healthy personal lifestyle for the consumer and looking across components of the health continuum, reduces onset rates of disease and generates increased awareness that supports early prevention.

At the heart of the issue is understanding that innovation needs to be seen as an enabler, as opposed to an additional cost creator, in providing crucial answers to healthcare issues in Greece. The challenge primarily lies in convincing local stakeholders that more can be done with less. It is important to demonstrate that the industry’s technological advances are indeed aligned with the objectives of efficiency and productivity.

Many of the stakeholders are extremely favorable to the value brought to healthcare through innovative technologies; however, allocation of resources is a challenge.

When the discussion shifts to the allocation of resources, the tendency is to resort to conventional methods. This has proven to be a detractor, as the problem of efficiency remains.

The financial crisis has been largely overlooked as an opportunity to implement new solutions that can be evaluated according to the outcomes they generate, even on a pilot scale. For those cases that provide significant benefits to the value of healthcare, there should be a greater push to invest in them and grow them.

It should be recognized that when circumstances are dire, it is perhaps the right time to look toward new and innovative methods. More stakeholders should be open to exploring novel healthcare paradigms—as novel as the technologies and practices that hold the answers—and implementing accordingly.

The Healthcare Sector’s Role on Economic Growth and Social Welfare

KONSTANTINOS DELIGIANNIS, GENERAL MANAGER, GE HEALTHCARE SEE

There has always been a strong link between healthy societies and healthy economies. We could even say a vicious circle: Income and human development are interdependent. Contribution and participation in procedures of economic growth mean reaping the benefits of growth. Sufficient income leads to the satisfaction of basic human needs, which in turn affects people’s health and the configuration of healthcare.

A population’s state of health depends greatly on socioeconomic inequalities or lack thereof, which are a priori related to unemployment levels. A healthy population will most probably be able to achieve higher education and specialization. Education will maximize the chances of employment, which in turn generates income for the population. Sufficient income will promote health through better choices of living and nourishment and will also allow for expenditures for check-ups and early diagnosis of diseases.

Healthy populations will spend less on medical bills, minimizing government expenditures. Moreover, they will be able to contribute to the economy through their employment and tax payments. Employment is the basis of economy, and the only way to ensure employment is by safeguarding people’s health. Investment on health is indeed an investment on social welfare. Promoting a healthier lifestyle, insisting on the importance of early diagnosis and regular check-ups, spending for research and development as well as investing on new technologies are all measures that must be considered an investment into a country’s economy.

Accordingly, the healthcare sector in Greece should be considered a priority when examining ways to achieve economic growth and promote social welfare. Regarding the public healthcare sector, there is a great and urgent need to:

  • Simplify procedures, eliminate bureaucracy, and abolish facilities and structures that are no longer useful—or transfer them to locations that are most needed.
  • Invest in the associated biomedical technology and the improvement of the quality of services.
  • Establish strict evaluation and assessment criteria, both for facilities and personnel (management and employees).
  • On the other side, our country’s private healthcare sector needs to be strengthened by:
  • Creating incentives for investments, especially foreign ones, in order to improve quality and increase competition within the local services market.
  • Encouraging the modernization of equipment, services, and infrastructure.
  • Establishing solid processes for the assessment of infrastructures and healthcare services along with transparent regulation enforcement and rigid application of penalties where appropriate.

Finally, Greece will sooner or later realize that strengthening public and private sector collaboration is the only way to maintain a sustainable healthcare system in times of recession. Modern economic theory and current ways of implementing local and regional administration recognize the role of public-private partnerships (PPP) in fostering economic growth.

Last but not least, the European Union’s Third Health Program 2014-2020 is still awaiting public and private applications for participation in European Union funding programs.

Patients Need Access to Innovation

ELENA CHOULIARA, COUNTRY PRESIDENT & MANAGING DIRECTOR, ASTRAZENECA GREECE & CYPRUS

In a time when Greece is facing major socioeconomic challenges, healthcare is a key topic on the political agenda. The public healthcare system in Greece faces serious structural inefficiencies concerning the organization, financing, and delivery of services, resulting in budget deficits and unpredictability of the healthcare market. Two major issues affecting the pharma industry are excessive public pharmaceutical expenditure versus the set targets and the implementation of flat, cash generating measures.

