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Intolerable inequality

Healthcare authorities must avoid differences in the administration of costly pharmaceuticals

Associations of patients and of physicians agree that the reductions to healthcare budgets, and the cutbacks that hospitals have found themselves obliged to implement, have been causing restrictions in the administration of certain high-cost medications, such as some palliative oncological pharmaceuticals, the new treatment against hepatitis C, and the new breed of oral anticoagulants. Patients’ associations also complain of delays in the implementation of new — and costly — treatments. Certainly, in the context of the economic crisis our country is going through, the introduction of new treatments poses a heavy challenge for the public healthcare system. But dealing with this difficulty should in no case involve arbitrary restrictions, due to economic causes, on medications which have been shown to be effective or result in unacceptable situations of comparative grievance.

The case of hepatitis C is paradigmatic. Infection by this virus causes damage to the liver, which may give rise to cirrhosis and cancer. The new treatment for this infection lasts between six months and a year and costs 30,000 euros, but raises the cure rate from 45 to 75 percent of the patients treated. In Spain it is estimated that there are some 900,000 people infected by the virus and who could benefit from this treatment. The sooner treatment begins, the better. The specialists recommend treatment starting with grade 2 of fibrosis, but most hospitals do not authorize it until an advanced phase of liver damage has been reached. The result is an intolerable inequality between patients in adjacent regions, and even between patients in two hospitals of the same city. These divergences are unjust, and affect a central principle of the public healthcare system: equality.


One thing that is wanting here is a greater agility in the approval and adoption of new therapeutic treatments. The healthcare authorities ought to make a rigorous examination of new pharmaceuticals, and approve only those that bring substantial advantages; but once these have been approved, any delay in their administration is an act of irresponsibility. They also ought to set up a streamlined decision-making procedure that would enable the application of reasonable and broadly shared criteria in the dispensation of treatments, so as to prevent situations of manifest inequality between one region and another.

What makes a public and universal healthcare system potentially great is the very fact that it does not set up barriers in terms of access and treatment, and treats all citizens equally.