Abstract
This chapter provides a political economy perspective on reforms of pharma price and expenditure control in Turkey over the 2000s. This is carried out through (a) embedding the description of the properties of pharma price control and health care system within their broader socio-political context, and (b) exposing the social struggles underpinning these polices.
Over the 2000s, changes in pharma price and expenditure control policies in Turkey supplemented the neoliberal reforms within the health care system. External reference pricing system (ERP) introduced in 2004 consolidated the power of transnational pharma capital in pricing. While over the period 2004–2008 changes in pharma price and expenditure control policies alongside growing public financing of health care significantly expanded pharma market and sales, since 2009, amidst the spiralling impacts of global financial crisis, increasing stringency of pharma price and control policies appeared to have circumvented favourable accumulation prospects for both local and transnational pharma capital. The latter set of policies indicate how public policies mediate contradictory interests of capital within the processes of accumulation. In due course, however, pharma pricing policies is increasingly enmeshed with fluctuations in exchange rate markets, threatening access to vital drugs used in the treatment of chronic diseases, and raising concerns about both the quality of locally produced drugs and possible anti competitive practices amongst producers of certain groups of pharma products.
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Notes
- 1.
This argument is an extension of the relational conceptualisation of the state that views it as a material condensation of class relationship of forces, and state policies, such as pharma price and expenditure control policies, as expressions of those relationships (Poulantzas 1978).
- 2.
For an alternative view see Mercan (2012).
- 3.
In the Price Communique issued by the Ministry of Health an original product was defined as a product whose efficiency, quality and safety had been proved and was licensed for the first time in the world market. A generic product in turn was defined as a product, which has the same active ingredients, same effectiveness and safety with the original product. The main distinguishing feature of the original products in the wording of 2004 price control scheme is the first time world marketing criterion rather than patent protection. Price Control Communication, Ministry of Health 3 March 2004.
- 4.
- 5.
This was explicitly allowed in the 2007 Price Decision.
- 6.
Discounts were to implemented on the retail prices (including the VAT) at the dispensing pharmacies.
- 7.
Clustering of drugs on which reimbursement limits are imposed may be organised according to two principles, the so-called generically equivalent clustering and therapeutically equivalent clustering (Dickson and Redwood 1998). In the former, branded and generic drugs containing identical and bioequivalent active ingredients in identical or similar formulations and pack size are selected to form clusters, while in the latter therapeutically interchangeable or comparable drugs of different chemical structures are selected to form clusters (Dickson and Redwood 1998).
- 8.
Protocol detailed a series of further reductions in reference price ceilings used in external reference pricing, and increases in mandatory discounts when actual expenditure exceeds the amounts determined in the budget.
- 9.
The concerned decisions were taken in the Economic Coordination Council, which includes the members of the Ministry of Labour and Social Security, Ministry of Health, Undersecretariat of Treasury, the Ministry of Finance, Ministry of Economy.
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Interview 5. Pricing Expert, Pricing Cost Analyses Department, General Directorate of Pharmaceuticals and Pharmacies, 31st of October 2011.
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Eren Vural, I. (2015). Politics, Reforms, and Regulation of Pharma Prices and Expenditures in Turkey over the 2000s. In: Babar, ZUD. (eds) Pharmaceutical Prices in the 21st Century. Adis, Cham. https://doi.org/10.1007/978-3-319-12169-7_15
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