The excess of pharmaceutical spending remains uncontrolled: The fixed budgets of €1.945 million for the retail expenditure and of €570 million for the hospital expenditure were set without taking into consideration the population’s real needs, the primary healthcare system’s structural inefficiencies, and the number of uninsured and low-income citizens, which have increased dramatically due to the crisis. This results in pharmaceutical overspend, which is covered by patients through increased copayments and by pharma companies in the form of rebates and clawbacks. In 2016, pharma companies paid more than €1 billion in rebates and clawbacks back to the state, while patient out-of-pocket contributions reached another €1 billion. Thus, pharma industry and patients financed approximately 50% of public pharmaceutical expenditure, with 2017 showing further deterioration.

The current framework for the reimbursement of new innovative medicines disincentivizes investment in R&D and penalizes innovation in Greece. Firstly, the recently voted additional 25% rebate, which is imposed on top of existing volume-scaled rebates, raises the minimum rebate for a new medicine to 39%, and may thus result in delayed or no launch of certain medicines in the Greek market. Secondly, the stricter criteria that require prior launch and reimbursement of a new medicine in a significant number of EU countries before it is even assessed locally could delay the reimbursement of new medicines by up to three years post-EMA approval. Thirdly, the list of reimbursed biomarker tests has not been updated since 2014, despite the fact that new biomarkers are available and are a prerequisite for access to new, reimbursed personalized breakthrough medicines. As a result, patients need to pay out-of-pocket for the new biomarker tests to have access to effective, personalized treatment. All the above hamper access to innovation for Greek patients and create an unpredictable business environment, with detrimental effects on the population’s health status and on the sustainability of the pharmaceutical industry in Greece.

In order to establish a viable healthcare environment, we must review the current reimbursement framework; accelerate the comprehensive implementation of structural reforms, such as the introduction of a reliable, local health technology assessment (HTA) organization; and promote investment in innovation, in order to both ensure timely access to new medicines and support an industry that has long been one of the strongest growth pillars of the Greek economy. The pharmaceutical industry employees in total (direct and indirect employment) approx. 87,000 people, invests more than €100 million in R&D, pays €400 million in taxes and insurance contributions, and contributes € 6.2 billion—or 3.5%—to the Greek GDP

At AstraZeneca, by putting patients first and by following the science, we continue to strive to bring innovative, life-saving treatments to Greek patients. True to our motto, What science can do, we work towards innovation every single day. Breakthroughs in science are happening at a rapid rate, and AstraZeneca, being one of the leading companies in the field, is currently conducting a significant number of clinical studies, with six new drugs scheduled to hit the market by 2020. Patient welfare and unrestricted access to life-changing therapies is at the core of what we do.

Everything Is Changing… But Is It?

THEODORE LIAKOPOULOS, PRESIDENT, MEDICAL DEVICES & DIAGNOSTICS COMMITTEE, AMERICAN-HELLENIC CHAMBER OF COMMERCE AND MANAGING DIRECTOR, MEDICAL PRODUCTS, JOHNSON & JOHNSON COMMERCIAL AND INDUSTRIAL S.A.

After seven challenging years full of surprises, change seems to be the only constant in Greece… Yet the more some things change, the more they tend to remain the same. Governments come and governments go. Ministers come and ministers go. Memorandums come and memorandums go. Reforms come and reforms go. Laws come and laws go… There is so much happening in Greece, but does anything really change?

For healthcare, it is generally acknowledged that much has been done, including the recent breath-giving arrears clearance. However, and as demonstrated by the annual Health Consumer Powerhouse reporti, a lot remains to be done. Greece has one of the lowest healthcare quality indices and expenditure-to-quality ratios in Europe, meaning that the system is underfunded and has limited patient access to quality care, while at the same time what it spends, it spends insufficiently. Currently, the market is served by low-price but high-cost medical devices of inferior clinical and economic outcomes. Succinctly, the price observatory mandates the lowest market price, the DRGs have suffered horizontal tariff reductions, and ­­the tender selection criteria are based on price. Sometimes, the system treats medical technology as a commodity.

