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System of counting reimbursement costs by public payers

System of counting reimbursement costs by public payers PPRI Project Christine Leopold Gesundheit Österreich GmbH PPRI Conference Warsaw, 29 October 2007. Pharmaceutical E xpenditure in % of Health E xpenditure (2005). European averages EU-25: 18. 6 % EU-15: 15. 6 % EU-10: 23. 7 %

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System of counting reimbursement costs by public payers

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  1. System of counting reimbursement costs by public payers PPRI ProjectChristine LeopoldGesundheit Österreich GmbH PPRI ConferenceWarsaw, 29 October 2007 1

  2. Pharmaceutical Expenditure in %of Health Expenditure (2005) • European averages • EU-25: 18.6% • EU-15: 15.6 % • EU-10: 23.7% • Member States differences • <= 10%: LU, DK, IE, NL; NO • => 25%: BG, HU, LT, PL, SI, SK 2

  3. Public/private funding of pharmaceutical expenditure Source: PPRI 2007 3

  4. Cost-containment mechanism • On the price level • Discounts/rebates • Margin cuts • Price freezes/price cuts • Price reviews • On the reimbursement level • Reference price system • Generic substitution • Claw-back / Pay-back • On the level of doctors • Pharmaceutical budgets • Prescription monitoring • Generic prescribing Do these mechanism increase the burden for the patient? 4

  5. Example: Reference price systems • Methodology • Cluster of equivalent/similar pharmaceuticals • Setting a reference price • Co-payment for pharmaceuticals with higher price • Relevance • in all EU Member States but AT, CY, FI, IE, LU, MT, SE, UK • System of obligatory substitution in SE • Step-price system for off-patent pharmaceuticals in NO 5

  6. Burden for the patients • Private pharmaceutical expenses • Co-payments • Prescription fees (e.g. AT, DK, EE, FI, IT, PL, SK, UK) • Deductibles (IE) • Percentage co-payments • Reference price system 6

  7. Burden for the patients Share of private pharmaceutical expenditure * HU: 2000=2001, 2005 = 2004 Source: OECD Health Data 2007 7

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