발간보고서

home > 자료실> 발간보고서

HEALTH STATUS AND MEDICATION CONSUMPTION IN ECUADOR

HEALTH STATUS AND MEDICATION CONSUMPTION IN ECUADOR : 작성자, 카테고리, 작성일, 조회수, 원문,출처, 정보 제공
작성자	관리자	카테고리	전문가 인사이트
작성일	2016-01-12	조회수	3,705
원문
출처

글 Esteban Ortiz-Prado: GPKOL위원

학력사항

2009 University of Calgary / Medical Science(MS)
2005 University of Ecuador / Medicine(MD)

경력사항

2013-2015 Manager, R&D department, ENFARMA
2012-2013 Senior Adviser, Minister of Higher Education
2011-2012 Clinical Research Coordinator, Tom Banker Cancer Centre
2006-2010 Research Associate, Department of Radiology University of Galgary

세부 전문분야 및 컨설팅 내용

R&D Planning : I worked until august 2015 as the manager or director of the R+D of the only government owned pharmaceutical company in Ecuador
Clinical Trial : I directed the first vaccine clinical trial lead by the government of Ecuador for the pentavalent vaccine
GMP, GCP and Regulatory Affairs : All the regulatory needs in order to register a new product, homologation for Korean products and experience rebuilding the vaccine facility in Ecuador
Project management : All the necessary experience for Drug discover, Project management, Research Team building, Scientific writing for grants competition and academic diffusion, Carry out clinical trials (Phase I-IV), Offer higher recommendations , Conferences and academic events organization, Regular capacitation’s, Regulatory affairs

Table of Contents

ABSTRACT

INTRODUCTION

METHODOLOGY

RESULTS

CONSLUSIONS

REFERENCES

ABSTRACT

This is an analysis intended to determine the possible relationship between access to health systems and drugs with the socio demographic characteristics from a dataset of the entire Ecuadorian population.
The data was obtained from the Ecuadorian National Statistics Databases (INEC) as well as other scientific, institutional, technical-administrative and economic datasets available regarding the Ecuadorian and regional pharmaceutical market through profound PubMed and Ovid scientific information search.

Families who are in the lowest percentile of poverty spend more out of pocket money purchasing pharmaceutical drugs than wealthier families. Furthermore, lowest deciles (1-3) have no other access to private health coverage. On the other hand, the supply of health of both the private and public sector is inequitable according to geographical localization. In consequence, populations from biggest cities have more access to health care services than population located in rural areas.

Health is a right enshrined in the Ecuadorian Constitution. Despite of the great efforts of the current government, health access remains uneven in respect to drugs access and the intended out of pocket expenses per family. It demonstrates that interference on capital has improved access to health of Ecuadorians.

INTRODUCTION

Health access is a basic right of Ecuadorian population, enshrined in the Ecuador's Constitution and in the Organic Health Law (1,2). This human right must be essential for the whole population irrespectively of their economic situation or geographical localization.

Statistics demonstrate that Ecuador has markedly increased its social investment during the last years compared to previous governments (Fig.1).

The mentioned social investment has reached historic levels concerning issues like social care programs, malnutrition care, and catastrophic diseases, among others managed by the Public Health Ministry (MSP). Current government's social investment is intended to the enforcement of health public policies to attend its population health needs, and mainly to guarantee that every citizen has access to high quality health and drug services.

The Ecuadorian health system is similar to the systems from the other countries of the region; in which, the government finances most of the public services. In consequence, a major percentage of the population uses public services and only a 10% uses private health care (3–5).

Moreover, the government's Integral Public Health Network (RPIS) serves or should serve to the 90% of Ecuadorian population regardless of its geographic localization (6). Even though the government theoretically invests in health care to protect the 90% of people through RPIS, drug access is not equitably distributed in the population. Ecuadorian homes pay for the 55% of the total spending in health, central government pays the 19%, the social security pays the 9%, and the private entities, local governments, and army pay the resting 17% (7). In this respect, it is fundamental to be acquainted of the demographic and economic factors that influence on health care services access.

METHODOLOGY

An observational descriptive study was performed searching scientific information in Pubmed, Ovid and Google Scholar databases, in order to obtain data concerning local, regional and worldwide pharmaceutical market and the health investments. Additionally, we reviewed data from the National Survey of Household Income and Expenditure in Urban and Rural Houses (ENIGHUR) realized by the Ecuadorian National Statistics Databases (INEC), the International Marketing Services (IMS), data from the Public Drugs Company (ENFARMA EP) and the Public Health Ministry (MSP).