This takes place in an external healthcare environment that focuses on long-term overall costs, patient outcomes, and quality of care, basing decision making on evidence-based medicine, health economics, and a plethora of metrics. In Europe, the new Medical Device Directive aims to increase product safety for patients, and the new procurement law focuses both on price and qualitative criteria, assessing the most economically advantageous choice. In Greece, implementation deadlines are constantly shifting. The long anticipated HTA remains to be seen, the DRGs implemented at the end of 2011 have not been evaluated or updated, and the central tenders are on hold.

All these in a country that what it lacks in resources, it makes up for with abundant talent. A huge pool of renowned scientists and experts is both able and willing to support restructuring and change. The industry is able to further support this endeavor, providing international expertise and innovative solutions, enhancing healthcare outcomes, and reducing long-term healthcare expenditure. Globally, the industry now focuses on mutually beneficial value-based solutions, taking into account cost-effectiveness, budget impact, and clinical efficacy, providing value-for-money solutions that are geared toward sustainability. This is the type of deal making we are currently lacking in Greece.

The AmCham MD&D committee, with AmCham’s support, is always searching for opportunities for improvement, for meaningful and transparent implementation proposals, for bridging ideas and interests of stakeholders and decisions makers, for always being a catalyst for open dialogue and honest discussion.

As the AmCham MD&D committee president, I assure you that we will continue to support Greek patients, the Greek healthcare system, and the economy. In the last five years alone, AmCham MD&D companies have contributed over €30 million for scientific seminars and professional education, have donated over €6.5 million, and are currently employing over 1,000 individuals.

i Euro Health Consumer Index 2016

The Value of Innovation in Healthcare

VICKY OIKONOMOU, EXTERNAL AFFAIRS DIRECTOR, JANSSEN GREECE, CYPRUS, MALTA, PHARMACEUTICAL COMPANIES OF JOHNSON & JOHNSON

At the Janssen Pharmaceutical Companies of Johnson & Johnson, we envision a world without disease. To achieve this, we strive to couple our strong internal capabilities with the most compelling external science to transform how diseases are thought of, treated, cured, prevented, and intercepted in the future.

For more than a century, Janssen has developed medicines with the goal of helping people get well and stay healthy. At our core, we are focused on discovering, developing, and delivering innovative and transformative medicines that address the most serious and complex medical challenges of our time.

Today, thanks in large part to biomedical innovation, people around the world are living longer, healthier, and more productive lives than ever before. In fact, between 1986 and 2000, 40% of the improvement in life expectancy has been due to innovative drugs1.

More recently, innovative medicines are estimated to have contributed to 73% of the improvement in life expectancy between 2000 and 2009 once other factors—such as income, education, immunization, reduction in risk factors, and health system access—are taken into account2.

This innovation is the result of intensive research and development around the world. According to a Deloitte study, the biopharmaceutical industry has the highest R&D intensity in comparison to five other industries, including the automotive and consumer electronics industries, with a substantially higher percentage of revenue reinvested. The biopharmaceutical industry reinvests 14.7% of revenue back into R&D, with consumer electronics being the next most research-intensive industry at 5.3%3, 4, 5.

A unique characteristic of pharmaceutical R&D is that very few compounds get through the 10-to-15-year-long research and development process to become commercially available medicines. Of those that make it out of the lab and into clinical trials, only 16% are eventually approved. Consequently, the cost of developing a successful innovative medicine also accounts for the cost of other potential treatments that have failed in development.

An important aspiration of the modern Greek healthcare system is to improve the health of the population at sustainable cost, and innovative medicines can represent exceptional value, both in lives saved and in improving health while bringing down expenses in other parts of the healthcare system, such as hospitalization. However, the public dialogue around pharmaceutical innovation has focused largely on the cost of purchasing drugs rather than on the cost of disease, including diagnosis, treatment, hospitalization, and care.

