EKIP– Expert Club for Economics and Politics A Different Opinion
What happens when a country has a limited public health resource that has no clear owner? Quite simply, it is distributed according to the needs of certain market players, and the entire system starts bidding for a piece of it.
What's happening?
Such is the case with the Swiss pharmaceutical giant Novartis in Greece. It is indicative of what happens in systems where public spending on medicines is not optimized and every new medicine enters uncontrollably as a result of unregulated practices. The prosecutor's office in Greece has begun investigating the corruption scandal that has shaken the health system, because over 10 years the Swiss company paid a total of about 50 million euros in bribes to politicians, doctors and other interested parties so that its expensive medicine could be preferentially prescribed to patients.
The prosecutor's office believes that this has cost the state budget several billion euros in the years of a deepening financial crisis and debts to creditors that Greece continues to face. In recent years, the European Commission has been trying to advise Greece to optimize its drug budget. Like Bulgaria, Greece is one of the last places in the use of generic drugs, while on the other hand it is one of the first in prescribing original drugs, as is the case with Novartis.
What is the problem?
Like Bulgaria, Greece is also a country that experiences considerable financial problems in the field of healthcare, some of which are due to the high prices of medicines prescribed by doctors. According to data from the World Health Organization (WHO), co-payment by patients is 40%. In Bulgaria, co-payment is about 46% (the highest in the European Union). The lack of clearly written rules for implementing a cost-effective drug policy, as well as the lack of a pro-generic policy, lead to budgets constantly growing.
The main problem in Greece, as well as in Bulgaria, according to reports by international health institutions, is the lack of clearly defined policies for spending the public budget. This harms no one – namely the taxpayers (patients) who benefit from the services of health insurance. Many stakeholders in the health care system contribute to the prescription of certain, more expensive medications.
In most cases, various patient organizations play a significant role as a liaison between pharmaceutical companies, patients, health departments and doctors, so that certain medications can be included in the reimbursement list and thus the NHIF pays for them, without the necessary thorough studies on the costs and effectiveness of the specific medication being carried out. Last year, the NHIF's drug budget exceeded 1 billion leva, which is 25% of the entire department's budget for one year.
What is the solution?
The constantly increasing costs of healthcare, as well as of medicines, are felt as a serious problem in countries such as the UK, Germany, Denmark, the Netherlands. Therefore, these and other countries actively promote the preferential use of analogues of original medicines (generics), precisely because of their cost-effectiveness, and also because of the fact that with a smaller budget more people can be treated, as well as to increase access to medicines for patients in a financially disadvantaged situation.
The problem with moving to such a policy is the lack of political will and the fear of some leaders that they may incur trouble from various stakeholders. Another problem with taking decisive action in favor of patients and the public health budget is the lack of administrative and expert capacity to build and tailor the reform needed for the country, which would be beneficial for all participants in the system.
