Background Medicines shortages deteriorate. No prompt solution is foreseen. Interest vary between stakeholder values and patient outcomes. More analyses will not contribute substantively to relief. Distinct contributions to the solution of problems are urgently needed.
Purpose This work aims to report on the causes and solutions of medicines’ shortages.
Material and methods Twenty-three lead stakeholders were interviewed. Erroneous incentives and/or system shortcomings and potential to improve shortages prevalence were evaluated. Applied methodologies comprise qualitative research, system dynamics-aided simulation and best hospital pharmacy practices.
Results One-hundred and thirteen relevant causes of medicines’ shortages and 126 approaches to improvement were issued in mind-maps.
Governments’ actions are limited to epidemiology and responsibility for public health. The State monopoly serves to fix reference pricing. However, free trade is not touched while macro-economy runs satisfyingly. Commodity exchange of starting materials might be a break-out option. Dogmata such as Public Health as cost booster need revision. In fact, added values arising from healed patients being reintegrated into work processes should be validated.
Manufacturers do not opt for business without free trade and guidance-independent decision making. Unmet gain perspective and break-even induce deregistration for economic reasons. Upcoming personalised medicine requests precision medicine, whereas large-scale production is transferred to low-income countries, although quality, reliability and capacity are undoubtedly inferior. The construction of new production plants have to anticipate two upcoming decades. Precious APIs and products could be sustained by transfer to intermediate scale manufacturers.
(Pre-) wholesalers carry burdens of capital bound for stock-keeping. Replenishing is not compensated. GPS-aided medicines spotting from source to consumer might help to overview and warrant steady flow.
In the past, hospital pharmacy manufacturing has been reduced for economic reasons. Vulnerabilities in the supply chain and of patient outcome were not considered. The revised truly inspiring Swiss Act on Medicinal Products requests more independence and ability of hospital pharmacies to produce formula hospitalis and magistralis.
Conclusion Some stakeholders still have the best (i.e. unrestricted gains) and the worst alternatives (i.e. loss of reputation, unmet break-even points, new legislation with shifting tasks and responsibilities to the State) to voluntarily negotiated agreements. Therefore, negotiations led by a referee board and a true private/public partnership might markedly improve the availability of medicines.
References and/or acknowledgements SNSF/BFH/COST.
No conflict of interest.
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