Pharmaceutical Policies under Economic Crisis: The Greek Case
Introduction: The purpose of this paper is to critically assess the Pharmaceutical reforms implemented in Greece before and during the economic crisis. The effects of the crisis are multiple in terms of GDP reduction, severe cuts of health and pharmaceutical expenditures and the deterioration of the health status of the population. However, the crisis has been a "window opportunity" to implement the long anticipated reforms in the health sector. Methods: The analysis is based on Time series data from the OECD Health data source covering the period 1970-2014. Double Logarithmic models are explored to estimate income elasticity for pharmaceutical expenditures. The value of the income elasticity in the Pre-crisis period is 1.72 the highest in Europe. The average annual growth of Pharmaceutical expenditure in the pre-crisis period was 12.3% i.e. the highest among the EU-28 countries and during the crisis this rate dropped to -8.5% the lowest among the EU-28. Results: The evolution of thePharmaceutical policies and reforms are discussed with reference to HTA, Co-payments, Claw-back and the E-Prescribing. The mixture of both demand and supply side measures resulted in a substantial reduction of pharmaceutical expenditures from 5,6 bil. Euros in 2009 to 2 bil. Euros in 2016. One of the main contributing factors to cost containment policies is the effective launching of E-prescribing. Exclusion and deprivation of citizens of effective and innovative medicinal treatments should be avoided and their access to health services and medicines should be assured. The new strategy in medicinal products should ensure good quality at affordable prices. The Greek Government, in an attempt to reach the Memorandum objective of 1 percent of GDP on pharmaceutical spending should develop incentives to promote the use of generic medicines and the cost-effective use of medicines in general Conclusions: With all its pros and cons, Greece appears to be an interesting case study to assess the success and failures of the various pharmaceutical reforms implemented. (original abstract)
- European Commission. Investing in Health. Brussels: European Commission, 2013 Contract No.: SWD(2013) 43 final.
- WHO. Health 2020: a European policy framework supporting action across government and society for health and well-being. Malta: World Health Organization Regional Office for Europe, 2012.
- Carone G, Schwierz C, Xavier A. Cost-containment policies in public pharmaceutical spending in the EU. Available at SSRN 2161803. 2012.
- Vogler S, Zimmermann N, Leopold C, de Joncheere K. Pharmaceutical policies in European countries in response to the global financial crisis. Southern Med Review. 2011;4(2):22-32.
- Yfantopoulos J. Pharmaceutical pricing and reimbursement reforms in Greece. European Journal of Health Economics. 2008;9(1):87-97. Aaserud M, Austvoll-Dahlgren A, Kösters JP, Oxman AD, Ramsay C, Sturm H. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. The Cochrane Library. 2006.
- Baltagi BH, Moscone F. Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling. 2010;27(4):804-11.
- Kanavos P, Schurer W, Vogler S. The pharmaceutical distribution chain in the European Union: structure and impact on pharmaceutical prices. 2011. 9. Kanavos P, Manning J, Taylor D, Schurer W, Checchi K. Implementing value-based pricing for pharmaceuticals in the UK. London: 2020health. 2010.
- Angelis A, Kanavos P. Value-based assessment of new medical technologies: towards a robust methodological framework for the application of multiple criteria decision analysis in the context of health technology assessment. PharmacoEconomics. 2016;34(5):435-46.
- Espin J, Rovira J. Analysis of differences and commonalities in pricing and reimbursement systems in Europe. Brussels: DG Enterprise and Industry of the European Commission. 2007.
- Ess SM, Schneeweiss S, Szucs TD. European healthcare policies for controlling drug expenditure. Pharmacoeconomics. 2003;21(2):89-103.
- Mrazek M, Mossialos E. Regulating pharmaceutical prices in the European Union. Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality Copenhagen, European observatory on health systems and policies. 2004:114-29.
- Mossialos E, Mrazek M, Walley T. Regulating Pharmaceuticals In Europe: Striving For Efficiency, Equity And Quality: Striving for Efficiency, Equity and Quality: McGraw-Hill Education (UK); 2004.
- Yfantopoulos P, Yfantopoulos J. The Greek Tragedy in the Health Sector: Social and Health Implications. Vierteljahrshefte zur Wirtschaftsforschung. 2015;84(3):165-82.
- Europea C. The economic adjustment programme for Greece. European Economy, Occasional Papers, Directorate-General for Economic and Financial Affairs. 2010(61).
- Economou C. Greece: Health system review. Health systems in transition. 2010;12(7):1. 2/2016: Pharmaceutical Policies under Economic Crisis: The Greek case 16
- Karakolias SE, Polyzos NM. The newly established unified healthcare fund (EOPYY): current situation and proposed structural changes, towards an upgraded model of primary health care, in Greece. Health. 2014;2014.
- Vlismas K, Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas Y, Sitara M, et al. Quality, but not cost, of diet is associated with 5-year incidence of CVD: The ATTICA study. Public Health Nutrition. 2010;13(11):1890-7.
- Noorbakhsh F. The human development index: some technical issues and alternative indices. Journal of International Development. 1998;10(5):589-605.
- Yfantopoulos J. The Greek version of the EuroQol (EQ-5D) instrument. Archives of Hellenic Medicine. 2001;18(2):180-91.
- Anagnostopoulos F, Yfantopoulos J, Moustaki I, Niakas D. Psychometric and factor analytic evaluation of the 15D health-related quality of life instrument: The case of Greece. Quality of Life Research. 2013;22(8):1973-86.
- Yfantopoulos JN, Chantzaras AE. Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. Eur J Health Econ. 2016.
- OECD. Health at a Glance: OECD Indicators. OECD Publishing, 2015.
- Vandoros S, Stargardt T. Reforms in the Greek pharmaceutical market during the financial crisis. Health policy (Amsterdam, Netherlands). 2013;109(1):1-6.
- Rawlins M, Barnett D, Stevens A. Pharmacoeconomics: NICE's approach to decision-making. British journal of clinical pharmacology. 2010;70(3):346-9.
- Devlin N, Sussex J. Incorporating multiple criteria in HTA. Methods and processes London: Office of Health Economics. 2011.
- Kristensen FB. Development of European HTA: from vision to EUnetHTA. Michael. 2012;9:147-56.
- Geitona M, Assessing the value of medicinal innovation in an era of increasing austerity. Soc Cohesion Dev. 2012;7(1):39-51