Abstract
The 3rd Latin American and Caribbean Congress on Health Economics took place at Havana Convention Center from 28th to 31st October 2008. The conference was an excellent opportunity for the exchange of personal encounters regarding health economics and its related disciplines from the perspectives of research, teaching and management. Specialists from mostly Latin American countries attended the event. High-ranking specialists from other countries highlighted the importance and popularity of the conference. A total of 313 delegates from 23 countries were present at the congress, 160 of whom were Cuban.
The 3rd Latin American and Caribbean Congress on Health Economics covered a broad range of health economics topics. Presentations were classified into three groups:
• Lectures presented by personalities
• Round table presentations from experienced specialists
• Delegate-selected papers
The conferences included those presented by JR Balaguer and JL Rodriguez, Cuban Ministers of Public Health and Economics and Planning, respectively. G Therborn, Professor at the University of Cambridge, UK, G Lopez-Casanova, President of the International Health Economics Association and G Gonzalez, President of the Latin American and Caribbean Health Economic Association, also presented lectures.
In addition to the scientific program, three precongress courses were hosted at the National School of Public Health. O Mujica (Pan American Health Organization) chaired a course on ‘Health Socioeconomics Inequities’ and J Rovira (University of Barcelona, Spain) organized two courses on ‘Health Technologies Economic Evaluation applied to Decision Making and Simulation of Intellectual Property Rights on Drugs Prices and Accessibility’. Also, the following special meetings were held in the Conventions Center: Latin American and Caribbean Health Economics Association, Master in Health Economics Graduates and Professors Encounter and the National Regulatory Agencies Task Force on Economic Regulation Meeting.
Conference themes
Public health: planning, financing & decision-making
In the round table session ‘Regulation and Criteria Setting for National Packages and Pharmaceutical Policies’, L Niessen (Johns Hopkins School of Public Health, USA/East Anglia University, UK), F Paoluci (Australian Centre for Economic Research, Australia) and R Pérez Cristiá (Medicines Regulatory Authority, Cuba) focused their presentations on health programs and priority settings related to new treatments and drugs in Cuba and countries in the Organization for Economic Co-operation and Development. The importance of resource limitations and the increasing role that the State plays in healthcare were established. However, in many countries, health coverage is not complete and the State is not able to assume this responsibility. Health insurance introductions were analyzed. It was noted that it is necessary for a combination of population needs, the interests of providers and government responsibility to face health problem identification and financing.
An important session covered the topic ‘State Role in Public Financing and Healthcare Planning’. The ‘Health Economics Intervention in Uruguay’s Health System Reform’ was presented by I Oreggioni (Ministry of Public Health, Uruguay). It was demonstrated that both health assistance and financing models were introduced. MA Domingues Ugá (Osvaldo Cruz Foundation, Brazil) presented on the Brazilian health system financing situation. Health provision in Brazil is 60% private and health expenditures are very low at only 3.4% of gross national product. Data presented by R Castiñeiras (National Institute of Economics Research, Cuba) demonstrated that health, education, food, employment, culture and other social issues are included in the Cuban Social Model, based on political will and state planning and financing.
The primary healthcare in three Latin American countries was discussed. A Palacios (Ministry of Health, Chile) presented on the use of health satellite accounts in Chile, which are based on an information network. C Sanabria (Major National University of Saint Mark, Peru) presented primary healthcare in Peru, measured using expenditures classified data. These countries are facing a fragmented health system, which means that, even with growing gross national product, health financing is not increasing. Finally, P Bivona (Central Bank, Paraguay) presented an exercise linking the standard of primary healthcare with life cycle.
The last topic in this theme was the presentation of the ‘Observatory in Health: Latin American and Caribbean Initiative’. Its objective is to build a regional analysis group involved in health assessment development and promotion. FM Knaul (Mexican Health Foundation, Mexico) and colleagues from Mexico and Colombia presented examples in four topics: financial protection, health accounts, effective coverage and human resources.
Health economics efficiency
In the scientific session on ‘Public Health System Efficiency’, MH Lima (Brazil), R Mendes (Brazilian National Bank for Economic and Social Development, Brazil) and A Schweiger (Association for Health and Economics, Argentina) presented experiences from Brazil and Argentina regarding the registration of hospital costs. They highlighted techniques used for determining direct and indirect cost distribution in hospitals in each of their countries. They also discussed difficulties in the trade-off between using resources and the achievement of projected goals.
National account methodological issues were summarized in the session – titled ‘Health Satellite Accounts: Advances in America’, previous to the presentation of ‘Satellite Accounts as a Tool for Policy Building’. Experiences were presented regarding sources used to determine healthcare expenses.
