Regional integration among developing countries, revisited

Economic integration among developing countries became an important policy issue in the 1960s and early 1970s. But although intraregional trade increased in some trading groups, it remained a modest share of total trade. However, dramatic changes in the world economy have affected the environment for regional integration and cooperation. The formation of new, powerful economic and trading blocs, such as the single market of the European Community, the US-Canada free trade area, initiatives in the Pacific basin, and the transition to market economies in Central and perhaps Eastern Europe, seems to have fostered a trend toward new regionalism in the world economy. The virtual failure of the GATT negotiations may speed this up. To minimize economic losses and avoid marginalization, regional groups of developing countries must increasingly work out common positions and join one of the influential groups. Both factors require the gradual yet rapid dismantling of barriers to the free flow of production factors within regional groups. Obviously, intraregional trade cannot become an alternative to trade flows that are basically oriented to the world market. But in the 1990s, intraregional trade and economic relations are likely to grow parallel to, or even at a higher rate than, extraregional contacts.TF054105-DONOR FUNDED OPERATION ADMINISTRATION FEE INCOME AND EXPENSE ACCOUNT,Economic Theory&Research,Environmental Economics&Policies,Trade and Regional Integration,Trade Policy

Attempt to increase the transparency of fourth hurdle implementation in Central-Eastern European middle income countries: publication of the critical appraisal methodology

BACKGROUND:In middle income countries the number of trained health technology assessment specialists is limited and the public budget for health technology assessment is considerably lower compared to developed countries. These countries therefore must develop their own solutions to improve the quality and efficiency of health technology assessment implementation in reimbursement decisions. Our study aimed to develop a scientifically rigorous and detailed appraisal checklist for economic evaluations of pharmaceuticals in the single health technology assessment process.METHODS:The research design entailed a review of economic evaluations, submitted for reimbursement of pharmaceuticals, by two independent academic reviewers to identify the most common methodological problems. Fifty economic evaluations submitted in 2007-2008, randomly selected by the Health Technology Assessment Office served as data sources. The new checklist was developed by an iterative working process: first by assessing ten economic evaluations, then improving the checklist by generating new question items, then employing the improved checklist to assess the next ten economic evaluations. After appraising 25 documents, the reviewers reconciled their opinions and improved the checklist with the researchers of the Health Technology Assessment Office during an expert panel discussion. The reviewers scrutinized the second 25 economic evaluations, after which the expert panel finalized the checklist with consensus.RESULTS:The final checklist consists of 91 yes or no questions in 11 main topics concerning comparator selection, efficacy, effectiveness, costs, sensitivity analysis, methodological approach, transparency, and interpretation of results. The new checklist is based on current Hungarian evaluation practice. As the published checklist will be part of the official single health technology assessment process of pharmaceuticals, submitters will be able to assure the quality of their economic evaluation.CONCLUSIONS:The transparent critical appraisal method should improve the consistency of pharmaceutical reimbursement decisions and facilitate the utilization of economic evaluations in other fields of health care decision-making in other Central-Eastern European countries

Overview on Patient Centricity in Cancer Care

Successful implementation of treatment in cancer care partially depends on how patients’ perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were I) to identify patient preferences and values (PPVs) in cancer care as indicated by patient organizations (POs), II) to determine how these PPVs are captured in cancer care guidelines and III) to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level ‘one-size-fits-all’ solution

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed

"From the Association Agreements to Full Membership? The Dynamics of Relations Between the Central and Eastern European Countries and the European Union"

This paper focuses on some of the fundamental future issues in the relationship between the Central and Eastern European countries (CEECs) and the European Union. Thus it does not deal with achievements and shortcomings of EU-CEECs relations as reflected by bilateral developments in the last years. More importantly, it tries to address the dynamics of developments and some of the major challenges European integration is likely to face well before the end of the century. Divided into eight chapters, the analysis starts with the adjustment criteria preceding CEECs membership (chapter I), to be followed by developments and special interests in sensitive areas, including the question of financial transfers (chapters II and III). Chapter IV looks at intermediate or alternative proposals to full membership. Special chapters are dedicated to the timing of membership and to the question whether accession should happen individually or in a group approach (chapters V and VI). Chapter VII examines the future of intra-European balance, while the last chapter offers some conclusions

The Hungarian Economy and Its EU Accession

The pre-history of EU integration is presented briefly: at the first stage before 1989, when the Hungarian strategy opted for integration with the international financial institutions, and post 1989. The issues of implementing the requirements that are the precondition to become a successful EU member within the immediate future are pointed out. This success can be measured at two levels. First, a large part of Hungarian society has to feel within a relatively short time that EU membership means feasible enrichment and accelerated catching up with the EU average. Second, it can be considered a success when Hungary develops an active, future-oriented policy line in EU by strengthening European competitiveness.