Finally it has been published special number from the magazine Economy, policies and health law dedicated to the memory of Joan Rovira Forns. As those who follow us will remember, we had already referred to his figure on the occasion of the workshop celebrated in his honor, shortly after his death was announced. Today we celebrate that one of the magazines in the field of health economics collects, in a special issue, reflections and studies that dialogue with Joan’s intellectual legacy, and perhaps give ideas to some to expand her legacy, or take over in ideas that, due to their ambition, require several generations. of health economists.
An attempted summary of Joan’s academic life.
Recognizing that any attempt to summarize the life and work of an academic will always be incomplete, in this entry we highlight some aspects of Professor Rovira’s research that we consider among his most significant contributions, as we comment in the introductory article of the special number.
It can be stated, without exaggeration, that Joan Rovira was a pioneer in the analysis of pricing and reimbursement of medicines, as well as in the study of mechanisms to control pharmaceutical spending and guarantee equitable global access, and in the standardization of economic evaluation – he was the author of the first guides used by the ministry.
Among his great contributions, he highlighted his ability to address the permanent challenge of balancing the promotion of pharmaceutical innovation with the goal of universal access, and he advised a multitude of governments, from Brazil, Colombia, Costa Rica, Ecuador and others, creating decision models to determine what price they should pay for the medicines their population needed. In the area of orphan drugs, for example, he explored the complex economic challenge of financing treatments for rare diseases, arguing for the need to design sustainable policies that reconcile research incentives with affordability. Likewise, although it was Senior Economist of the World Bank, was not very sure of his role, and took advantage of his work to investigate the effectiveness and efficiency of pharmaceutical loans granted by international institutions such as the World Bank, and, through his editorial work, he stressed the urgency of establishing fair pricing strategies in low-income countries.
In recent years, he has also shown a growing interest in behavioral economics and public participation in health decision-making, convinced that social legitimacy is as important as technical solidity in the design of health policies. This special edition collects and develops ideas in line with these themes, as we highlight below:
(i) Standardize and expand the economic evaluation of health technologies
The first block of this special issue focuses on how to support evidence-based decision making in health. Vallejo-Torres, Oliva-Moreno and Lobo (2025) analyze the incorporation of economic evidence in Therapeutic Positioning Reports in Spain. Although there is increasing reference to cost-effectiveness data, its practical application in reimbursements is still uneven. The authors insist on the need for greater methodological consistency and clear regulatory expectations—an agenda fully aligned with Rovira’s advocacy for standardization and transparency in economic evaluations.
(ii) Rationalize health decision-making
The complexity of how reimbursement decisions are made is another of the great current debates. Rejón-Parrilla, Epstein, Pérez-Troncoso and Espín (2025) provide a valuable perspective through interviews with health policy experts in Spain, highlighting that these decisions require balancing economics, clinical evidence, ethical values and political pressures. It is recommended that reimbursements explicitly consider unmet medical needs and rare diseases, using measures such as quality-adjusted life years (QALYs). QALYin English) and cost-effectiveness thresholds. This debate reflects Joan’s impact on the formation and dissemination of economic evaluation.
In this same line, Papadopoulos, Visinti, Kyriopoulos and Kanavos (2025) analyze the determinants of negative recommendations in health technology evaluations (STD or STDsin English). They detect that anticancer or orphan drugs, low quality of evidence, and uncertainty in cost-effectiveness are key factors that determine this negative direction of STD recommendations. Furthermore, they show systematic differences between STD agencies, especially in oncology and rare disease treatments, an area where Joan had made decisive contributions.
(iii) Towards fair access to medicines
Ensuring fair, transparent and sustainable access to medicines was another of Joan’s passions. Since the 1990s, it was already exploring international mechanisms to improve affordability, such as the external reference price or the financing strategies of the World Bank. Fernández, Del Llano Vidal, Espín and Del Llano (2025) They return to this debate and evaluate the evidence of initiatives that range from alternative models of innovation and production, to the management of intellectual property and new forms of public procurement. The article relieves that equitable access to medicines continues to be a challenge to meet.
(iv) Participatory and sustainable health systems
The last section of this issue addresses how to strengthen public participation and better respond to local health needs. López-Valcárcel and López-Casasnovas (2025) study the effects of decentralization during the COVID-19 pandemic in Spain. They conclude that they allowed responses that were more adapted to each region, but they emphasize the need for coordination mechanisms to guarantee equity. The use of QALYs to evaluate the health response reflects Joan’s vision for integrated evaluation frameworks in national and multilateral contexts.
In a complementary way, McGuire, Wharton, Hodgson, Kourouklis, Jofre-Bonet and Tran (2025) proposes a new index to measure the resilience and sustainability of health systems, allowing international comparisons and monitoring over time. This line of research is in full harmony with the broad and transformative vision that has always characterized Joan Rovira’s work.
Without forgetting
One of the most distinctive features of Joan Rovira was his contribution of practical ideas that could be used for the design of health policies and access to medicines in Europe and Latin America. For example, it addressed the concept of “equitable pricing” to improve the affordability of medicines in low-income countries and explored how regional cooperation could facilitate access to health technologies. Also, global challenges, such as drug shortages and inequalities in access to essential therapies, developed decision models applied especially in Latin America to balance innovation with budgetary limitations. At the same time, he became interested in underlying conceptual issues, such as the scope of the concept of “well-being” or the way in which health systems define and measure it. the “value”, incorporating ethical and social dimensions such as equity and autonomy.
This special issue not only serves to highlight Joan’s contributions, but we hope it will also give greater visibility to her ideas, some pioneering that have yet to be developed. There is no better way to say goodbye to a friend and colleague than with a “see you always”, and as we said in another entry with the certainty that the “changeover is underway”, that he will continue to inspire researchers, professionals and policy makers with his example, and his ideas.
