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New Zealand PHARMACEUTICAL FUNDING
876
that the evidence to justify the need for a routine booster for low responders as defined above was insufficient. The length of protection remains unknown. Immunity may persist even after anti-HBs has declined to undetectable levels, and several observations support this. 78 HBV infections have been reported in adults who responded to vaccine-generally after antibody levels had become very low or undetectable. Only 1 was clinically relevant. This individual had subclinical disease but was HBsAg-positive for several weeks and could have transmitted HBV during this period. No infection resulted in clinical disease or an
Round the World From
our
Correspondents
New Zealand PHARMACEUTICAL FUNDING
IN New Zealand the annual bill for
drugs is running at around
$500 million, and the government subsidy for pharmaceutical costs is
huge. Last September the New Zealand Medical Association set
up a working party to look into pharmaceutical benefit costs and the
proportion of the health vote that this takes. They were invited to report back in ten weeks, which is what Dr L. E. J. King and his five colleagues dutifully did in November, 1987. The working party found that the current$1 prescription charge did not deter patients from obtaining their medication, and that a modified system of charging could be sustained, although patients should have a say in the cost-benefit analysis of pharmaceuticals. The working party acknowledges the need for the pharmaceutical companies to make a profit and provide a reasonable return for shareholders. However, another commercial reality in recent years has been that New Zealand appears to have paid more for drugs than many other countries. For example, in one survey, New Zealand paid more than the UK for over 20 of 40 medicines. A study of 9 out of 10 most commonly prescribed medicines in Australia and New Zealand suggested that New Zealand prices were higher by about 37%. The working party recommends that a professional negotiating unit be set up to purchase drugs for New Zealand. The patent for pharmaceuticals could be increased from 16 to 20 years, provided there is a lower wholesale cost of drugs. Guidelines are needed for the registration and marketing of generic drugs. However, the working party states unequivocally that the public are the funders, the users, and the decision makers, and should co-operate with health professionals to decide what should be provided. As well as the negotiating unit, which would also be responsible for pricing and auditing, an information advisory committee is recommended. This committee would protect confidentiality, monitor ethics, and supply information to pharmacists, doctors, and other professionals. Many hospitals have a preferred medicines list, especially for antibiotics. The working party looked at the system used by Wellington Hospital Board. In Wellington a consensus on many common drugs has been reached by asking specialists to agree on a limited range within their expert area. Having been agreed, this list is published and if a junior doctor wishes to prescribe outside the list, then a consultant must give permission. All hospitals should consider a preferred medicines list that is reached by consensus and limited to junior but not senior staff, says the working party. The estimated savings in the Wellington scheme have been calculated for the same two months in 1986 and 1987. Since the introduction of the list and the consequent restrictions on prescribing, there have been financial advantages and a 145% reduction in the total number of doses prescribed. Drugs in New Zealand are paid for largely by the public through taxation. Private doctors, as the initiators and planners of care, should consider costs. While the total cost of the pharmaceutical bill has soared, the total number of prescriptions submitted for pricing and the number per full-time general practitioner has remained
HBV carrier state. Until more data are available one might consider revaccinating individuals when anti-HBs levels fall to < 10 IU/1 or once 5-7 years after the initial course of vaccination. Immunocompromised individuals should be revaccinated more frequently according to their anti-HBs responses. Any cases of acute or chronic hepatitis B in vaccine responders should be reported to public health authorities and one of the WHO collaborating centres, since the information is vital to further development of policies for booster immunisations.
The working party found no evidence of wanton or excessive prescribing, but changing the prescribing habits of private practitioners is likely to result in savings. The working party believes it essential that scientifically based, cost-effective, unbiased pharmaceutical information be available to doctors. Examples of such information are The Medical Letter in the USA, Drug and Therapeutics Bulletin in the UK, and the Australian Prescriber. The undergraduate curriculum should include teaching on rational and cost-efficient prescribing. The working party has an alternative proposal for New Zealand. Financial status should not determine access to health care, and access to medicines should not depend on the patient’s ability to pay. The working party tends towards no charges for pharmaceuticals, or at least a system with no significant financial barrier. But how will the system be funded? The working party cites the Australian system as an example, because of its certain targeting of benefits and protection for the chronically ill or low-income family. Every family pays part of the charge for a certain number of prescription items per year, after which all drugs are free. This promotes individual responsibility but protects those families who through no fault of their own have high prescription costs. The family pays$5-10 for each item up to a total of 25 per year and then the prescriptions are free. Pensioners receive their prescriptions free, and concessionary beneficiaries pay$2.50 for up to 25 items, after which there is no charge. It is essential, says the working party, that any public funds saved by pharmaceutical charges should be returned to the health system. constant.
