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Εγγραφή ή
Είσοδος2.7.2
Controlling pharmaceutical spendingIn order to achieve EUR 1 billion of reduction in outpatient pharmaceutical spending in 2012 and reach the 1 percent of GDP target in 2014, the Government steps up its efforts, and further develops the set of incentives and obligations for all participants along the medicines supply chain (including producers, wholesalers, pharmacies, doctors and patients) to promote the use of generic medicines.
2.7.2.1 Contingency measures to deliver the overall targets
1. Prior to the disbursement, if the reduction in pharmaceutical spending is not consistent with the target, additional measures will be taken. These can include a prescription budget for each doctor and a target on the average cost of prescription per patient and, if necessary, across-the-board further cuts in prices and profit margins and increases of co-payments.
2. The Government revises the co-payment structure for medicines to exempt from co-payment only a restricted number of medicines related to specific therapeutic treatments. [Q4-2012]
2.7.2.2 Pricing of medicines
1. The Government revises downward the price of medicines, based on the three EU countries with the lowest prices. In addition, the government re-prices medicines now cheaper than 10 EUR, including implementing a 10% price reduction in the prices of these medicines [quarterly update of price list - next price list published by mid-October 2012, next by December 2012]
2. The Government applies an automatic claw-back mechanism (every six months)quarterly rebate) to on the turnover of pharmaceutical producers which guarantees that the outpatient pharmaceutical expenditure (EOPYY budget) does not exceed the above targets [Continuous].
3. Prior to the disbursement, if, for any reason, the claw-back is not able to achieve the target, the government adopts legislation which activates contingency measures (including e.g. a cross-the-board cut in prices). Such measures produce equivalent amount of savings.
4. Prior to the disbursement, the government sets, through Ministerial decree, the new claw back threshold for 2013, based on the above mentioned targets (2.4 billion for outpatient and 0.66 billion for hospital, inpatient, medicines ).
5. Prior to the disbursement, the government repeals the current provision of the law which hampers the collection of the rebate from pharmacies in case of delays in payments on the part of EOPYY.
6. The Government produces an implementation report on the impact of the new profit margins of pharmacies by Q1-2013 and shares it with the European Commission, ECB and IMF staff. If it is shown that this new model to calculate profit margins does not achieve the expected result of a reduction of profit margins down to 15%, the regressive margin will be further revised.
7. EOPYY negotiates a 5% discount through price-volume agreements on medicines (200 medicines) [Continuous for 2013 and 2014]
8. The Government extends the application of the 9% rebate on pharmaceutical companies (which exists for outpatient and hospital medicines) to the expensive products sold in EOPYY pharmacies [legislation adopted by Q4-2012]
2.7.2.3 Prescribing and monitoring
The Government will,
1. extend the current e-prescribing to all doctors, health centres and hospitals. E-prescribing is made compulsory and must include at least 90 percent of all medical acts covered by public funds (medicines, referrals, diagnostics, surgery) in outpatient both NHS facilities and providers contracted by EOPYY and the other social security funds. [Q4-2012]; the extension to NHS facilities will be finalised by Q2-2013.
2. implement the system (API) whereby pharmacies electronically register manual prescriptions from doctors into the e-prescription application established by IDIKA. [October 2012];
3. continue publishing prescription guidelines/protocols for physicians, with priority for the most expensive and/or mostly used medicines, and makes them compulsory [Continuous];
4. enforce the application of prescription guidelines through the e-prescription system. [Q2-2013];
5. further develop monitoring and control of e-prescription by introducing ICD-10 and SPC filters in the e-prescription system [Q2-2013];
6. produce detailed monthly auditing reports on the use of e-prescription in NHS facilities and by providers contracted by EOPYY. These reports are shared with the European Commission, ECB and IMF staff teams. [Continuous];
7. continue to provide a regular assessment of the information obtained through the e-prescribing system. [Continuous];
8. produce detailed quarterly reports on pharmaceutical prescription and expenditure which include information on the volume and value of medicines, on the use of generics and the use of off-patent medicines, and on the rebate received from pharmacies and from pharmaceutical companies. These reports are shared with the European Commission, ECB and IMF staff teams. [Quarterly updates];
9. provide detailed reporting on individual prescription behaviour to each physician relative to the average of comparable (specialty, patient workload) physicians (both in NHS facilities and contracted by EOPYY and other social security funds until they merge) and signals when they breach prescription guidelines. This feedback is provided at least every month and a yearly report is published covering: 1) the volume and value of the doctor's prescription in comparison to their peers and in comparison to prescription guidelines; 2) the doctor's prescription of generic medicines vis-à-vis branded and patent medicines and 3) the prescription of antibiotics. [Continuous];
10. enforce sanctions and penalties as a follow-up to the assessment and reporting of misconduct and conflict of interest in prescription behaviour and non-compliance with the EOF prescription guidelines [Continuous];
11. Prior to the disbursement update the price list and the positive list of reimbursed medicines notably by reimbursing only the cost effective packages for chronic diseases, by moving medicines from the positive to the negative and OTC lists and introducing the reference price system developed by EOF. These lists must be updated at eleast twice a year.