The debate about the value and price of medicines taking place today has potentially meaningful consequences for a pharmaceutical innovation model that has delivered exceptional advances for patients over the past decades. Pharmaceutical innovators—including Janssen—are actively engaging in a dialogue on value, access and affordability, and price, as we need to establish a common understanding of the cost of disease and the assessment of the value of innovative medicines, as well as identify and advance solutions that will result in more people having access to life-changing medicines and ensure that we can continue to attract investment in biomedical research that will enable us to win battles against devastating diseases in the future.

1 F. R. Lichtenberg, The Impact of New Drug Launches on Longevity: Evidence from Longitudinal, Disease-Level Data from 52 Countries, 1982–2001, National Bureau of Economic Research Working Paper No. 9754 (Cambridge, MA: NBER, June 2003).

2 Lichtenberg, F: Pharmaceutical innovation and longevity growth in 30 developing OECD and high-income countries, 2000 – 2009 (2012)

3 EvaluatePharma® World Preview 2016, Outlook To 2022, 9th Edition, September 2016. Pg27 http://info.evaluategroup.com/rs/607-YGS-364/images/wp16.pdf

4 High value, high uncertainty: Measuring risk in biopharmaceutical research and other industries Investing in the future of health. Deloitte. 2014 pg12 http://www.janssen-emea.com/sites/default/files/High%20value-high%20uncertainty.pdf

5 2015 PhRMA industry profile report http://www.phrma.org/sites/default/files/pdf/2014_PhRMA_PROFILE.pdf

CR Contributions for the Greek Patients & and Society

SUSANNE KOHOUT, COUNTRY PRESIDENT & MANAGING DIRECTOR, NOVARTIS HELLAS

Healthcare challenges are evolving as populations age and the world faces dramatic increases in chronic diseases. The very nature of business itself is also changing, with society demanding more from companies. We have a unique opportunity to impact millions of people—as an industry, as a company, and as individuals.

Novartis has a sound strategy for navigating a world with a growing, aging population and continuously evolving healthcare needs. Corporate social responsibility is an essential ingredient of good business and a core part of our business. We learned early on that CSR isn’t only about what we do—how we do it is just as important. That is why we take a twofold approach: expanding access to healthcare and doing business responsibly. We invest in programs and partners to ensure that our medicines reach as many patients as possible around the world. And we invest in our associates and our culture at Novartis to learn, adapt, and conduct global business responsibly and sustainably into the future.

During 2013-2015, Novartis Hellas invested more than €138 million in the country, through R&D, tax payment, salaries, scientific and social programs. Our cooperation with Greek pharma companies is accomplished through an €80 million investment, while the company maintains the percentage of its indirect purchases from Greek suppliers at 88%, further strengthening the domestic market. Furthermore, our people are our main asset. Novartis employs 500 associates and is highly committed to their development and reward, to diversity, volunteerism, attraction and retention of the best talents in Greece.

We are the number one company locally in a number of clinical trials, conducting more than 100 clinical trials involving around five thousand patients. Since 2015, we have provided 15,000 free screenings to our fellow citizens in need and have implemented four awareness campaigns for the public to raise awareness about severe/chronic diseases, as well as about patients’ rights. Our patient-centric approach is also reflected in our annual cooperation with and support of more than 35 patient organizations.

As we aim to reduce our environmental footprint, we are making continuous progress toward our long-term emission reduction targets, while also improving our material and waste management.

Innovation and corporate responsibility efforts can only be successful if they are embedded in a culture of high ethical standards. By promoting values such as collaboration, integrity, and courage, we are creating a strong behavioral framework for our people, internally and externally. Operating with high integrity and transparency builds our organization’s sustainable future—one that is focused on helping patients, protecting the environment, and gaining the trust of our partners.

Patient Support Programs: Putting the Patient First and Saving Money for the Health System

SPYROS FILIOTIS, VICE PRESIDENT & GENERAL MANAGER, PHARMASERVE-LILLY S.A.C.I.

Over the years, multiple research teams have established that patients do not take their medication as prescribed. This low patient adherence to treatment is the number one factor for patients not getting the full benefit out of the treatment. Poor adherence to medication leads to poor therapeutic outcomes, increased complications of diseases, reduced quality of life, and increased overall healthcare costs.

