On behalf of the Ministry of Health, Welfare and Sport (VWS), Gupta Strategists evaluated the effectiveness and efficiency of about thirty policy instruments deployed by the Medicines and Medical Technology directorate in the 2017–2023 period. The instruments examined ranged from laws and regulations to consultation structures, subsidies and international cooperation.

Findings per product group
For medicines, availability has been a complex problem for years amid a field of competing individual interests. Price pressure benefits affordability, but brings risks such as suppliers leaving the market. The complex dynamic calls for stronger direction from VWS.

For medical devices, the challenge lies in the balance between availability on one hand and quality and safety on the other. Two basic insights are still missing: which devices are critical on the basis of medical necessity, and which are vulnerable due to historical shortages or monopolies? These insights are needed in order to prioritize signals and reports well and act in a targeted way.

For human-derived materials, future-proof availability requires specific attention to diversity in the stem-cell donor registry, the international dependence on blood plasma, and the prudent use of subsidies and recruitment campaigns.

Overall, it stands out that policy is structurally introduced without concrete objectives and measurement criteria being set in advance. That makes it difficult, in retrospect, to assess whether an instrument has really worked — and therefore to learn from it.

Overarching recommendations

1. Create the right incentives in the chain, for instance by further differentiating the inventory obligation, coherently revising the Wgp–GVS preference-policy triangle and exploring availability criteria alongside price in the procurement of critical medicines, in line with the proposed Critical Medicines Act.
2. Set up an effective structure to tackle availability problems with the whole system in the room — at executive, strategic, tactical and operational level — with clear responsibilities and mandate per body.
3. Ensure timely and usable information flows, for example by setting up one central reporting point and bringing data from the entire chain together through a trusted third party.
4. Monitor and evaluate policy so the sector keeps learning from the (side) effects of policy instruments: set SMART targets in advance, work out a monitoring and evaluation plan before policy is introduced, and test new policy through a pilot.

Questions? Feel free to contact Niels Hagenaars.