In the round table session of ‘Economic Evaluation of Health Promotion’, M Pinto (National School of Public Health, Brazil) presented an economic evaluation of illness related to tobacco consumption cancer from two specific perspectives: hospital care and chemical therapeutics. Furthermore, AM Galvez (National School of Public Health, Cuba) provided information concerning the elaborate process of a methodological guide for the economic evaluation of health promotion.
An important session discussed the ‘Economic Effect of Digital Radiology’. It was demonstrated that this technology reduces radiology costs in comparison with traditional approaches. It also improves the quality of care owing to the decrease in patient waiting times and improvements in diagnostic quality. The most remarkable characteristic of this technology is that no films are necessary, so productivity is increased.
In the scientific session on the ‘Economic Evaluation of Health Technologies’, it was pointed out that the management of technological policies has an important socioeconomic effect. It is important to maximize health, while taking into account the availability of resources, in order to assure equity. In current conditions, regulatory agencies are required. Difficulties in the assessment of changes in social costs relating to the introduction of health technologies were analyzed. In particular, informatics and communications technologies have been associated with decreasing costs and better patient care. More accurate drug prescription, improving information and higher quality treatment proceedings are among the most positive effects achieved.
Health socioeconomic subjects
Experts from Mexico, Chile, Brazil and Cuba participated in the session on ‘Latin American and Caribbean Health Inequities’. Presented topics include reproductive inequities in Mexico between 2003 and 2006, labor market and health service offers, utilization and financing in Brazil, assignment of resources for healthcare integration and social determinants of elderly people’s health status in Chile, inequities in Argentina’s health system and Cuban experiences related to the social management of teenage sexual and reproductive health.
Human resources training & competency in healthcare
Specialists from Uruguay, Venezuela, Brazil, Norway and Cuba agreed on the statement that human resources are essential in healthcare systems. There was also an agreement on the importance of achieving accessibility to 100% of healthcare workers in order to allow the use of updated tools and normative intended for productivity increase in planning human resources in the health sector.
Economic regulation & health technology assessment
This topic was presented as a ‘Scientific Journey’, sponsored by the Pan American Health Organization, the National Health Surveillance Agency (Brazil) and the Medicines Regulatory Authority (Cuba). Some of the most important topics analyzed are described in the following sections.
Drug price regulation
Experts from Brazil and Cuba presented experiences in international drug price comparisons, team work and the emphasized role of clinical assessment in price records. The seminar on ‘Drugs Economic Regulation’, organized by the Brazilian National Health Surveillance Agency, was mentioned and it was suggested that economic regulation should also be extended to health service technologies.
Policies of drug price & reimbursement
J Espín (Andalusian School of Public Health, Spain) presented on the topic of European pharmaceutical policies. Differences in drug prices and consumption levels among countries were mentioned. The goal was to assess drug price policies and reimbursement in the EU in relation to expense control and patient accessibility. Rovira discussed the conditions and challenges of price and reimbursement policies in Latin America, linked to the globalization of intellectual property rights and market monopolization. It is necessary to introduce accessibility policies and price control. The problem with exclusivity of products and steps that could reduce it, such as intellectual property management and compulsory licenses, were emphasized. Cuban drug prices and accessibility policy were presented by C Lara (Center for Pharmacoepidemiology Development, Cuba). Drug prices are subsided by the Cuban State. J Fitzgerald (Pan American Health Organization) presented the case of antiretroviral price negotiation between Latin America, Caribbean countries and pharmaceutical companies. As a result, drug prices have decreased. However, there are still varying prices for antiretroviral treatment among countries; therefore, new strategies must be developed in order to lower these prices.
Patents & drugs accessibility project
Rovira presented a patents and drugs accessibility project and simulation model that is useful for decision-making. However, more studies regarding this tool are necessary. References to the international drugs market and prices within countries were also presented. G Hernandez (National University, Costa Rica), D Guzman (Plenitud Foundation, Dominican Republic) and M Cortes (Colombia) presented their experiences in the use of the simulation model in their respective countries.
Public health, innovation & intellectual property rights in America
Innovation and intellectual property accessibility were analyzed as a component of the regional perspective of global strategy. Opportunities and challenges in the implementation of the Latin American strategy and the role of regional stakeholders were discussed. Specifically, technology transfer to practice in the region is ready to take advantage of potentialities and the joint efforts of regional countries.
Conclusion
The 3 days of intensive work left the attendees and organizers worn-out but satisfied. The next goal is to meet again in Santiago, Chile, where the fourth Congress will be held.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.