Σάββατο, 22 Οκτωβρίου 2011


The Economic Adjustment Programme
for Greece
Fifth Review – October 2011
Σημαντικές αναφορές της έκθεσης σε φαρμακεία και πολιτικές υγείας.
(Όλα τα σχόλια στα ελληνικά είναι από τον Γιώργο Κουτέπα). 
Given the high share of public expenditure that is spent on healthcare, healthcare reform is a crucial component of Greece's fiscal consolidation efforts. These efforts will depend a lot on an efficient pricing of medicines, the proper accounting and monitoring of expenditure, modern procurement, invoicing and administration, the introduction of the positive list linked to the reference price system; the full implementation of the eprescription system and the concentration and specialisation of NHS hospitals and departments while ensuring mobility of staff.
These areas include: equalising contribution rates for EOPYY, i.e. increasing contribution rates for OGA;
reducing the number of administrative staff and the number of physicians contracted with EOPYY
Applying binding clinical and prescription guidelines, eventually linked to the e-prescription systemspeeding up the implementation of e-prescription (!) and minimising delays in invoicing and eliminating arrears (=καθυστερήσεις πληρωμών...) . This last point is particular important as some social security funds have not been able to collect the rebate from pharmacies when there are delays in payment
Increasing use of generic medicines - compulsory e-prescription by active substance and of less expensive generics when available
Associating a lower cost-sharing rate to generic medicines that have a significantly lower price than the reference price (lower than 60 percent of the reference price) on the basis of the experience of other EU countries;

-setting the maximum price of generics to 60 percent of the branded medicine with similar active substance.
Starting from 2012, pharmacies' profit margins are calculated as a flat amount or flat fee combined with a small profit margin with the aim of reducing the overall profit margin to no more than 15 percent, including on the most expensive drugs as defined in law 3816/2010.
(Είναι προφανές ότι μιλάει για το μέσο όρο του ποσοστού κέρδους και όχι για οριζόντια μείωση! Ειδικά με τη χρήση του συστήματος τιμολόγησης που προτείνει το ποσοστό είναι πλέον κλιμακωτό και σε αυτό οριζόντια μείωση δεν υφίσταται. O στόχος με την πλήρη χρήση του rebate και μικρή τροποποίηση του ποσοστού στα ΦΥΚ μαζί με υπολογισμό του όγκου πωλήσεων προσεγγίζεται και μένει να δούμε αν θα υπάρχει κάποια τυπική προσαρμογή στο σύστημα τιμολόγησης)
-publishes binding prescription guidelines for physicians defined by EOF on the basis of international prescription guidelines to ensure a cost-effective use of medicines; [July 2011]
-publishes and continuously updates the positive list of reimbursed medicines using the reference price system developed by EOF. [Q2-2011]
Ongoing with delays.
A large number of prescription guidelines have been developed and
await final agreement by the National Health Council. However, they
have not been published and they are not binding. This risks jeopardise
their effectiveness.
After some delay and following several rounds of consultation and
changes, the criteria for the positive price list and reference price
system for reimbursement has been published in September 2011. The
reference price system and positive list implementation are due to
EOPYY starts operating. The new fund will lead to a substantial reduction of administrative staff of at least 50 percent and of contracted doctors of at least 25 percent as compared to the four originating funds combined. The aim is to achieve a ratio of patients per doctor in line with the European average. [Q3-2011]
Government extends the use of capitation payments of physicians, currently used by OAEE, to all contracts between social security funds and the doctors they contract. The new payment mechanism starts for each new contract renewed in 2011 and for all contracts from 2012. It defines a minimum number of patients per doctor, on the basis of the experience of other EU countries. The new system will lead to a reduction in the overall compensation cost (wages and fees) of physicians by at least 10 percent in 2011, and an additional 15 percent in 2012 as compared to the previous year. [Q3-2011]
Government starts to produce a semi-annual report on the prescription and consumption of medicines and diagnostic tests. This report includes information on the rebate received from pharmacies and from
pharmaceutical companies and on the volume and value of medicines.
 It provides a feedback report to all physicians on their prescription volume and value, at least on a quarterly basis. Monitoring and reporting of misconduct and conflict of interest in prescription behaviour are intensified. [Q4-2011]
Ο έλεγχος συμβατότητας των περιορισμών στην άσκηση των επαγγελμάτων θα πρέπει να γίνεται με βάση το κοινοτικό δίκαιο. The government has reported that no contradictions were found with EU law / competence rules. The Commission has given examples of regulations of lawyers and engineers (δεναναφέρει φαρμακοποιούς) that could be problematic from the point of view of EU law / competition rules.(…και βέβαια δεν υπάρχει καμία αναφορά στο ωράριο…)
The independent task force of health policy experts produces, in cooperation with the European
Commission, ECB and IMF, a first draft of its policy report, with specific recommendations on policies to
be implemented. The report and policies proposals cover the following areas:
-health system governance to reduce the fragmentation of the system;
-financing: pooling, collection and distribution of funds;
-harmonisation of health packages across funds;
-service provision and incentives for providers including:
-integration between private and public provision;
-primary care vis-à-vis specialist and hospital care;
-efficiency in the provision of hospital services;
pharmaceutical consumption;
-human resources;
-public health priorities, health promotion and disease prevention;
-data collection, health technology assessment and assessment of performance;
-expenditure control mechanisms.
The Task Force is working on the 1st draft of the final report, which will be delivered by end-October 2011, and the final report, which it will deliver by end-November 2011. The delays are mainly related to the change of Chairman.

1 σχόλιο:

  1. .. βλέπουμε για μια ακόμα φορά 2 τακτικές στην ερμηνεία των όρων του Μνημονίου:
    - διασταλτικές (ή και τελείως πλασματικές ερμηνείες) κάποιων οδηγιών της Τρόικας -όπως τους περιορισμούς συνταγογράφησης, την Η/Σ, την ορθή χρήση generics, τη δραστική κτλ...
    - τη χρήση μέτρων που καθόλου δε ζητούνται από αυτήν -όπως αλλαγές ωραρίων, κάθετη μείωση κέρδους, ελεύθερη συνταγογράφηση κτλ
    .. νομίζω μπορούμε να καταλάβουμε, αν αναγάγουμε την εφαρμογή των όρων του Μνημονίου και σε άλλα πεδία -στο πιο ζέον π.χ. που είναι η οικονομία- γιατί μια ήδη αδύναμη συνταγή που εκτελείται μισή ή/και λάθος καταλήγει στην καλύτερη αναποτελεσματική και στη χειρότερη καταστροφική!