Abstract
Background: Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study attempts to capture the resulting increase in patients’ out-of-pocket (OOP) expenses for prescription drugs during the 2011-2014 period. Methods: The authors conducted a retrospective review of financial data derived from 39 883 prescriptions, dispensed at three randomly chosen pharmacies located in Lamia, central Greece. Results: The study recorded an average contribution rate per prescription as follows: 11.28% for 2011 (95% CI: 10.76-11.80), 14.10% for 2012, 19.97% for 2013, and 29.08% for 2014. Correspondingly, the mean patient charge per prescription for 2011 was €6.58 (95% CI: 6.22-6.94), €8.28 for 2012, €8.35 for 2013, and €10.87 for 2014. During the 2011-2014 period, mean percentage rate of patient contribution increased by 157.75%, while average patient charge per prescription in current prices increased by 65.22%. The use of a newly introduced internal reference price (IRP) system increased the level of prescription charge at a rate of 2.41% for 2012 (100% surcharge on patients), 26.24% for 2013 (49.95% on patients and 50.04% on the appropriate health insurance funds), and 47.72% for 2014 (85.06% on patients and 14.94% on funds). Conclusion: Increased cost-sharing rates for prescription drugs can reduce public pharmaceutical expenditure, but international experience shows that rising OOP expenses can compromise patients’ ability to pay, particularly when it comes to chronic diseases and vulnerable populations. Various suggestions could be effective in refining the cost-sharing approach by giving greater consideration to chronic patients, and to the poor and elderly.
Highlights
The ongoing financial crisis in Greece has already led to drastic changes in the country’s health sector
Total health expenditure fell from 10.1% of the gross domestic product (GDP) in 20091 to 6% in 2014.2 Apart from other health reforms, pharmaceutical expenses have been downsized from 2.3% of the GDP in 2012 to less than 1% in 2014, below the European Union (EU) average of 1.5%
Highest rates of pharmaceutical expenditure among The Organization for Economic Co-operation and Development (OECD) countries in 2012 (25.2% as a percentage of health expenditure compared to the OECD average of 15.9%),[3] whereas public funding for pharmaceuticals was set at 1.5% of the GDP in Greece for 2012, which amounted to the highest percentage among EU countries.[4]
Summary
The ongoing financial crisis in Greece has already led to drastic changes in the country’s health sector. The recent government reforms reclassified diseases and their corresponding drugs, by shifting more diseases to the highest cost-sharing class of 25%,6,7 and by leaving some chronic conditions to the class of 10% and some life-threatening conditions to the class of 0%.8 In essence, this means that very few patients are left with free prescription drugs. The government introduced a new internal reference price (IRP) calculation system in an effort to further contain the cost of pharmaceutical care.[9,10] The IRP is set by Social Security according to therapeutic categories, and, as of 2014 all chemicals and preparations are subject to the IRP system This leads to more OOP expenses for the patient; apart from paying 10% or 25% of the drug IRP, the patient has to pay the price difference in case that the drug retail price is higher than the IRP. The aim of this paper is to present the evolution of these expenses between 2011 and 2014, that is, the main period in which major interventions in the pharmaceutical sector took place
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