University of Groningen
Access to innovative medicines in a middle-income country
Moye Holz, Daniela Denisse
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Publication date: 2019
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Moye Holz, D. D. (2019). Access to innovative medicines in a middle-income country: The case of Mexico and cancer medicines. Rijksuniversiteit Groningen.
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Access to Innovative
Medicines in a
Middle-Income Country
The Case of Mexico and Cancer Medicines
Cover design and layout by Elisa Calamita, persoonlijkproefschrift.nl Printing: Ridderprint BV | www.ridderprint.nl
ISBN/EAN: 978-94-034-1533-8 (printed version)
ISBN/EAN: 978-94-034-1532-1 (electronic version)
Daniela D. Moye Holz
Access to Innovative Medicines in a Middle-Income Country. The Case of Mexico and Cancer Medicines.
Doctoral Dissertation, University of Groningen, the Netherlands.
The research presented in this thesis was carried out at the GZW Global Health – Public Health Research Department of the Research Institute SHARE of the Graduate School of Medical Sciences of the University of Groningen. This research was supported by the Consejo Nacional de Ciencia y Teconología (CONACYT), Mexico.
Copyright © 2019 Daniela D. Moye Holz
All rights reserved. No part of this thesis may be reproduced, stored or transmitted in any way or by any means without the prior permission of the author, or when applicable, of the publishers of the scientific papers.
Access to Innovative Medicines in
a Middle-Income Country
The Case of Mexico and Cancer Medicines
PhD Thesis
to obtain the degree of PhD at the University of Groningen
on the authority of the Rector Magnificus Prof. E. Sterken
and in accordance with the decision by the College of Deans.
This thesis will be defended in public on
Wednesday 24 April 2019 at 16.15 hours
by
Daniela Denisse Moye Holz born on 1 March 1985
Supervisors Prof. H.V. Hogerzeil Prof. S.A. Reijneveld
Co-supervisor Dr. J.P. van Dijk Assessment Committee Prof. R.H. Henning Prof. H.G.M. Leufkens Prof. A. Figueras
Contents
Chapter 1. Introduction 9 1.1. Universal health coverage and access to healthcare for
non-communicable diseases – the case of cancer in low- and middle-income countries
10
1.2. Access to essential medicines and the case of innovative essential medicines
13
1.3. The health system and access to essential medicines in Mexico 15 1.4. Objective and research questions 21 Chapter 2. Policy approaches to improve availability and affordability of
medicines in Mexico – an example of a middle-income country
33
Chapter 3. The impact of price negotiations on public procurement prices and access to eight innovative cancer medicines in a middle-income country – the case of Mexico
57
Chapter 4. Access to innovative cancer medicines in a middle-income country - the case of Mexico
89
Chapter 5. Availability, prices, and affordability of selected essential cancer medicines in a middle-income country – the case of Mexico
109
Chapter 6. Access to cancer medicines in public hospitals in Mexico: the view of stakeholders
133
Chapter 7. Discussion and Conclusions 155 7.1. Main Findings 156 7.2. Reflections on Main Findings 158 7.3. Methodological considerations 164 7.4. Policy Implications 169 7.5. Conclusions 177 Summary 183 Samenvatting 189 Resumen 197 Acknowledgements 205
Research Institute SHARE 213
“A bird sitting on a tree is never afraid of the branch breaking because her trust is not on the branch but on its own wings…” – Unknown. To my biggest role model, the most wonderful and loving mom - for this achievement is also yours. Thank you for giving me big strong wings.
And for the other great women that came before me: my grandmothers Catalina and Ana María.