12. select a number of the most expensive medicines currently sold in pharmacies, to be sold in hospitals or EOPYY pharmacies. [Q4-2012].
13. Implement a mechanism to reduce off-label prescription [Q4-2012]
2.7.2.4 Increasing use of generic medicines
1. The Government increases the share of the generic medicines to reach 35 percent of the overall volume of medicines sold by pharmacies by end-2012 and 60 percent by end-2013. This will be achieved by:
i. setting the maximum price of the generic to 40 percent of the price of the originator patented medicine with same active substance at the time its patent (exclusivity period) expired. After this first reduction, when exclusivity period expiry, Ffurther reductions are achieved through external reference pricing based on the three EU countries with the lowest prices. This will be done also by linking off-patent (when exclusivity period expires) products to the average of the three lowest prices in the EU and the price of the generic to 80% of the downward revised price of the offpatent Further reductions are achieved through external reference pricing based on the three EU countries with the lowest prices. Producers are allowed to offer lower prices, thus allowing an increased competition in the market. [Continuous];
ii. automatically reducing the maximum price of originator medicines when their patent (exclusivity period) expires (off-patent branded medicines) to 50 percent of its price at the time of the patent expiry. Further reduction will be achieved by linking off-patent products to the average of the three lowest prices in the EU, to be revised periodically with price list . Producers can offer lower prices, thus allowing an increased competition in the market. [Continuous];
iii. creating dynamic competition in the market for generic medicines through price reductions of at least 10 percent of the maximum price of each new generic producer entering the market. [Q4-2012];
iv. introducing an internal reference price system for reimbursement [October 2012];
v. introducing (EOPYY) additional incentives and mechanisms, including a prescription quota system for phyicians, to ensure generic substitution [Q4-2012];
vi. deciding about the reimbursement of newly patented medicines (i.e. new molecules) on the basis of objective and strict medical and cost-effective criteria and, until internal capacity is in place, by relying on best practice health technology assessment of their cost-effectiveness carried out in other member states, while complying with Council Directive 89/105/EEC. [Continuous];
vii. excluding from the list of reimbursed medicines those which are not effective or cost-effective on the basis of objective criteria. [Continuous];
viii. Prior to the disbursement, making it compulsory for physicians to prescribe by international non-proprietary name for an active substance, rather than the brand name.
ix. Prior to the disbursement, mandating the substitution of prescribed medicines by the lowest–priced product of the same active substance in the reference category by pharmacies (compulsory "generic substitution").
2. The Government takes further measures to ensure that at least 50 percent of the volume of medicines used by public hospitals is made up of generics with a price below that of similar branded products and off-patent medicines. [Continuous]
3. Government makes it compulsory for all public hospitals to procure at least 2/3 of pharmaceutical products by active substance, using the centralised tenders procedures developed by EPY and by enforcing compliance with therapeutic protocols and prescription guidelines. [Q4-2012]
4. The Government, pharmaceutical companies and physicians adopt a code of good conduct (ethical rules and standards) regarding the interactions between pharmaceutical industry, doctors, patients, pharmacies and other stakeholders. This code will impose guidelines and restrictions on promotional activities of pharmaceutical industry representatives and will forbid any direct (monetary and non-monetary) sponsorship of specific physicians (sponsorship should be attributed through a common and transparent allocation method), based on international best practice. [Q4-2012]
5. The Government speeds up administrative and legal procedures, in line with EU legal frameworks for the entry of cheaper generic medicines in the positive list. [Q4-2012]
2.7.3
Reviewing the provision of medical services contracted by EOPYY 1. To improve the current financial situation of EOPYY and ensure that the budgetary execution is closer to a balanced budget in 2012 and 2013, a set of measures will be implemented prior to the disbursement, including:
i. restricting the benefit package;
ii. increasing cost-sharing for private care;
iii. negotiating price-volume agreements and revising case-mix agreements with private providers;
iv. revising the fees for and number of diagnostic and physiotherapy services contracted by EOPYY to private providers with the aim of reducing related costs by at least EUR 80 million in 2013.
v. introducing a reference price system for reimbursement of medical devices.
vi. progressively increasing the contributions paid by OGA members to the average of those paid by other members of EOPYY.
