Panos Kanavos Director, International Health Policy, Dept. of Social Policy & LSE Health, London School of Economics 1. Introduction ad hoc European Union: EU third party (a) (b) (c) (d) (e) value added tax: VAT vested interest European Union: EUEU 2001 2 http://pharmacos.eudra.org/f3/g10/docs/synthesis.pdf 819
2. National Systems 1total pharmaceutical expenditure control incentive 1 2 3. Regulation of Supply 3.1 Price and Rate of Return Controls EU 1 health fund explicitly implicitly EU 2 EU 3 (1) 820
discretionary power (2) favoritism (3) formula 3.2 Price Revisions 3.3 Price-volume Agreements 3.4 Price Comparisons explicitimplicit (Average Pricing) (International Price Competition) 3,4 2 821
1 EU 822
1 EU 3 Purchasing Power Parities: PPP 4 EU 2 2 823
2 3.5 Health Economic Evaluations health economic valuation marginal NICE pharmaco-economic guidelines cost-effectiveness criteria QOL QOL 824
3 EU 4. Regulation of Demand 3 4.1 Influencing the Prescriber social health fund 3 3 2 3 2 3 825
4.2 Positive and Negative Lists 3 (inclusive) (exclusive) by default negative list positive list 3.5 over the counter: OTC 4.3 Prescribing Guidelines Treatment Protocols and Rational Prescribing effective efficient indication independent source of information Bulletin of Medicines Bandolier rationalconsistent medical establishment negative recommendation 826
gate keeper therapeutic class IC patient smart card freedom to prescribe 4.4 Prescribing Budgets sanction and reward 1997 Primary Care Group 1997 12 827
GMS indicative drug budget 1993 7 saving 50 ASL 1997 30 ASL Finmig ASL rational prescribing solidarity 4.5 Altering the System of Paying Physicians fee-for-service capitation basis policy MG-France CNAM 1 EU GP1 GP 15 15 5 GP GP ONDAM GP GP GP 110 828
33 GP GP 1 1998 150 4.6 Pharmacy Dispensing EU latitude substitution similar therapeutic substitution International Non-proprietary Name : INN tick-in tick-out 4.7 Dose the Distribution Chain Influence Demand? EU regressive margin 2 3 EU gross income 829
4.8 Remuneration of Pharmacists progressive flat digressive 6.82 15.00 clawback Health Care Tariff Board 1 2000 12.55 3 4.9 Generics and Generic Policies as Part of the Demand-side 4 1997 value volume electronic prescription system 830
4 EU 5. Demand Side 5.1 Role of the Patient EU parallel trade product 831
5 2000 EU 832
5 2000 EU 5.2 Patient Co-payments 4 (1) fixed fee: (2) (3) (4) (1) (2) (3) (2) 5 EU EU (capped system) 80 5.3 Taxation VAT OTC VAT OTC prescription only medicine: POM 8 VAT 833
VAT 6 4 8 POM 25 21 VAT VAT VAT VAT 1997 8 31999 4 6. Other Policy Segments 6.1 Parallel Trade paralle trade product SPC supplementary protection certificate EC centralized procedure EC EEA EC EC 6.2 Hospital Products hospital product 15 50 10 15 834
6 EU OTC 2000 2 6.3 The Role of Information Systems Pharmanet Carte Vitale IC smartcard Krankenversicherten KarteIC PRODIGY 150 IT 6.4 Over-The-Counter OTC Medicines over the counter : OTC self-limiting illness OTC OTC OTC 835
1 3 OTC OTC OTC EU OTC OTC 6 OTC OTC OTC LSE Panos Kanavos 13-14 EBM 836