242
funding, and some consumer activists suggest they may be vulnerable to financial or
informational manipulation by pharmaceutical industry. Gaps in communication
between medical professionals and patients could be bridged by a system offering
accreditation from the public sector and/or opening the door to reimbursement or
eligibility for funds from public coffers to organizations seeking effectively to
prevent hypertension. The behavior-altering benefits for (pre-)patients of public
funding for patients’ organizations could be substantially cheaper and potentially
more effective than the “top-down” model of most public sector programs.
Public Policy and Pharmaceutical Reimbursement
Throughout Europe, government intervention in pharmaceutical markets, including
pricing and access to reimbursement, has a pronounced effect upon the access of
patients to medication, whether this effect be one of denial, delay, rationing, or
promotion. This governmental footprint is especially prominent for innovative
products, costly as they often are. An overview of a series of Finnish studies of
hypertension from 1982–2002 noted that the European emphasis has changed from
detecting to treating high blood pressure. The report highlighted reimbursement as
an important challenge above and beyond the doctor/patient issues discussed above:
“In Finland, the strict reimbursement criteria for antihypertensive drug treatment
presented by the national social insurance institution may also play some role in
unsatisfactory BP control. In these criteria, the BP levels justifying the reimburse-
ment of antihypertensive drug costs are clearly higher than those recommended by
the hypertension guidelines,” leading to the conclusion that “in particular, effective
antihypertensive drug treatment should have been prescribed for individuals with a
moderate or high absolute CVD risk more frequently than at present” [ 43 ]. To pre-
scribe medications after the optimum moment, in insufficient amounts, or ones
which are cheaper but less effective is hardly a phenomenon unique to Finland, but
sadly merely one more instance of the public sector overvaluing short-term budgets
over long-term prevention of cardiovascular disease. Governmental policies can
stop their own hearts in this way.
Prevention and Financial Incentives for Physicians in the USA
The USA has been the site of a long-running debate on the merits of creating
incentives for caregivers to emphasize preventive care. This debate is one more
indication of the widely acknowledged need of the US system to provide signifi-
cantly better care.
Compared with the monolithic nature of European national services, the plural-
ism characteristic of health-care finances in the USA is simultaneously advanta-
geous and not toward providing incentives to hospitals and individual doctors. This
N. Keles et al.