Academic journal article Bulletin of the World Health Organization

Effect of the Economic Recession on Pharmaceutical Policy and Medicine Sales in Eight European countries/Effet De la Recession Economique Sur la Politique Pharmaceutique et Les Ventes De Medicaments Dans Huit Pays europeens/El Efecto De la Recesion Economica Sobre la Politica Farmaceutica Y la Venta De Medicinas En Ocho Paises Europeos

Academic journal article Bulletin of the World Health Organization

Effect of the Economic Recession on Pharmaceutical Policy and Medicine Sales in Eight European countries/Effet De la Recession Economique Sur la Politique Pharmaceutique et Les Ventes De Medicaments Dans Huit Pays europeens/El Efecto De la Recesion Economica Sobre la Politica Farmaceutica Y la Venta De Medicinas En Ocho Paises Europeos

Article excerpt

Introduction

European public authorities struggle to maintain a high level of access to health care while restraining increases in expenditure associated with an ageing population and higher demand. (1-4) The recent global economic recession has put additional pressure on public budgets. (5,6)

In 2008, Europe was affected by the financial crisis. As the recession in Europe continued, the effect was felt especially in southern European countries and Ireland in 2010 and 2011. Soon the problem of financial debt for individual European countries developed into a crisis in the Eurozone, which then became a high priority for the European Central Bank and the European Parliament. All countries were urged to implement cost-saving measures that affected public financing for health care. (7)

Recession, which is defined as two successive quarters of negative growth in gross domestic product (GDP), can have a detrimental effect on the health of the population because economic downturns are strongly associated with a decline in health-care utilization and a deterioration in health outcomes. (8) For example, suicides and homicides increased among working-age men and women when unemployment rose rapidly during past recessions in Europe. (9) In the current recession, the number of uninsured non-elderly Americans increased by 5.6 million between 2007 and 2009 (10) and over a quarter of Americans reported reduced routine use of medical care. (11) Over the same period, insurance policy deductibles and copayments for visits to physicians and for prescription medicines increased, leading to a greater cost burden for patients. (12-14) Similar effects were seen in Greece. Studying the health effects of the economic crisis in the country it was found that patients had less access to care and preventive services and, consequently, faced higher risks of infection with sexually transmitted diseases. (15) The World Health Organization examined the influence of the recession on expenditure on, and the sales and prices of, medicines between 2007 and 2009 in 84 countries. It found that the economic recession had mixed effects and that the largest declines in medicine sales occurred in high-income countries and in Europe, particularly in the Baltic states. (16)

It has been shown that countries that were seriously affected by the crisis, such as the Baltic countries, Greece, Portugal and Spain, abruptly implemented several pharmaceutical policy measures between 2010 and 2011. This included price cuts, changes in reimbursement rates and the imposition of value-added tax on medicines. (17) In other European countries, such as Italy, in which cost-containment measures were already in place when the crisis began, the implementation of planned policy changes was accelerated. (18)

Because different countries were affected differently by the recession and attempted to overcome budgetary constraints in different ways, we decided to analyse systematically how European pharmaceutical policies were affected by the recession by comparing changes in pharmaceutical pricing and reimbursement policies between economically stable and economically less stable countries. In addition, we investigated changes in the sale of pharmaceuticals in major therapeutic classes before and after the recession in these two types of countries. We expected that some of the cost-containment policies, such as those affecting out-of-pocket payments, would shift the financial burden of medicines onto patients and hypothesized that pharmaceutical sales would decline during this period, especially in less economically stable countries.

Methods

Data sources

For this longitudinal study, we used data from two sources to derive information on pharmaceutical policies: (i) the Pharmaceutical Pricing and Reimbursement Information Network (Austrian Health Institute, Vienna, Austria), which collects information from experts in national pharmaceutical pricing and from authorities responsible for reimbursement --the latter provide regular pharmaceutical policy updates; and (ii) the PharmaQuery database (IMS Health, Philadelphia, United States of America), which contains data on pharmaceutical policies. …

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