Data were digitally stored in an Excel spreadsheet from the Microsoft Office® program. Descriptive statistics were analyzed in Sigmaplot 10 version and bibliographic references were managed with Zotero 4.0.11 version.

RESULTS

Herein we represent the most important findings from variables related to economical incomes and some socio-economical indexes, including health and drug access in Ecuador.

DOMESTIC DEMAND FOR PHARMACEUTICAL DRUGS Domestic demand for drugs is determined by medical prescription in private services, by the Integral Public Health Network (RPIS) and by people who purchase prescription and nonprescription drugs (self-medication).

Several factors influence on the domestic demand of medicines such as drugs price, incomes level of population, drug acquisition mechanisms, structure from offers, drug access regulation, management and drug use related to the epidemiological profile of the society (2,6,8).

Thus, it is necessary to analyze if drugs acquisition is in accordance with the epidemiological needs and the medical guides adopted by the health authorities.

According to data from the Central Bank of Ecuador (BCE) the pharmaceutical budget of the government has increased in 55% during the last 5 years (9). In addition, the pharmaceutical market raised to 1100 million US dollars, which represents an annual expenditure per capita of $ 74 (8,10). Concurrently, as reported by the BCE, Ecuador spent $ 362 per capita in health care. Hence, the $1100 million of the pharmaceutical market represents more than 20% of the government health investment (10,11). This amount is twice the percentage that Suiza invests in drugs (12). The amount of drugs sold in Ecuador has raised exponentially due not only to a higher government investment, but also to an increase in the purchasing power of Ecuadorian people.

Nonetheless, the drugs sold are not in accordance with the epidemiological profile of the population. For instance, Ecuador has bought more than 36 million of units of infant formula milk since 2006 to 2011, which represents approximately $ 300 million (10).

Prescription and nonprescription drugs sales during 2010 and 2011 reached high ciphers. During this period of time, Atorvastatin (Avastin®), a medicine used to treat hypercholesterolemia became the most sold drug in Ecuador. Moreover, the nonprescription drug with the highest sales level was an anti-inflammatory, Naproxen Sodium (Apronax®)(8,10).

On the other hand, chart 2 shows most prevalent diseases in Ecuador from 2001 to 2011, being the post prevalent the maternal and perinatal diseases and the digestive system diseases, which are not in concordance with the most marketed drugs during 2010 and 2011.
The most marketed prescription drugs during 2010 and 2011 are not completely related to the ten most prevalent diseases from 2001 to 2011. These drugs comprehend medicines for Cardiovascular, Infectious and Parasitic, Neoplasms, Respiratory Tract and Digestive System Diseases. Nonetheless, maternal and perinatal diseases, diabetes, tropical diseases, and nutritional deficiencies are not attended by these drugs (Fig. 2).

Remarkably, the most marketed nonprescription drugs during 2010 and 2011 are not congruous with the ten most prevalent diseases from 2001 to 2011. Nonprescription drugs are only direct to three of the most prevalent illnesses: digestive system diseases, respiratory tract diseases, and nutritional deficiencies (Fig. 3). Comparing prescription with nonprescription drugs, the last ones are the least concordant with the epidemiological profile of Ecuador.

ACCESS TO HEALTH CARE SERVICES

As a matter of fact, urban areas have greater supply of health services including data such as the number of doctors and beds per 10,000 people.

Altogether, the data form INEC, WHO, World Bank and MSP demonstrate that although in Ecuador the number of doctors and hospital beds per person have increased considerably, we have not reached yet the minimum desired (Fig. 4) (11,16).

Ecuador being a small country, with approximately 16 million inhabitants distributed in 24 provinces; has deficiencies in the health care system at regional or provincial level. Indeed, Ecuador has a total average of 0.6 beds per 1000 inhabitants, whereas the minimum standard average is about 1.9/1000 (16).

A fundamental fact is that Ecuador has about 15 doctors per 10.000 people. There is no a prescript standard worldwide, but European countries have 35 doctors per 10.000 inhabitants in contrast to African countries, which have 2/10.000 inhabitants(11,16).

