Policies beyond the crisis: lesson learned

Abstract

Some European and further countries have been hit by the global financial crisis since 2008, and some of them were hit hard. The crisis has had major impacts on the health systems, including the pharmaceutical sector since cost-containment measures with possible negative impacts were set. Responses to the global financial crisis According to a survey with the PPRI (Pharmaceutical Pricing and Reimbursement Information) network (see also E4), a total of 445 measures (related to pharmaceutical pricing and reimbursement) were reported during the per-iod of 2010-2014. This corresponds to, on average, nearly 13 measures per country, but with great variability between the countries (range: 2-44). The most frequently reported policy measures were price cuts, followed by changes in co-payment and in the reimbursement lists (formularies). The highest number of measures (130 measures) was reported for 2012 in which the crisis was at the peak in some countries. Overall, during the 4 years, Portugal was the country that reported the highest number of measures, followed by Belgium, France and Iceland. An analysis for merely 2010-2011 evidenced that price cuts and changes in co-payments were also the policy measures taken most fre-quently in that time period. But countries with the highest number of measures were different at that time; this included Iceland, the Baltic States (Estonia, Latvia, Lithuania), Greece, Spain and Portugal [1]. Despite the limitations of that survey (in particular a possible reporting bias), the study suggested that during the global financial crisis a higher number of pharma-ceutical policy measures were taken, several had a focus on cost-containment, and that these were frequently measures that could be undertaken short term. However, a crisis might also offer an opportunity to move forward with policy options that had not been feasible at other times. Despite this focus on cost-containment during the crisis, policies to achieve other objectives, such as encouraging a more effective and efficient use of medi-cines and promotion of generic policies, could also be observed, in the Baltic states, for instance [2-4]. Cuts in public expenses risk negatively impacting health outcomes. First analyses available for Greece suggest that the crisis, and the policy responses to it, brought negative effects on the quality of health services, a lower utilization of health care and signs of worse health outcomes, such as increasing rates of mental health, suicides, and epidemics, and a deterioration of self-rated health [5,6]. There is less evidence on the impact of the crisis in the pharmaceutical sector. The effect on public pharmaceutical expenditure was observed, with modest and even negative growth rates in the 'crisis countries' during some years [7,8]. Vandoros and Stargardt [9] concluded for Greece that despite a major drop in pharmaceutical expenditure, more cuts would be necessary and could only be achieved through increased efficiency if the quality of healthcare and public health should not be compromised. They also addressed the threat that companies could withdraw from the Greek market in the light of the low price levels for ori-ginator medicines to which several other European coun-tries refer to in their price setting [10]. However, product withdrawals took place at a very small scale in Greece [9]. More research is needed to learn whether, or not, access to medicines has been negatively impacted by the crisis. A study on eight European countries (three economically stable, and five less economically stable countries) showed that although less economically stable countries imple-mented more pharmaceutical policy changes during the recession than economically stable countries, pharmaceu-tical sales volumes (quarterly sales of products in the 10 highest-selling therapeutic classes in each country between * Correspondence: sabine.vogler@goeg.at