USA CAMPS FOR CHILDREN WITH ASTHMA
THE summer camp, which originated as a vacation alternative for children, has become ever more popular here over the past two decades. Many educators and physicians consider camping so important to child development that specialised camps for children with chronic diseases such as bronchial asthma have sprung up. The names given to some of these camps are unfortunate. The camp for asthmatic children sponsored by the American Lung Association of Massachusetts, the Massachusetts Allergy Society, and the Massachusetts Thoracic Society is called—Camp Chest Nut (not even "chestnut", which would be bad enough.) Other examples of camps with names degrading to asthmatic children are Wheez
(California), Not-A-Wheeze (Arizona), Weasel (Kentucky), Huff’n Puff (Montana). No less disrespectful are Camp Superkids (Minnesota), Camp Superstuff (California), and Champ Camp (Colorado). Everyone, including the children, recognises the irony, and what is probably meant to encourage the children in fact humiliates them. A few camps do have attractive names-for example, Massawixie (New York), Sun Deer (Michigan), Tapawingo (Illinois), and Friendly Pines (Arizona). How does a child feel when a friend asks him the name of his camp, and he has to respond "Chest Nut", "Wheez", "Weasel", or "Huff’n Puff"? Asthmatic children ill enough to require a camp with special medical facilities do not need to be reminded of their plight in this humiliating way. Ridicule cannot have been the intention of those who coined the names; in trying to be original, lighthearted, or clever they achieved insensitivity. Would anyone name a camp for diabetic children "Camp Sweet Pea" or one for the mentally ill "Camp Corn Flake"?
that the evidence to justify the need for a routine booster for low responders as defined above was insufficient. The length of protection remains unknown. Immunity may persist even after anti-HBs has declined to undetectable levels, and several observations support this. 78 HBV infections have been reported in adults who responded to vaccine-generally after antibody levels had become very low or undetectable. Only 1 was clinically relevant. This individual had subclinical disease but was HBsAg-positive for several weeks and could have transmitted HBV during this period. No infection resulted in clinical disease or an
Round the World From
our
Correspondents
New Zealand PHARMACEUTICAL FUNDING
IN New Zealand the annual bill for
drugs is running at around
$500 million, and the government subsidy for pharmaceutical costs is
huge. Last September the New Zealand Medical Association set
up a working party to look into pharmaceutical benefit costs and the
proportion of the health vote that this takes. They were invited to report back in ten weeks, which is what Dr L. E. J. King and his five colleagues dutifully did in November, 1987. The working party found that the current$1 prescription charge did not deter patients from obtaining their medication, and that a modified system of charging could be sustained, although patients should have a say in the cost-benefit analysis of pharmaceuticals. The working party acknowledges the need for the pharmaceutical companies to make a profit and provide a reasonable return for shareholders. However, another commercial reality in recent years has been that New Zealand appears to have paid more for drugs than many other countries. For example, in one survey, New Zealand paid more than the UK for over 20 of 40 medicines. A study of 9 out of 10 most commonly prescribed medicines in Australia and New Zealand suggested that New Zealand prices were higher by about 37%. The working party recommends that a professional negotiating unit be set up to purchase drugs for New Zealand. The patent for pharmaceuticals could be increased from 16 to 20 years, provided there is a lower wholesale cost of drugs. Guidelines are needed for the registration and marketing of generic drugs. However, the working party states unequivocally that the public are the funders, the users, and the decision makers, and should co-operate with health professionals to decide what should be provided. As well as the negotiating unit, which would also be responsible for pricing and auditing, an information advisory committee is recommended. This committee would protect confidentiality, monitor ethics, and supply information to pharmacists, doctors, and other professionals. Many hospitals have a preferred medicines list, especially for antibiotics. The working party looked at the system used by Wellington Hospital Board. In Wellington a consensus on many common drugs has been reached by asking specialists to agree on a limited range within their expert area. Having been agreed, this list is published and if a junior doctor wishes to prescribe