NATIONAL EPIDEMIOLOGY

Epidemiological data in Ecuador are represented in the data system from INEC. However, we consider that some of them are not accurate enough due to a lack of methodologies standardization for data collection. For instance, when a patient dies because of traumatic brain injury, frequently the first improper diagnosis is cardiopulmonary arrest. In consequence, statistics and data analysis are altered by this imprecise diagnosis.

Considering imprecisions above mentioned, the data demonstrate that main causes for hospital discharges are parturition attention and digestive tract diseases (Fig.8) (17).

On the other hand the main mortality causes are Diabetes Mellitus
Type II and Hypertensive Disease and its consequences (Table 4).

The data analysis shows some differences between public and private medical attention. In first place, public service seems to receive more abortion and pneumonia cases than private service. In contrast, arterial hypertension and abdominal pain may be the most frequent cases in the private health service compared to the public service. The mentioned data suggest that patients with severe prognosis attend to public services irrespectively of their economic condition. On the other hand, patients with no severe prognosis attend to private services because they would not have been attended in the public sector

From the point of view of public health, poverty in Ecuador remains a risk factor for infectious diseases, accidents and injuries; whereas, diabetes and hypertension seem to affect the population irrespectively of their economic status.

MEDICINES PURCHASING ACCORDING TO NATIONAL EPIDEMIOLOGY. Ortiz-Prado et al. reported that the pharmaceutical market in Ecuador is about $ 1,200 million dollars (8), which compared to other markets, should maintain a direct relationship between the national epidemiology and the public and private expense (18,19).

Considering this basis, we studied the behavior of the public and private market health to determine what are the drug expenses of the government and the private services used for.

The pharmaceutical products which most money generated from 2006 to 2011 are shown in Figure 7.

Disaggregating these data we found differences between the amount of drugs acquired by the government and the drugs acquired by the private service in pharmacies in Ecuador (10). The public health service spent more than $ 214 millions of dollars in the 10 most sold drugs in Ecuador since 2006 to 2011 (Fig. 8). Most of these drugs are oncologic, which are purchased to treat different cancer, and the second most sold drugs are used to treat chronic diseases.

In respect to drugs units, most of the public service demand consists of antibiotics, intravenous rehydration solutions, ant parasitic, and contraceptives, among others (Fig. 9).

The private sector in Ecuador buys mostly popular medicines, which do not require medical prescription such as vitamins, non-steroidal anti-inflammatory drugs (NSAID's), analgesics, and hepatic protectors (Fig. 10.)

Nonetheless, contrary to the relation units/USD, when we analyzed the drugs by units, the most sold products are vitamins, NSAID's, and analgesics (Fig. 11).

CONSLUSIONS

Ecuador is a small country whose demand for pharmaceutical products is intended to satisfy the needs of the public and the private market. However, even though the state is the main trading partner of the industry, the expenses in millions of US dollars satisfies only a reduced past of the population according to epidemiological statistics of this country.

The number of doctors and beds available depend on the province of residence. Besides of this variation, in Ecuador none province has 1.9 beds per 1000 population as recommended by the WHO.

The vast majority of high-cost medicines, specifically designed to treat a variety of cancers or catastrophic illnesses are acquired by the public sector, which evidences that even wealthier families attend to the public services when they present a catastrophic disease.

Public hospitals treat more patients from infectious diseases and acute conditions. In the private sector are, some of these illnesses are treated as well, but they treat other diseases that are not catered in the public sector.

Figure 1 Social investment in Ecuador. Source: BCE, MSP, Blue (health expenditure, yellow, Social Expenditure, Grey Health/social expenditure

Figure 2 Public Health System, modified from Economic Politics Coordinator Ministry, 2012.

Table 1 Most marketed drugs in Ecuador from 2010 to 2011. *It is understood by “most marketed drugs”, the drugs sold the most in US dollars in all dosage forms established, according to the data obtained in pharmacies. Source: IMS 2011(20)

Table 2 Disease status in the last 10 years, source MoH of Ecuador 2014.

Table 3 Relationship between most marketed prescription drugs and most prevalent diseases in Ecuador, 2010-2011.

Figure 3 Relationship between most marketed prescription drugs and most prevalent diseases in Ecuador, 2010-2011.

Figure 4 Number of Beds per province in Ecuador

Figure 5 Number of hospital beds per 1000 inhabitants and poverty relationship. Analysis by Ecuadorian provinces in 2012. NBI: Unsatisfied Basic Needs. Source: INEC

Figure 6 Hospital mobility in Ecuador for 2011-2013

Table 4 Mortality in Ecuador, 2011

Figure 9 Most sold Drugs by Units in the Public Health Service in Ecuador.

