Governing drug reimbursement policy in Poland: The role of the state, civil society, and the private sector

Abstract

This article investigates the distribution of power in Poland's drug reimbursement policy in the early 2000s. We examine competing theoretical expectations suggested by neopluralism, historical institutionalism, corporate domination, and clique theory of the post-communist state, using data from a purposive sample of 109 semistructured interviews and documentary sources. We have four concrete findings. First, we uncovered rapid growth in budgetary spending on expensive drugs for narrow groups of patients. Second, to achieve these favorable policy outcomes drug companies employed two prevalent methods of lobbying: informal persuasion of key members of local cliques and endorsements expressed by patient organizations acting as seemingly independent "third parties." Third, medical experts were co-opted by multinational drug companies because they relied on these firms for scientific and financial resources that were crucial for their professional success. Finally, there was one-way social mobility from the state to the pharmaceutical sector, not the "revolving door" pattern familiar from advanced capitalist countries, with deleterious consequences for state capacity. Overall, the data best supported a combination of corporate domination and clique theory: drug reimbursement in Poland was dominated by Western multinationals in collaboration with domestically based cliques.

When health technology assessment is confidential and experts have no power: the case of Hungary

“…The organisational and legal framework of the Polish Agency for Health Technology Assessment (AHTAPol) was also established after joining the EU, in 2004. The political significance of AHTAPol recommendations in the reimbursement process was reported to be important, and their support is vital for legitimising reimbursement decisions (Ozieranski et al ., 2012a; Ozieranski and King, 2016). HTA recommendations are publicly available from AHTAPol’s website, and therefore HTA activities can be monitored and compared to reimbursement decisions to gain more understanding on potential influence of AHTAPol (Kolasa et al ., 2011b; Bochenek et al ., 2017).…”

The Emerging Social Science Literature on Health Technology Assessment: A Narrative Review

“…A more critical take on stakeholder involvement, rooted in political sociology/political economy, examines the roles of other actors than patients, including members of appraisal committees, clinical experts, policymakers, and bureaucrats. 71,72,102,103 Just like work by established HTA analysts 87 and scholars of pharmaceutical regulation, 10 this literature examines the way various actors attempt to game the system by biasing or capturing HTA regulators. For instance, several studies of lobbying methods deployed by drug manufacturers in Poland to secure favorable HTA outcomes document a mixture of universal lobbying strategies, such as endorsements by clinical experts, coupled with contextdependent approaches, such as informal clique influence.…”

“…For instance, several studies of lobbying methods deployed by drug manufacturers in Poland to secure favorable HTA outcomes document a mixture of universal lobbying strategies, such as endorsements by clinical experts, coupled with contextdependent approaches, such as informal clique influence. 102,103 But manufacturers are not the only stakeholders with vested interests in HTA. There are also HTA consultancies assisting the industry in developing evidence submissions, who may be interested primarily in creating business for themselves, rather than creating or reforming HTA systems, 71,102 and the "epistemic community" of HTA experts, who have potential material or reputational gains from creating and maintaining HTA institutions.…”

“…102,103 But manufacturers are not the only stakeholders with vested interests in HTA. There are also HTA consultancies assisting the industry in developing evidence submissions, who may be interested primarily in creating business for themselves, rather than creating or reforming HTA systems, 71,102 and the "epistemic community" of HTA experts, who have potential material or reputational gains from creating and maintaining HTA institutions. 36,50 In addition, politicians and bureaucrats have a strong stake in limiting impact on public budgets.…”

Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics

“…Ozieranski and King urge researchers of pharmaceutical lobbying to consider universal as well as country-specific lobbying since companies’ arguments and tactics are carefully calibrated to fit local circumstances. 28 Nonetheless, in the context of pandemic stockpiling, the arguments and tactics deployed by Roche are likely to repeat themselves whenever many countries negotiate procurement of medical countermeasures in a monopolistic market. As countries are now in the process of renewing their antiviral contracts—and in the absence of joint procurements—we believe there is a need to increase awareness of Roche’s past lobbying in the event of more of the same when negotiating renewal contracts.…”