BRUSSELS, Mar 11 (APM) - France has come in for criticism of lax management of its healthcare and pharmaceutical spending, in the context of European Union efforts to bring national budgets back into balance after the financial crisis.
The European council of economic and finance ministers on Tuesday endorsed a series of critical analyses that the European Commission has drafted on member countries’ public spending record - including, in many cases, commentary on management of pharmaceutical budgets.
France - already the 'black sheep' of budgetary control across the entire range of public spending - was singled out for adverse comment for its performance in healthcare too.
Last year, the Commission publicly recommended France should “take steps to tackle the increase in public expenditure on health projected over the medium and long term, including in the area of pharmaceutical spending”.
But its assessment of France’s performance since then is uncomplimentary.
“Limited progress has been made in tackling the projected medium-term and long-term rise in public expenditure on healthcare,” according to the Commission's analysis. “The projected increase in healthcare expenditure remains significantly higher than GDP growth”, and public spending on health as a proportion of GDP is projected to continue to exceed the EU average.
There have been some improvements in tackling the overspend, the Commission acknowledges. “Costs have been kept under control in the last few years thanks to improved monitoring, with public expenditure on health planned to be below the target set in the initial finance law for the fifth consecutive year in 2014”.
Additional savings in healthcare expenditure for 2015 are expected to total 3.2 billion euros - the first step in a planned 11 billion euros reduction in public healthcare expenditure between 2015 and 2017, aimed at limiting the annual increase in public health expenditure to 2% on average during that period.
For 2015, the measures include a further cut in pharmaceutical prices and support for the use of generic medicines, efforts to eliminate prescriptions and treatments that are considered medically unnecessary and further optimisation of hospital spending, the Commission notes approvingly.
Savings in administrative costs are also planned and a draft law on public health seeks to increase the efficiency of healthcare expenditure by applying a ‘clinical pathway’ system and encouraging a shift towards outpatient care.
But the Commission's view is that not enough has been done and there is currently some uncertainty over how France will attain the cost reductions it is seeking.
As the Commission comments, the law on financing social security now includes measures to curb the cost of pharmaceuticals through a managed entry agreement - but no demonstration of its effectiveness is reported.
Similarly, the plans for new efficiencies through adopting clinical pathways and a shift from hospitals to ambulatory care remain an aspiration rather than an achievement. And “guidelines to reinforce prevention could also achieve cost-effectiveness in the longer term”, but there is at present no sign of them.
Ireland receives a more favourable report, with compliments on “progress in the area of healthcare, including in reducing public spending on pharmaceuticals”.
Some structural cost-saving measures are being implemented in public expenditure on pharmaceuticals and “recent reforms to bring down prices from very high levels have worked”.
The generics penetration rate is now close to 70% in volume terms of publicly-covered outpatient use, resulting in substantial cost savings.
The inclusion of 'cost-effective prescribing behaviour' as a priority “should further assist value-for-money gains” in 2015.
Nonetheless, “public spending on pharmaceuticals remains well above the EU average” and negotiations with industry, aimed at reducing the cost of patented products, have fallen behind schedule.
“This puts the achievement of any further significant savings in 2015 at significant risk,” warns the Commission.
The Commission’s attention to pharmaceutical budgets is uneven across Europe, with some countries receiving no analysis of this segment of spending. Others receive terse counsel about deficiencies.
In Cyprus, “overall progress regarding healthcare reform has been very limited” and with little movement on automating hospital bills, or on defining pharmaceutical policies under the national health system.
Italian reforms of competition law have eased distribution of pharmaceutical products, but “does not open the market for drugs with compulsory prescription but with no state reimbursement, and does not address the bottlenecks to the uptake of non-patented drugs”.
In Latvia, “there is some scope for efficiency gains as regards pharmaceutical purchases and hospital transfers”.
In Portugal, “centralised procurement continues to save the national health service money”. Generics eligible for public reimbursement in the outpatient sector have continued to expand their market share, resulting in less spending on medicines.
Similarly, “spending on pharmaceuticals can be cut by negotiating pharmaceuticals prices with the industry”.
In Romania, fiscal controls have been put in place, with monthly monitoring of hospitals’ budget execution and registering of arrears, monitoring of pharmaceutical expenditure via e-prescription and setting clear spending limits.
“Access to innovative medicines has been improved in 2014 and legislation for evidence-based revisions of the list of reimbursed pharmaceuticals was put in place.”
Spain “has increased cost-effectiveness of the healthcare sector, but challenges remain”. Pharmaceutical spending has started to grow again, “and might rise even further due to the introduction of some innovative medicines”.
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