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Perspectives on the European Health Policies Opportunities and challenges for CEE countries

ROMANIA Insights, challenges and opportunities on the pharmaceutical market Dan ZAHARESCU Executive Director of ARPIM Romanian Association of International Medicines Manufacturers. Perspectives on the European Health Policies Opportunities and challenges for CEE countries

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Perspectives on the European Health Policies Opportunities and challenges for CEE countries

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  1. ROMANIAInsights, challenges and opportunities on the pharmaceutical market Dan ZAHARESCUExecutive Director of ARPIMRomanian Association of International Medicines Manufacturers Perspectives on the European Health Policies Opportunities and challenges for CEE countries Brussels – 12th of April 2010

  2. General overview 2010 • 21,500,000 inhabitants and only 4.000.000 payers to HC social insurance fund • 47% of inhabitants in rural area – less than 10% of medicines sales • 53% of inhabitants in urban areas – over 90% of sales • 3,500,000 Romanians are working abroad, most of them in EU countries, without contributing to the HC fund for their families which remains at home • 90% of Romanians are stating that their major concern is to have a good healthcare status • Only 10% of Romanians are proactive, respecting the prevention rules and have a healthy life style • 355 €/capita brut monthly average income (INS – Feb 2010) • The contribution to the HC social insurance fund is 5,2% from the salary of the employee and 5,7% on the salary fund is paid by the employer (10,7% set the lowest level in EU).

  3. Healthcare in 2010 • Romania presents higher rates of mortality and morbidity than average in Europe, for most of the maladies • Lack of public policies regarding the healthcare in the last 20 years • 20 ministers of health in 20 years • Healthcare is observed by authorities only from the public service side, the market aspects being totally ignored • Only 3.36% of GDP is allocated for HC – approx. half of the minimum EU and less than the average allocated in the African Countries (5,9%) • In the total of HC expenditures • 23% are allocated for medicines (most regulated) • The difference of 77% is not regulated at all • 400 €/capita is the average spending for healthcare services

  4. Healthcare expenditures per capita (PPP$)

  5. Pharma market overview • Romanian accession in EU was responsible for rapid regulatory reforms, dramatically improving the market environment. • No progress since 2007. • Continued problems in the last decade: • Lack of financing – affecting systematically the access of the patients to the HC services and medicines. • Lack of transparency and predictability in the regulation process – generating difficulties in building a solid system. • Strong pressure on the medicines manufacturers who are supporting cumulatively: • Lowest prices in EU for Rx products • Fixed exchange rate for one year in a very unstable environment • 160 mil. EUR loses due to the refuse of authorities to update the exchange rate • Long payment terms – extended to 210 days in September 2009 • Claw back as an overtax of 5 to 11% of the turnover – not applied yet

  6. Romanian pharmaceutical market evolution (mil. Eur)

  7. Critical analysis • The Healthcare Budget – was always insufficient in the last 15 years and the systemic under financing is the root of the most problems. • Today the healthcare financing is under heavy external pressure (IMFand EU obligations) – The funds available are covering only half of the year 2010! • Health Care System debts are in this moment around 250 million Eur., covered by an arbitrary extension of payment terms for medicines up to 210 days. • The suppliers (medicines manufacturers, distributors and others become major creditors of the health system) • The health services package covered by the Social Insurance System is not realistic compared with the resources. • In the actual financial difficulties of the system, the risk of discontinuity of the access of the patients to the health care is real.

  8. Consequences • Impossibility of coherent and complete coverage of the population needs with healthcare services • Impossibility of development for complementary / supplementary HC insurances, because “there is no object of activity for them”, all the services being offered by the social healthcare insurances. • Public funds allocated for healthcare should be more realistic versus needs and more sustainable.

  9. Conclusion • The actual crisis is offering the opportunity to discuss about the reforms that are absolutely necessarily in the Romanian HC system • Today, the public HC system in Romania is 30-40 years behind the EU countries, not reformed and inefficient • Unfortunately, the measures taken by the authorities are chaotic, not predicable and arbitrary, specific to fire fighting and every body is loosing in these conditions. • Solutions are not simple, they can not be taken from a day to another, but they must be started if we want to have in the future a healthcare system at decent standards.

  10. THANK YOU! dan.zaharescu@arpim.ro

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