2. The government starts publishing a quarterly report on the prescription and expenditure of diagnostic tests. [quarterly updates - next report Q4-2012]
2.7.4
National Health System (NHS) service provision2.7.4.1 Reorganisation and management of the health care sector
1. The plan for the reorganisation and restructuring, as set in Law 4052 / March 2012 is implemented with a view to reducing existing inefficiencies, utilising economies of scale and scope, and improving quality of care for patients. This implies reducing hospital operating costs by 8 percent in 2012 and an additional 5% in 2013 and reducing beds substantially, as legislated by MD OG1681/B (28-7-2011). This is to be achieved through:
i. increasing the mobility of healthcare staff (including doctors) within and across health facilities and health regions;
ii. adjusting public hospital provision within and between hospitals within the same district and health region;
iii. revising the activity of small hospitals towards specialisation in areas such as rehabilitation, cancer treatment or terminal care where relevant;
iv. revising emergency and on-call structures;
v. optimise and balance the resource allocation of heavy medical equipment (e.g. scanners, radiotherapy facilities, etc.) on the basis of need.
vi. reducing administrative costs notably by removing deputy managers posts;
vii. reducing cost with outsourcing services such as IT services, laboratory services and hospital servicing costs (e.g. cleaning services).
2. Produce an annual report comparing hospitals performance on the basis of the defined set of benchmarking indicators [Continuous]
3. The Government updates a report on human resources for the whole health care sector annually and uses it as a human resource planning instrument. [Continuous]
2.7.4.2 Accounting, control, IT and monitoring systems
1. Internal controllers are assigned to all hospitals and all hospitals adopt commitment registers. [Q4-2012]
2. EOPYY publishes a monthly report with analysis and description of detailed data on healthcare expenditure with a lag of three weeks after the end of the respective month. This report will make possible the more detailed monitoring of budget execution, by including both expenditure commitments/purchases (accrual basis [Q1-2013]) and actual payments (cash basis). The report will also (1) describe performance on the execution of budget and accumulation of arrears, and (2) recommend remedial actions to be taken. [Continuous]
3. Further measures are taken to improve the accounting, book-keeping of medical supplies and billing systems, through:
i. the introduction of analytical cost accounting systems [Continuous];
ii. the regular annual publication of balance sheets in all hospitals. [Q12-2013];
iii. the introduction of the uniform coding system for medical supplies developed by the Health Procurement Commission (EPY) and the National Centre for Medical Technology (EKEVYL) and the use of the observe.net system to monitor the procurement and use of tenders for medical supplies. [Continuous];
iv. the introduction of inbound hospital logistics and stock management [Q4-2013]
v. timely invoicing of full treatment costs (including staff payroll costs) - i.e. no later than 2 months to other EU countries and private health insurers for the treatment of non-nationals/non-residents. [Q4-2012];
vi. enforcing the collection of co-payments and implementing mechanisms that fight corruption and eliminate informal payments in hospitals. [Continuous].
4. ELSTAT starts providing expenditure data in line with Eurostat, OECD and WHO databases i.e. in line with the System of Health Accounts (joint questionnaire collection exercise). [Q4-2012]
5. The programme of hospital computerisation allows for a measurement of financial and activity data in hospital and health centres. Moreover, the Minister of Health defines a core set of non-expenditure data (e.g. activity indicators) in line with Eurostat, OECD and WHO health databases, which takes account of the future roll-out of DRG (diagnostic-related groups) schemes in hospitals. [Continuous]
6. The government starts to programme of hospital computerisation includes the development of a system of patient electronic medical records. [Q41-20123]
7. In all NHS hospitals, the Government, with technical assistance from experts across EU, continue piloting a set of DRGs, with a view to developing a modern hospital costing system for contracting (on the basis of prospective block contracts between EOPYY and NHS). DRGs include a detailed item on costs of personnel. [Continuous]
8. An analysis will be made of how hospital accounting schemes integrate DRGs at hospital level in view of future activity-based cost reporting and prospective budgets payment for hospitals [Q4-2012]
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