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The missing stakeholders

Taking a step back will help companies see the elephants in the room

Seat missingAll of us are now engrossed in communications that address different aspects of market access. In this short article I wanted to touch on an area that has not yet been mobilised, but I am sure it will soon be making itself felt with a variety of consequences.

Simpler times
We already know that access means different things to different people and stakeholder behaviours and actions in healthcare reflect their different agenda and needs. We also have countless reports and papers on market access, so I am not going to repeat here what we all know so clearly.

However, to see elephants you often need to take a step back. There are the core reasons why market access has become such a focus in the health sector. There are the simple basics of: "If I have a company that discovers, develops, manufactures and sells new innovative therapies and interventions, then who is going to pay for them and will I get the price I need to operate my business model and satisfy shareholders?"

In the old days it was simpler. There were only about three or four decision makers, half of those being clinicians so promotion could be direct, persuasive and the products were bought. Now it has changed. At the last count I ended up with more than 20 stakeholders that can directly or indirectly affect or decide on permission to market or impact price. The decisions now are not clinical ones. I'm generalising of course, but agenda now are not clinical agenda, with some notable exceptions.

External influences
The obvious pressure on the payers' side is financial. Times are hard. Monopoly buyers or regulators have real power that is only tempered by votes and elections. But the other influences are subtle and profound. They range from pressure to demonstrate real innovation and incremental value, to pressures from stratified medicine and even stratified healthcare leading to new ways of assessing or mobilising budgets.

We know all of this and practise the communications and information now needed. From a government or payer perspective you can define this as: "Show me how I can provide modern healthcare for my people/society and I will allow you to sell products, but not at your price". To which we see the industry response: "We will change price structures for many medicines and where we can demonstrate real innovation or real effect in specific patient groups, then we will expect to be paid and make profit. Plus we will now work with you to develop new ways of addressing health rather than illness!"

So where is the elephant? I think there are two. Firstly, we seem to be forgetting a core component of the next phase. Who is the true client? People are the true clients for health and the care provided for them. As this realisation takes hold we move into the next phase of market access.

The other elephant is transparency, which will drive the transition. It will be the ability of people to get information that will help them see and understand the motives driving stakeholder positions and the decisions they make. People at last will be able to see if decisions are for their health benefit or some other motive entirely.

At the moment people are the missing stakeholder in market access, but they are just about to be mobilised and then the next phase will start.

Nick May

The AuthorH&K
Nick May
is head of healthcare EMEA
at Hill & Knowlton
Email him at:

10th May 2011


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