ELORZA Maria Eugenia
Public Policies for provision of drugs for diabetes mellitus type II. A case study: Bahia Blanca City
Lugar: Arlington, Virginia; Año: 2011 vol. 12 p. 795 - 796
Introduction The epidemiological transition has determined that some chronic diseases are nowadays the main causes of morbidity and mortality. Diabetes Mellitus Type 2 (DMII) affects 80% of diabetic population. Pharmacological treatment in general involves oral hypoglucemiants, and glibenclamide and metformin are the most commonly used (1). In Argentina, public policies from different levels of government guaranteed public provision of these drugs to the people without any type of health coverage: national law 23.753 (1989), provincial law 11.620 (1994) and REMEDIAR, a national program for access to generic drugs (2002). In 1996 PRODIABA, a provincial program which provides free oral hypoglucemiants for diabetic patients, was created. While both programs, REMEDIAR and PRODIABA should deliver glibenclamide 5 mg and metformin 500 mg, delays in the delivery of metformin determined the intervention of the municipality of Bahia Blanca (MBB). Local authorities had to provide this drug to ensure the treatment of type 2 diabetic population without health coverage. The objective of this paper is to quantify monetarily (expenditure) the current municipal provision of metfomin and the amount of this drug that should be allocated to potential type 2 diabetic patients if they had pharmacological treatment. Materials and methods The glibenclamide and metformin tablets deliverd by PRODIABA and MBB to the population treated in some primary health care centers of public sector (CAPS) were quantified from October 2008 to September 2009. Potential type 2 diabetic population of MBB was estimated based on the prevalence in the adult population of the central area of Argentina (2) and using projected population statistics for 2008 (based on Censo 2001) were used. Results In the review period 625 type 2 diabetic patients were treated at primary level. The municipal provision of metformin tablets was 118210 (3940 treatments), more than half of the amount provided by PRODIABA and it was 34% of the total public provision. The municipal expenditure was 25000 ($ 0,21 per tablet). According to prevalence data and projections of adult population without any type of health coverage of MBB, there may be 4940 type 2 diabetic pacients. However, only 625 received public treatment (12,6% of potential patientes). If the municipality provided the drugs to guarantee access for all patients with DMII, the total annual provision would be 2.751.580 tablets (91.719 treatment) with a total cost of 577.832 (prices according to the municipal public procurement). Conclusions Although access to treatment for DMII would be guaranteed by provincial and national public policies, it was showed that local levels must manage additional provisions, which questions the effectiveness of centralized policies on the provision of drugs. Municipal government, through the CAPS, seems to be the appropriate level to ensure and promote chronic disease treatments.