Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, SESSTIM, UMR 912 Inserm, IRD, Aix-Marseille Université, 27 boulevard Jean Moulin, 13385 Marseille, France; Centre de Recherche, Médecine, Sciences, Santé, Santé mentale, Société, CERMES 3, UMR 988 Inserm, CNRS, EHESS, Université Paris 5 Descartes, 7, rue Guy Môquet, 94801 Villejuif, France.
Laboratoire SPHERE, UMR 7219, Université Paris Diderot, bâtiment Condorcet, case 70935 rue Thomas Mann 75205 Paris cedex 13, France.
Soc Sci Med. 2017 Aug;187:243-250. doi: 10.1016/j.socscimed.2017.03.059. Epub 2017 Mar 28.
New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity.
新型强效丙型肝炎药物可以治愈这种疾病，但由于价格过高，正在破坏非洲和欧洲国家的医疗体系的稳定性，因此并未广泛普及。本文以 2013 年法国和喀麦隆的丙型肝炎治疗准入为例，分析了药品配给与卫生系统近期转型之间的关系。借助在巴黎和雅温得进行的民族志观察和访谈，从患者、协会、卫生专业人员和公共卫生专家的角度分析了获得这些治疗方法的情况。在喀麦隆，配给是通过各种社会经济限制层层实施的，而且没有患者组织倡导丙型肝炎治疗。在法国，丙型肝炎治疗的准入问题已经政治化，集体动员谴责配给是对全民社会保障承诺的威胁。在这项研究中，我们在结构调整的背景下考察了非洲在配给方面的长期经验，并汇集了法国和喀麦隆的经验。本文通过记录稀缺性的社会和政治构建，分析了医疗体系药物化现象，即医疗体系中越来越多地使用药物，这表明在药物丰富的情况下，药物化是一个经常被使用的概念，而对配给的平行分析则凸显了一种药品经济学，它根据稀缺经济来塑造公共卫生辩论和政策，尤其是在紧缩时期。
