In a poster presentation at the 34th Spanish Health Economics Association annual meeting, Karla Hernandez-Villafuerte presented the first stage of research into the pharmaceutical market in Latin America. The post demonstrates the variety of approaches across these countries and the importance of HTA.

1. 2. Pharmaceutical Market
Paraguay has in general no availability of breast/bowel cancer screening and cervical cytology at the primary health care level.
Guatemala and Peru have in general no availability of of breast/bowel cancer screening at the primary health care level.
47% of the countries have no availability of cervical cytology at the primary health care level.
Objective
• Every country in the sample has an official list of essential
medicines.
• Smuggling is a problem particularly in Central America,
Bolivia and Peru. For instance, in Bolivia a fifth of the
commercialized drugs come from the smuggling of
pharmaceutical products.
• The highest proportion of the out-of pocket expenditures is
for pharmaceutical products.
1. Health Systems
Introduction
Comparison of Health Care Systems in Latin America with a Focus on the
Pharmaceutical System
Karla Hernández-Villafuerte1
Latin America countries are usually classified as a unique group in terms of the
characteristics of their healthcare system and pharmaceutical coverage. However, there
are important differences between the countries with complicated structures of
reimbursement.
The objective is to compare the healthcare structures of the
Latin American countries with special attention on the
pharmaceutical system.
1Economist, Office of Health Economics, 105 Victoria Street, London SW1E 6QT. Tel: +44 20 7747 8886 • www.ohe.org • KHernandez-Villafuerte@ohe.org.
3. Formularies (HTA role)
• A number of formal attempts to incorporate HTA in the priority setting process can be observed. For instance, CONITEC in Brazil, the CCA in Chile,
CRES and IETS in Colombia, CENETEC in Mexico, CONETS in Venezuela, IECS in Argentina, among others. A central role of HTA analysis is the
recommendation for the inclusion or exclusion of medicines in the essential medicine list or the reimbursement list.
• Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Paraguay, Peru and Uruguay are members of REDETSA (Latin
American Network of Health Technology Assessment).
Conclusions: Inequality in access is the common factor that emerges from the comparison. Additionally, considerable attention has been given to
establishing a formal structure of application of health technology assessment; however, the process of inclusion of medicines in the reimbursement lists
requires further advances.
First Step: A non-systematic literature review of published official sources and peer-review journals (English
and Spanish). Analysis of quantitative information from official sources.
Objective: Explore the characteristics of the health system and the pharmaceutical market in each country.
Moreover, this is the preparatory work before the implementation in the second stage of a survey that will
be applied to people involved in institutions involved in HTA and in the pharmaceutical market in their
corresponding countries.
Methodology: Two Stage Project
Second Stage future research agenda:
1. Interviews with representatives of key
government agencies responsible for the
health sector in Latin America
2. Econometric models: cluster analysis
Health Indicators: Coverage (UHC) Health Indicators: Financing
Health Indicators:
Inequality and Epidemiological Profile
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
0
50
100
150
200
250
300
350
Venezuela
Argentina
Chile
CostaRica
Brazil
Panama
Mexico
Uruguay
Ecuador
ElSalvador
Colombia
R.Dominicana
Nicaragua
Honduras
Peru
Guatemala
Paraguay
Cuba
Bolivia
PHARMACEUTICAL SALES, US$ PER CAPITA (2011)
PHARMACEUTICAL SALES, % OF HEALTH EXPENDITURE (2011) (secundary axis)
Country Price Regulation in the Pharmaceutical Markets
Paraguay
Regulated: Through different coefficient depending if the product is produced in
the country or imported.
Ecuador Regulated: There is a limit on the profit margin.
Honduras Regulated: There is a limit on the percentage of gross profits.
Brazil Regulated: Price-fixing (Drug Market Regulation Council- CMED)
Colombia
Regulated but with different levels: 1) Direct regulation: Maximum price. 2)
Regulated Freedom: There are established criteria and methodologies to
determine the prices. Drug markets with high market concentration. 3) Freedom
under Surveillance: The manufacturers define the price freely, but they must inform
the authorities about any variation.
Nicaragua Regulated
Argentina No regulation. Sale prices are set according to market demands.
Venezuela
Mix System: Only the prices of the essential medicines are regulated (essential
drugs accounted for around 35% of total pharmaceutical sales in 2010).
Bolivia
Freedom under Surveillance: the manufacturers and importers define the price
freely, but they must inform the authorities.
Chile Free Market
Costa Rica Free Market
El Salvador Free Market
Guatemala Free Market
Mexico Free Market
Panama Free Market
Peru Free Market
DominicanR. Free Market
Uruguay Free Market
Pharmaceutical Sales
0.69
2
0.69
0.22
0.83
0.38
0.8 1 0.87 0.69
1.4 1.2
0.49
1 0.85 1.1 0.89
0.14
1.1
7.5
18.9
9.2
5.3
11.2
6.6
2.6
15
10.3
6.3
15.3
11.5
7.2
11.9
8.5
12.4
9.3
3.9
8.5
0
2
4
6
8
10
12
14
16
18
20
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Argentina
Bolivia
Brazil
Chile
Colombia
CostaRica
Cuba
DominicanR.
Ecuador
ElSalvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Uruguay
Venezuela
Maternal mortality ratio (per 1000 live births) (2010) (Second Axis)
Neonatal mortality rate (per 1000 live births) (2012) (second axis)
Immunization, measles (% of children ages 12-23 months)
Births attended by skilled health staff (% of total) (Last Available Data)
0
200
400
600
800
1000
1200
1400
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Argentina
Bolivia
Brazil
Chile
Colombia
CostaRica
Cuba
DominicanR.
Ecuador
ElSalvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Uruguay
Venezuela
Out-of-pocket health expenditure (% of total expenditure on health) (2011)
Health expenditure, public (% of total health expenditure) (2011)
Health expenditure per capita (current US$) (2011)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0%
10%
20%
30%
40%
50%
60%
Argentina
Bolivia
Brazil
Chile
Colombia
CostaRica
Cuba
DominicanR.
Ecuador
ElSalvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Uruguay
Venezuela
Percentage of all NCD deaths occurring under age of 70: Male (2010)
Cause of death, by communicable diseases and maternal, prenatal and nutrition conditions (% of total) (2008)
Gini coefficient (last data available) (secondary axis)