Health Care Reform and the Pharmaceutical Industry

Liberman, Aaron; Rubinstein, Jason

doi:10.1097/00126450-200203000-00004

Cited by 7 publications

(4 citation statements)

References 1 publication

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“…Over the past few years, the diagnostic thresholds for several common medical conditions have been lowered, resulting in a substantial expansion in the market for health care (36,53). For example, the most recent guidelines for high cholesterol (32) and high blood pressure (21) each define most of the older adult population as in need of regular medical attention.…”

Section: Changing Disease Definitionsmentioning

confidence: 99%

Rationale and Public Health Implications of Changing CHD Risk Factor Definitions

Kaplan

Ong

2007

Annu. Rev. Public Health

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The definition of disease is central to the practice of medicine and to public health policy. Practice guidelines set standards for disease identification and treatment. Quality care is often defined as adherence to these guidelines. Over the past few years, the diagnostic thresholds for several common medical conditions have been lowered, resulting in a substantial expansion in the market for health care. The most recent guidelines for high blood pressure, high cholesterol, and impaired fasting glucose each define a high percentage of the adult population as in need of regular medical attention. Under the latest proposed thresholds, virtually the entire adult population qualifies for a chronic condition diagnosis. We evaluate the health and financial outcomes associated with changes in diagnostic thresholds for the prevention of three risk factors for cardiovascular disease and stroke: blood pressure, serum cholesterol, and fasting plasma glucose. Estimates of the numbers of people affected, the cost implications, and the overall public health consequences are offered.

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Section: Changing Disease Definitionsmentioning

confidence: 99%

Rationale and Public Health Implications of Changing CHD Risk Factor Definitions

Kaplan

Ong

2007

Annu. Rev. Public Health

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“…For most of these conditions, an expensive pharmaceutical product is available with treatment costs approaching US$3/day. For older adults with a multiple diagnoses, the costs of medications may exceed the cost of food (Liberman & Rubinstein, 2002). In order to address the policy issues, we need to understand the impact of lowering diagnostic thresholds upon population health status and healthcare costs.…”

Section: The Cost Problemmentioning

confidence: 99%

Diagnostic and Treatment Decisions in US Healthcare

Kaplan¹,

Frosch

2004

J Health Psychol

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The practice of medicine links diagnosis to treatment. However, for many diagnosed conditions diagnosis and treatment may not affect health outcome. Examples include low-grade cancers that do not influence life expectancy or quality of life. Further, there is considerable uncertainty about the point along a biologic continuum where treatment should begin. Changes in diagnostic thresholds often increase healthcare costs even though the benefit of the treatment is uncertain. Although this uncertainty is understood by the healthcare providers, it often is not shared with patients. We advocate a new paradigm called shared medical decision making that makes uncertainty about diagnosis and treatment transparent to patients and engages them in the treatment decision process.

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“…In Ger many, costs for ambulatory pre scrip tions ex ceeded 24 bil lion Euro in 2003 and this is a re cord num ber in both ab solute and rel a tive terms [Schwabe 2004]. Patients could save about 10 -30% by pur chasing ge neric drugs as op posed to brand-name drugs [Liberman and Rubinstein 2002]. German statu tory health in sur an ces could save another 1.5 bil lion Euro if the po ten tial of ge neric pre scrib ing was ex ploited to the full [Nink and Schröder 2004].…”

Section: Introductionmentioning

confidence: 99%

What do primary care patients think about generic drugs?

Himmel

Simmenroth-Nayda²,

Niebling³

et al. 2005

144

129

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What do pri mary care pa tients think about ge neric drugs? Ab stract. Ob jec tive: To ex am ine the at titude of pa tients to wards ge neric drugs and pre scriptions con tain ing ge neric drugs as an al ter na tive to brand-name prod ucts, with a spe cial fo cus on in for ma tion on pa tients at titude to ge neric drugs pro vided by their general prac ti tio ners (GPs). Meth ods: A to tal of 804 pa tients in 31 gen eral prac tices were surveyed us ing a self-ques tion naire. The in fluence of age, sex, ed u ca tion, dis ease, knowledge of ge neric drugs, ex pe ri ence with generic sub sti tu tion and in for ma tion pro vided by the GP on pa tient at ti tudes to wards ge neric drugs and sub sti tu tions were ex am ined. Results: Nearly two thirds of the pa tients (509/804) stated that they knew of the dif ference be tween brand-name drugs and generics; of these, one third were not sat is fied with the in for ma tion given by their GPs and 37% of pa tients ex pressed gen eral skep ti cism to wards ge neric drugs be cause of their lower price. This at ti tude was more fre quent among those who felt that ge neric pre scrib ing was "in vented" to solve the fi nan cial cri sis in the Ger man health in sur ance sys tem at their expense (odds ra tio (OR): 6.2; 95% con fi dence in ter val: 4.0-9.8) and those who had not been con fronted per son ally with a ge neric sub sti tu tion (OR: 1.8; 1.3-3.0). Pa tients who had been skep ti cal when first con fronted with a ge neric sub sti tu tion were more fre quently among those who con sid ered in ex pen sive drugs to be in fe rior (OR: 4.5; 2.0-10.4) and they were fre quently not sat is fied with the infor ma tion on sub sti tu tion pro vided by their GP (OR: 2.7; 1.2-5.9). Con clu sion: GPs are in an ideal po si tion to in form their pa tients ade quately about the equiv a lence of brandname and ge neric drugs. How ever, the pa tient view that in ex pen sive drugs must be in fe rior may be dif fi cult to rec tify in the short term. Key words ge neric drugs-prescriptions-cost-ef fec tive ness-in for ma tion on drug ther apy-fam ily prac tice Re ceived De cem ber 8, 2004; ac cepted

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Health Care Reform and the Pharmaceutical Industry

Cited by 7 publications

References 1 publication

Rationale and Public Health Implications of Changing CHD Risk Factor Definitions

Rationale and Public Health Implications of Changing CHD Risk Factor Definitions

Diagnostic and Treatment Decisions in US Healthcare

What do primary care patients think about generic drugs?

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