Patients’ adherence is a complex issue to solve as it is influenced by many factors, such as the healthcare system, the disease, the treatment, the physician and caregivers, family and friends, and of course the patient him or herself.

Especially in chronic diseases, patients often may feel helpless in having to face complex therapies, multiple long-term medication regimes, a bureaucratic public healthcare system, and overall changes and challenges of adjusting to everyday life. Where can patients turn to overcome difficulties, get the necessary support, and feel confident and safe with their treatment? The answer is patient support programs (PSPs).

PSPs are enhanced self-management support programs that include interventions such as (but not limited to) visits to a patient’s home, individualized medication counseling, disease training, support, and reminders to improve medication behavior. The underlying objective is to help patients better manage their disease and complex medication regimens, improve medication adherence, and reduce complications and related costs. The ultimate goal is to assure patients, physicians, and the healthcare system that the time, effort, money, and personal sacrifice invested has the best possible healthcare outcome.

There are multiple benefits to PSPs:

Patients receive more attention and care from a healthcare professional. They feel more supported and they are empowered to take control of their condition. Ultimately, this leads to more motivated patients, better access to medication, continuation of the treatment, and improved health outcomes.

Health care providers (HCPs) have a service to better support their patients and a valuable tool to follow their patient’s therapeutic progress.

Pharma companies can provide a value-added service through patient support programs both to HCPs and to patients that can differentiate their medicines. They can also gather valuable statistical information on real-world use that can help with pricing and reimbursement discussions. Furthermore, poor adherence costs in lost revenue; even a modest 10% increase in adherence to a chronic medication leads to a significant rise in revenue, improved health outcomes, and decreased overall healthcare spending.

As for healthcare, outside the hospital, about 80% of the diseases reimbursed are chronic and adherence to long-term therapy for chronic illnesses in developed countries averages 50%. The health spending that can be gained in annual health expenditures worldwide could reach the 8% of total and more than half ($269 billion) can be gained through improved patient adherence, according to the 2012 report from the Institute for Healthcare Informatics. As a Cochrane review from 2008 states, “Effective ways to help people follow medical treatments could have far larger effects on health than any treatment itself.”

Pharma companies usually outsource PSPs to specialized service providers to be compliant with the respective local legal framework. In Greece, there are several providers with a variety of tailored services to cover every need. Our company’s experience through several PSPs for chronic disease treatments with our provider, the European Medical Research Institute (EMRI), has shown the great value of these programs in terms of patient satisfaction and increased adherence rates to therapies.

With PSPs, we achieve improved patient outcomes, reduce waste, improve sales, and lower public healthcare utilization. Consequently, patients do more, feel better, and live longer through personalized solutions.

Pharma Innovation: A Critical Component of Growth and Social Welfare or Economic Threat?

ZACHARY RAGOUSIS, PRESIDENT AND MANAGING DIRECTOR, PFIZER HELLAS

The ongoing public dialogue regarding pharmaceuticals and the recent measures on new medicines (barriers for reimbursement and 25% additional rebate) are making it obvious that a number of decision makers consider pharma innovation an economic threat and not a benefit for our health system and society. Unfortunately, public dialogue has mainly focused on the cost of medicines. Rarely do we have a broader debate about the value that these medicines bring to patients, the impact they have on their lives, on the health system, and on our society.

The following examples illustrate this mentality: Cerebrovascular diseases are the leading cause of death in Greece (ELSTAT data). We have more than 30,000 stroke events annually, with a devastating socioeconomic burden: high mortality and increased rate of disabilities, with an estimated total cost of €1 billion per year. These facts should have triggered discussions to formulate a national strategy on stroke prevention. Instead, we focus on the cost of stroke prevention treatments, ignoring all the direct and indirect savings stroke prevention would entail.

Surprisingly, this mentality is also met in regard to vaccination. Vaccination is globally recognized as the most efficient strategy and investment for healthcare systems. According to the CDC, for every $1 spent on childhood vaccination, $10.2 is saved in disease treatment costs. Contrary to this, there is a tendency to focus on the cost of vaccination in a period where cases of measles have re-appeared in Greece (100 reported cases) and efforts should be made to increase vaccination rates.

