Fallas de mercado del plan obligatorio de salud en medicamentos, 2005 - 2015 en Colombia

Abstract

The Economics of Social Protection includes several scenarios to understand the distribution of economic resources that are used to insure against social risks that a population is exposed to. From microeconomics arise elements of great importance, such as the exchange of goods and services or the role of different market agents and are fundamental in the concepts of cost and benefit for decision making, cost as the value of resources to which we must resign and the benefit as the maximum amount that is willing to pay. The context of social determinants, such as population growth or the aging of the population, becomes a key element because they can influence the income received by households, income that is part of the necessary resources that guarantee the functioning of insurance of Social Protection. There are multiple scenarios, but the one of interest for this research is the market failures of health insurance, from which, the different factors that promote them in a particular good are identified, such as medicines and their availability in the pharmaceutical market. The particular interest in medicines is due to the enormous public expenditure that impacts on health systems and has led to difficulties in their availability, a situation that merits structural reforms by the State due to market failures, and which ultimately do not satisfy the needs of the population. Elements such as price and quantities available are another key factor to study the demand of the pharmaceutical market and see how one variable behaves according to the other when the others remain constant. Health insurance guarantees access to a certain number of essential medicines, the question is whether they are sufficient according to the real needs of people who may have an alteration in their welfare state. The objective of this paper is to identify the main factors that promote the market failures of the Obligatory Health Plan - POS - medicines from 2005 to 2015 in Colombia. The main justification is focused on the regulation of article 15 of the Statutory Law that determines the abolition of the POS with certain exclusions. In the Theoretical Framework contemplates several concepts of health and pharmaceutical market and the types of market failures that occur most in the health system. The study design is quantitative through economic and descriptive analysis, based on the retrospective information of the SISMED Drug Price Information System in the period 2006 to 2015. The results are described in different graphs that illustrate the highest cost in those NO POS medications, among other aspects such as the preference for those commercial drugs or a distinctive brand, in turn considered NO POS and often covered by legal actions such as guardianship. Likewise, other comparison data are obtained, such as the Gross Domestic Product and the percentage involved in pharmaceutical expenditure that is ultimately used as a reference to analyze the out-of-pocket expenses and the level of impact of Colombian households. Finally, there is a discussion of all the results found based on the market failures of information asymmetry, monopolies and externalities, brief review of the degree of economic efficiency of the coverage of POS drugs and ending with the conclusions that invite reflection on pharmaceutical expenditure and the methodological structure by means of which efficient access should be guaranteed to drugs prescribed by a medical professional.