Homedes Núria, Ugalde Antonio, Forns Joan Rovira
University of Texas-Houston School of Public Health.
Int J Health Serv. 2005;35(4):691-717. doi: 10.2190/8F8L-0564-T9EN-EMP0.
Health care systems spend a relatively high percentage of their resources on the purchase of medicines, and the poor spend a disproportionate amount of their income on pharmaceuticals. There is ample evidence in the literature that drugs are very poorly used. World Bank-led health reforms aim at improving equity, efficiency, quality, and users' satisfaction, and it will be difficult to achieve these goals without making medicines accessible and affordable. The purpose of this article is to examine the adequacy of World Bank pharmaceutical policies, as recommended in various Bank documents, for Latin America and to examine the implementation of the policy recommendations. The authors found that the World Bank identified and recommended a set of pharmaceutical policies that matched the needs of the region. But, as revealed through fieldwork and a review of the literature, the recommended pharmaceutical interventions were left out of the health reforms, and most of the loans that included pharmaceutical interventions allocated funds only to the purchase of drugs. The authors formulate four hypotheses that may explain the lack of congruence between the recommended policies and the strategies financed by World Bank health reform loans to the Latin American region.
医疗保健系统将其资源的相对较高比例用于药品采购，而贫困人口在药品上的支出占其收入的比例过高。文献中有充分证据表明药品使用情况很差。由世界银行主导的医疗改革旨在提高公平性、效率、质量和用户满意度，而如果无法使药品可及且可负担，就很难实现这些目标。本文的目的是审视世界银行在其各类文件中为拉丁美洲推荐的药品政策是否充分，并审视这些政策建议的实施情况。作者发现，世界银行确定并推荐了一套符合该地区需求的药品政策。但是，通过实地调查和文献回顾发现，推荐的药品干预措施被排除在医疗改革之外，而且大多数包含药品干预措施的贷款仅将资金用于药品采购。作者提出了四个假设，这些假设或许可以解释推荐政策与世界银行对拉丁美洲地区医疗改革贷款所资助战略之间缺乏一致性的原因。