The reason behind this approach is the silo mentality that characterizes our system, the lack of connection between pharma budget, hospital costs, disability subsidies, etc. leading to fragmented and unconnected decisions. E-governance (i.e. big data from IDIKA) can certainly play a significant role to fill this gap, and it was heartening to hear that EOPYY has some promising plans in this direction.

Pharmaceutical companies, both local and multinational, definitely have a significant positive impact on the Greek economy. The industry’s estimated annual contribution is €6.1 billion, or approximately 3.5% of GDP, and the total effect in employment is more than 86,000 jobs. Moreover, during the crisis, pharmaceutical companies took on an increasing level of the healthcare burden via rebates and clawback payments, which have reached €1 billion last year.

The pharma sector can further contribute to the recovery of the Greek economy via increased investments in clinical trials and local manufacturing. Countries of similar size to Greece like Ireland or Belgium have succeeded in these areas, and we have the potential to follow their example. Belgium attracts investment of €2.5 billion for R&D every year, while Greece attracts only €90 million. Investments can be encouraged by establishing a stable and attractive environment based on mutual understanding and constructive dialogue between our industry and the government.

Pfizer Hellas has been operating in Greece since 1960. We are proud of our contribution to health and the local economy (estimated at €128 million for 2016, with 4.1 million packs of medicines produced in Greece). We are also proud of our highly educated people (more than 300), and we are making efforts to maintain a motivating and engaging environment for them. This is why Pfizer Hellas has been recognized as the company with the best working environment in Greece for 2017.

The Necessity to Define Hospital Budgets Based on Healthcare Needs

ANNE NIJS, MANAGING DIRECTOR, ROCHE (HELLAS) S.A.

Similarly to most countries, Greece is challenged continuously by rising healthcare costs. The population’s aging, as well the development of new treatments in areas of unmet medical need are to some degree the sources of this trend. Given the multilevel economic crisis that Greece has been facing since 2012, and the high rate of public pharmaceutical spending prior to 2010, a range of cost containment measures were adopted as temporarily until the implementation of structural reforms. However, in the absence of genuine reforms at every level of the health system, irrational measures such as the clawback were prolonged and even extended to more “sensitive” healthcare settings such as hospitals.

Undoubtedly, the fixed budget for inpatient pharmaceutical expenditure was introduced in an arbitrary manner. The in-hospital clawback for 2016, which amounted to €224 million, constituting almost 30% of total inpatient expenditure, as well as the admission by health authorities that the pharmaceutical budget for hospitals is incorrect, mandate that this be rectified urgently. At this point, it is important to note that despite it being the third quarter of 2017, pharmaceutical figures on expenditure and overspending have yet to be communicated by the Ministry of Health. This emphasizes the limited cooperation on such a crucial issue, but also the very complex and unfavorable environment in which companies are obliged to operate in Greece.

Sustainability of the system cannot be achieved as long as key structural reforms—such as therapeutic protocols, registries, fair pricing of innovative and generic medicines related to the added value, DRG-based hospital reimbursement, and rationalization of resource allocation—are still pending.

A poorly defined hospital pharmaceutical budget can have disastrous consequences, as it threatens patients’ timely access to innovative medicines and underestimates their great significance by failing to consider the added value of improved health, of lifesaving benefits, and changes in disease management. By imposing arbitrary spending ceilings to inpatient pharmaceutical expenditure, only marginal savings can be achieved, ultimately leading to higher total system costs and poorer health outcomes. A solely budget-centric perspective assesses only the cost, because it is direct and immediate, ignoring the real benefits for the patient and society that usually do not accrue for years. Nowadays, there is widespread consensus that sufficient public health care spending has a significant positive fiscal multiplier (4.3); therefore investments in health contribute to economic growth in the medium and long term, by creating a healthier and therefore more productive labor force.

Challenges can only be tackled through a more sophisticated understanding of the real costs but also the outcomes achieved for patients, families, the health system, and society as a whole. We are calling for the government to reflect on its commitment to ensure high-quality care and access to innovation for all citizens, but also to work on the sustainability of healthcare sector.

No Responses to «Turning Healthcare Around»