HEALTH-ARGENTINA: One-Third of Health Budget Goes Toward Medicine

By Marcela Valente Reprint | | Print |

Marcela Valente

BUENOS AIRES, Apr 12 1999 (IPS) - A federal law in Argentina authorises physicians to prescribe generic products – no specific brand name – and pharmacists to sell customers a more affordable product than the brand prescribed.

Nevertheless, this Southern Cone country is among the top 12 countries in the world in terms of spending on prescriptions and over-the-counter drugs.

No other country in Latin America spends a higher proportion of Gross Domestic Product on health, and experts believe that widespread complaints about the system arise from the fact that purchases of medicine by the public account for 33 percent of all spending on health.

Argentina spends more per capita on medicine than any other South American nation, which has made the pharmaceutical industry one of the strongest in the region, with an annual turnover of 3.2 billion dollars.

Local and international laboratories, while locked in conflicts over patents, take a united stance against sales of generic remedies, Dr. Gines Gonzalez Garcia, one of the sponsors of the law on generic medicine and author of the book “Political Remedies”, told IPS.

Gonzalez Garcia, the president of the non-governmental organisation Isalud, said a high rate of pill-popping was not an indication of development. Rather, the contrary is true, he added.

Although Argentina’s 35 million inhabitants take 13 million pills a day, “25 million take remedies in an exaggerated manner, while the remaining 10 million have little or no access to medicine,” he pointed out.

The original draft law on sales of generic medicine would have obligated physicians to prescribe drugs by their scientific names, to allow the patient to decide which brand to purchase.

But lobbying by the powerful pharmaceutical industry led to changes in the law, which in the end authorised doctors to recommend specific brands.

The choice can be between 30 or more brands, and prices vary enormously. A study released last month by the Secretariat of Industry indicated that the gap between the prices of antiinflammatory remedies or analgesics produced by different laboratories on the basis of the same generic product was as wide as 553.5 percent.

Thirty-eight different brands of the frequently used antibiotic ‘amoxilicina’ are sold, for example, with the price for the same dose ranging from six to 13 dollars. In the case of ‘bromaxepan’, 20 different packages are available, with the cost ranging from 2.20 to 16.20 dollars.

Only 33 percent of the affiliates of the country’s second- largest health services provider (IOMA) know what generic medicine is, and almost none of them ask for the generic product, tending instead to buy the brand prescribed by their doctors, according to a recent survey.

Gonzalez Garcia maintains that patients come out of 90 percent of visits to the doctor’s office in Argentina with a prescription in their hands.

That tendency, added to the growing levels of self-medication and over-the-counter sales – which have soared in recent years as supermarkets have been licenced to sell remedies – has led to a high level of demand.

The law on generic medicine, passed in the province of Buenos Aires in 1989 and later applied in other districts, began to be applied at a nationwide level in 1992. But by authorising physicians to recommend specific brands, the sought-after effect was minimised.

Rather than pulling prices down as intended, the law ended up being silenced by the pharmaceutical industry, which spends more – according to Isalud – in marketing brands among physicians than in developing new active ingredients.

Only two percent of pharmacies replace the brand prescribed with more affordable products and apply other measures suggested by the law, such as setting a reference price, according to which health insurance polices pay an average price, and patients who want a more expensive brand pay the difference.

Physicians, pharmacists and patients believe that prescriptions, rather than economic and social development, are the chief promoters of health and well-being, said Gonzalez Garcia.

“Prescribing is the most frequent, widespread and ‘natural’ medical practice,” criticised the expert, who warned that doctors “don’t prescribe, but sell brands of medicine.

“Until just a few years ago, generic names were the only names of medicines,” said Gonzalez Garcia. He pointed out that in medical school, students learned the universal nomenclature of the basic remedies.

“It is the need of the industry, not demand, which gives rise to so many invented names,” he added.

In the United States, a country with a high level of consumption of medicine, there are 19,000 generic products and 60,000 choices on the shelves, said Gonzalez Garcia.

But the case of Norway demonstrates that there is not necessarily a correlation between a high level of economic development and a wide variety of brands. In the Scandinavian country, there are 1,000 generic products and only some 2,000 choices of products.