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Preface
Introduction
Economic development
Systems analysis
Contextual Factors Which Influence a National Pharmaceutical System
The actors in the pharmaceutical systems
Health care professional groups
Drug producers
Drug control
Patients and their organizations
Evaluations
Deciding about the aim of the evaluation
The identification of the system and its goals
The identification of the evaluation dimensions and the decision on how to measure these dimensions
The collection of data
The summary of the results and the formulation of conclusions
Social constructionism and social representation theory
The actor-spectator paradox
The decision-making processes in the drug system
How attitudes and beliefs change - the balance model
Summary of the chapter
References
A historical perspective of drug research and diffusion
The period of folk medicine
The merchant period (1500 AD to the end of the eighteenth century)
The chemical period (the nineteenth century)
The animal testing period (from 1900 to the end of the 1930s)
The drug innovation period (from 1940 to 1964)
The post-Thalidomide period (1965 to present)
Future perspectives
Summary of the chapter
References
National drug policies
Efficient organization of drug support
Efficient organization of drug research
Efficient organization of drug production
Efficient organization of drug distribution
An efficient system for drug consumption
An efficient system of drug information
Choice of drugs with high therapeutic powers
Choice of drugs with few side effects
Low drug costs
How to develop and implement a national policy
Summary of the chapter
References
Planning the drug support
Patent and exclusivity policies
Trade name policy vs. generic name policy
Generic and therapeutic substitution
Generic prescribing
Drug registration
Drug reimbursement policies/national health insurance systems
The public and private drug sectors of developing countries
The primary health care policy
The essential drugs policy
Summary of the chapter
References
Drug research
Drug company strategies
Drug companies focusing on research to find new chemical substances intended for the international market
Drug companies concentrating on efficient drug chemical production (bulk production)
Companies concentrating on the marketing of non-patented ready-made drugs (generic production)
Drug companies concentrating on the marketing of drugs for self-medication
Drug companies concentrating on the sales of herbal medicines
Factors which determine the resources a drug company spends on R&D
The selection of research areas by a drug company
The research process
The project decision
The research administration after a project has been accepted
Research productivity
Ethical concerns in drug research
Summary of the chapter
References
Drug production
Background
Variations between countries
The decision regarding which drug(s) to produce
Production considerations
Marketing considerations
The organization of production lines
Production of drug raw materials
Drug quality
The principles of technical assistance support
The decision where to locate the plant
The determination of production quantities
Export decisions
Summary of the chapter
References
Drug prices, cost controls and profits in the drug industry
The price setting of raw materials
The price setting of ready-made drugs
The price setting of patented drugs
The price setting of non-patented drugs (generic drugs)
Price Competition
Cost controls
Cost control agencies which do not negotiate on drug prices
Agencies which negotiate with drug companies about drug prices and accept æreasonableÆ quotations
Agencies which negotiate about drug prices and only accept the cheapest (or a number of the cheapest) drug(s) fulfilling a specific medical need
The prices a patient has to pay in the public sector in countries which have a public distribution system
Drug prices at private pharmacies in developing countries
Drug prices at private pharmacies in developing countries
Summary of the chapter
References
Drug wholesaling and procurement
Importation
Different types of wholesale systems
How to evaluate a wholesaling system
Procurement
Summary of the chapter
References
Drug retail distribution
9.1Pharmaceutical care
The degree of formal government control of outpatient pharmacies
State owned systems
Private systems with government control of drug prices and of the locations of pharmacies
Private systems with state control of drug prices without location control
Private systems without state control of drug prices and of the locations of new pharmacies
Drug distribution aims
Short travel times to the pharmacy service
A satisfactory range of drug preparations
Convenient opening hours
Safety
Short waiting times for customers
Drug information and customer-pharmacy staff interactions
Suitable working conditions
Ethical considerations
Cooperation with other sectors of the health care system
Low drug prices in the pharmacy
An efficient organization
Summary of the chapter
References
Drug consumption
A historical perspective
Measurement of drug consumption
Sales value in monetary terms
The weight of the drugs consumed
Number of packages sold
Number of prescriptions
Number of dosages (or the number of tablets, litres of infusion solutions etc.)
Defined daily dose (DDD)
Prescribed daily dosage (PDD)
The percentage of the population using a drug
Factors which determine the volume of a drug consumed in a country
Factors found to be related to the volume of drug consumption
Time
The level of industrialization and income
Cultural and organizational factors
Factors which influence drug consumption at the individual level
Skewed distribution
Morbidity factors
Age
Sex
Civil status
Income and level of education
Role of Media
Other factors
Qualitative studies of drug consumption
Summary of the chapter
References
Marketing of drugs
Historical background
The transfer of production of raw drug materials from pharmacies to the drug industry (in Europe from the mid-nineteenth century to about the 1880s)
The selling of quasi-drug products outside the pharmacy system (in Europe from about 1880 to 1920)
The transfer of ready-made drug production from pharmacies to the drug industry (in Europe from about 1920 to 1950)
The introduction of new marketing activities (in Europe from about 1950 to 1980)
Marketing of drugs from the 1980s
The contextual factors which affect the diffusion of a drug
The marketing goals of drug companies
Factors determining what a drug company spends on the marketing of a new drug
The competitive situation
The age of the drug
The drug class
The expected effects of more commercial information
Rules of thumb
The size of the drug company
The company image
Historical factors, national culture and economy
The relative effects of different media and messages in commercial drug information to prescribers
Commercial media directed at the general public
A national perspective on commercial drug information
Summary of the chapter
References
The market structure
The international market structure
The market structure in a specific country
Summary of the chapter
References
Drug control
The definition of drug control
A process model of the drug control system in a country
The processes to ensure that each aspect of drug control complies with the necessary norms or standards
The control measures
Clinical trials
Summary of the chapter
References
Drug prescribing
Normative studies
Sociological studies
Information process studies of drug prescribing
Prescription studies based on a cognitive perspective
The non-habitual prescribing process
Therapeutic effect
Low incidence of side effects
Low drug costs
Patient convenience
Taste, smell and appearance of the drug
Documentation
The preparations available in the most frequently used dosage forms and strengths
The country of origin
The prescriberÆs company preferences
Drug availability
How standard selections change
Making a diagnosis
Placebo prescribing
Summary of the chapter
References
Patients' attitudes and behaviour
Background
Explanatory models
A process model: how a layperson deals with medical symptoms
Detection of symptoms
Symptom judgement stage
The stage of selecting courses of action
Treatment with traditional medicine and herbal medicines
OTC drugs
Patient compliance
How to measure compliance
A cognitive model of the factors which determine the degree of compliance
How to improve compliance
Summary of the chapter
References
Drug information
Background
The role of mass media
The drug information sources used
Research methods
Information about prescription drugs
Information about non-prescription drugs
Drug information from a sender's perspective
The receiver's satisfaction with the information
Message understanding
Proper use of the product
Emotional support
Attitudinal changes
Changes in knowledge
Behavioural changes
Health effects
Reduction in adverse drug effects
Satisfactory information costs
Mass media campaigns
The value problem
Summary of the chapter
References
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Pharmaceutical Systems: Global Perspectives

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