outside the list, then a consultant must give permission. All hospitals should consider a preferred medicines list that is reached by consensus and limited to junior but not senior staff, says the working party. The estimated savings in the Wellington scheme have been calculated for the same two months in 1986 and 1987. Since the introduction of the list and the consequent restrictions on prescribing, there have been financial advantages and a 145% reduction in the total number of doses prescribed. Drugs in New Zealand are paid for largely by the public through taxation. Private doctors, as the initiators and planners of care, should consider costs. While the total cost of the pharmaceutical bill has soared, the total number of prescriptions submitted for pricing and the number per full-time general practitioner has remained
HBV carrier state. Until more data are available one might consider revaccinating individuals when anti-HBs levels fall to < 10 IU/1 or once 5-7 years after the initial course of vaccination. Immunocompromised individuals should be revaccinated more frequently according to their anti-HBs responses. Any cases of acute or chronic hepatitis B in vaccine responders should be reported to public health authorities and one of the WHO collaborating centres, since the information is vital to further development of policies for booster immunisations.
The working party found no evidence of wanton or excessive prescribing, but changing the prescribing habits of private practitioners is likely to result in savings. The working party believes it essential that scientifically based, cost-effective, unbiased pharmaceutical information be available to doctors. Examples of such information are The Medical Letter in the USA, Drug and Therapeutics Bulletin in the UK, and the Australian Prescriber. The undergraduate curriculum should include teaching on rational and cost-efficient prescribing. The working party has an alternative proposal for New Zealand. Financial status should not determine access to health care, and access to medicines should not depend on the patient’s ability to pay. The working party tends towards no charges for pharmaceuticals, or at least a system with no significant financial barrier. But how will the system be funded? The working party cites the Australian system as an example, because of its certain targeting of benefits and protection for the chronically ill or low-income family. Every family pays part of the charge for a certain number of prescription items per year, after which all drugs are free. This promotes individual responsibility but protects those families who through no fault of their own have high prescription costs. The family pays$5-10 for each item up to a total of 25 per year and then the prescriptions are free. Pensioners receive their prescriptions free, and concessionary beneficiaries pay$2.50 for up to 25 items, after which there is no charge. It is essential, says the working party, that any public funds saved by pharmaceutical charges should be returned to the health system. constant.
USA CAMPS FOR CHILDREN WITH ASTHMA
THE summer camp, which originated as a vacation alternative for children, has become ever more popular here over the past two decades. Many educators and physicians consider camping so important to child development that specialised camps for children with chronic diseases such as bronchial asthma have sprung up. The names given to some of these camps are unfortunate. The camp for asthmatic children sponsored by the American Lung Association of Massachusetts, the Massachusetts Allergy Society, and the Massachusetts Thoracic Society is called—Camp Chest Nut (not even "chestnut", which would be bad enough.) Other examples of camps with names degrading to asthmatic children are Wheez
(California), Not-A-Wheeze (Arizona), Weasel (Kentucky), Huff’n Puff (Montana). No less disrespectful are Camp Superkids (Minnesota), Camp Superstuff (California), and Champ Camp (Colorado). Everyone, including the children, recognises the irony, and what is probably meant to encourage the children in fact humiliates them. A few camps do have attractive names-for example, Massawixie (New York), Sun Deer (Michigan), Tapawingo (Illinois), and Friendly Pines (Arizona). How does a child feel when a friend asks him the name of his camp, and he has to respond "Chest Nut", "Wheez", "Weasel", or "Huff’n Puff"? Asthmatic children ill enough to require a camp with special medical facilities do not need to be reminded of their plight in this humiliating way. Ridicule cannot have been the intention of those who coined the names; in trying to be original, lighthearted, or clever they achieved insensitivity. Would anyone name a camp for diabetic children "Camp Sweet Pea" or one for the mentally ill "Camp Corn Flake"?