Figure 10 Most sold drugs in the Private Sector in Ecuador (USD)

Figure 11 Most sold drugs in the Private Sector by units in Ecuador.

REFERENCES

Asamblea Nacional. Constitución Ecuatoriana del 2008. 2008.
MSP. Ley Orgánica de Salud. 2010.
Maceira D. Cuadrantes de Análisis en los Sistemas de Salud de América Latina. Buenos Aires [Internet]. 2012 [cited 2014 Sep 13]; Available from: http://v8000313.ferozo.com/wp-content/uploads/2014/07/Maceira-Unicef-LAC.pdf
Giedion Ú, Villar M, Ávila A, Estudios FM. Los Sistemas de Salud en Latinoamérica y el papel del Seguro Privado [Internet]. Fundación Mapfre; 2010 [cited 2014 Sep 13]. Available from: http://fundacionmapfre.com/ccm/content/documentos/fundacion/cs-seguro/libros/los-sistemas-de-salud-en-latinoamerica-y-el-papel-del-seguro-privado.pdf
Martínez S, Carrasquilla G, Guerrero R, Gómez-Dantés H, Castro V, Arreola-Ornelas H, et al. Cobertura efectiva de las intervenciones en salud de América Latina y el Caribe: métrica para evaluar los sistemas de salud. Salud Pública México. 2011;53:s78–s84.
Malo M. Reforma del Sistema de Salud del Ecuador: hacia el fortalecimiento de la APS. 2013.
León M. Financiamiento de la salud en Ecuador [Internet]. MCPE; 2011. Available from: http://www.orasconhu.org/ckfinder/userfiles/files/003-CASE-Mauricio%20Leon.pdf
Ortiz-Prado E, Galarza-Maldonado C, Cornejo, L, Ponce. Acceso a medicamentos y mercado farmacéutico en Ecuador. Rev Panam Salud Pública [Internet]. 2014; Available from: www.paho.org
Banco Central del Ecuador [Internet]. 2013 [cited 2013 Dec 23]. Available from: http://www.bce.fin.ec/frame.php?CNT=ARB0000841
IMS. Intercontinental Marketing Services Health (IMS Health - Intelligence Applied). El mercado farmaceutico Ecuatoriano. 2011.
The World Bank. Ecuador, data per country [Internet]. IBRD-IDA; 2014. Available from: http://data.worldbank.org/country/ecuador
Pavic M, Pfeil AM, Szucs TD. Estimating the Potential Annual Welfare Impact of Innovative Drugs in Use in Switzerland. Front Public Heal [Internet]. 2014 May 20 [cited 2014 Sep 2];2. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033008/
INEC. Encuesta Nacional de Ingresos y Gastos de Hogares". 2014.
Delgado J, Ramirez-Cardich ME, Gilman RH, Lavarello R, Dahodwala N, Bazán A, et al. Risk factors for burns in children: crowding, poverty, and poor maternal education. Inj Prev. 2002;8(1):38–41.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2013;380(9859):2224–60.
Organization WH, UNAIDS. Estadísticas Sanitarias Mundiales 2010 [Internet]. World Health Organization; 2010 [cited 2014 Sep 14]. Available from: http://books.google.com.ec/books?hl=en&lr=&id=1_R8e1h6UP8C&oi=fnd&pg=PA1&dq=Personal+sanitario,+infraestructura,+medicamentos+esenciales+&ots=Jz2_KkYBzk&sig=fe1Flu5noZZUwGdINSnv1ZSipG4
INEC. Ecuador en Cifras. Anuario de Estadisticas Hospitalarias: Camas y Egresos 2011 [Internet]. 2011. Available from: www.inec.gob.ec
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. The Lancet. 2002;360(9343):1347–60.
MAjOR ATS. Comparative quantification of health risks. 2004 [cited 2014 Sep 14]; Available from: http://whqlibdoc.who.int/publications/2004/9241580348_eng_Volume1.pdf

- 끝 -

제약산업정보포털

인기검색어 TOP 10

전체메뉴

자료실

발간보고서

HEALTH STATUS AND MEDICATION CONSUMPTION IN ECUADOR

관련기관 배너모음