Access to Medicines versus Access to Treatment: The Case of Type 1 Diabetes

By Beran, David; McCabe, Ariane et al. | Bulletin of the World Health Organization, August 2008 | Go to article overview
Save to active project

Access to Medicines versus Access to Treatment: The Case of Type 1 Diabetes


Beran, David, McCabe, Ariane, Yudkin, John S., Bulletin of the World Health Organization


Introduction

In recent years considerable attention has been paid to the issue of access to medicines. The topic burst into the global public spotlight in 2000 when 39 pharmaceutical companies took the South African government to court over its introduction of allegedly unlawful legislation, which gave the minister of health the right to import generic versions of patented drugs and allowed generics to be manufactured locally through compulsory licenses. After this trial, the terms parallel importation, compulsory licensing, intellectual property, generic drugs and TRIPS (the World Trade Organization's agreement on trade-related aspects of intellectual property rights) became part of the vocabulary of many nongovernmental organizations and policy-makers seeking to improve access to medicines in the world's poorest countries.

Since then public-health policy debates have largely focused on patents on medicines as the main barrier to patients' access to treatment. Advocates of this view blame patents for the high prices of essential medicines, putting them out of reach of many people who need them. Much of this controversy has specifically addressed medicines for communicable diseases such as HIV/ AIDS, malaria and tuberculosis. Less attention has been paid to the availability of drugs for noncommunicable diseases, although this group of illnesses including cardiovascular disease, cancer, chronic lung diseases and diabetes represents the leading causes of death worldwide. (1,2) This paper will argue that access to medicines is not simply a consequence of patents and that it is only one part of the dilemma of care for noncommunicable diseases faced by patients in resource-poor settings.

Access to medicines for chronic conditions

Few studies have examined the issue of access to essential medicines for chronic diseases. However, a recent publication by Mendis et al. (3) explores the availability and affordability of medicines for chronic conditions in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. (3) The study concludes that there is a need to improve the availability of medicine for chronic diseases, particularly in the public sector, and that medicines used in treatment regimens should be made more affordable. However, this paper only examines the issue of price as a barrier to access to medicines and does not consider either the additional costs of care or the other constraints to care faced by patients with chronic disease.

The focus on access to medicines is limited. Instead, policy-makers should take a broader view that encompasses barriers to access to treatment. Work has been conducted by two of the authors in Mali, Mozambique and Zambia with the Rapid Assessment Protocol for Insulin Access (RAPIA), a multi-level assessment of the health system. (4,5) This has shown that while the treatment of patients with diabetes is poor, this cannot be attributed entirely to barriers resulting from the price of medicines. A more complex picture exists of what these barriers comprise.

In none of the three countries surveyed was there one single price for insulin. Instead, prices depend on location of purchase, the complexity of the supply chain and the method by which the medicine was purchased. There is, for example, the price at which the government or central medical stores (CMS) purchase insulin and which may include duties or taxes. In some countries, government health facilities purchase insulin from the CMS at a higher price than the CMS purchased it from pharmaceutical companies or international distributors. This is due to the additional costs incurred as a result of the maintenance of storage facilities and transport costs that are passed on to the health units. Insulin may then be sold to patients with or without government subsidy. In Mail, for example, patients pay a higher cost for insulin than the CMS and health facilities because costs sustained along the distribution chain are paid for by the patient.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Access to Medicines versus Access to Treatment: The Case of Type 1 Diabetes
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.